Weekend Update

Congress returns from its Spring break tomorrow. I noticed that the House of Representatives has refreshed its website. This coming week is Public Service Recognition Week as highlighted on OPM's website.

On the good news front, "University of Wisconsin School of Medicine and Public Health researchers call it "wonderful news" that a much less expensive cancer drug seems to work well to treat the leading cause of blindness in people over the age of 50."  According to a UW press release, "The National Eye Institute study compared Avastin, a cancer drug that is commonly used off-label to treat age-related macular degeneration (AMD) [at $50 per dose], and Lucentis, the Food and Drug Administration-approved drug for treating AMD [at $2,000 per dose]. The Comparison of AMD Treatments Trials (CATT) found that the two drugs had similar effectiveness." At the OPM AHIP carrier conference, Robert Epstein, a Medco medical director gave a very entertaining and hopeful talk about anticipated, near term breakthroughs in these specialty drugs. Hopefully, this is just the start.

On Friday, the Health and Human Services Department issued a final rule implementing a value based purchasing program for hospital services covered under Medicare Part A. The program will not take effect until October 1, 2012, the beginning of the federal government's 2013  fiscal year. The HHS press release explains that

In FY 2013, an estimated $850 million will be allocated to hospitals based on their overall performance on a set of quality measures that have been shown to improve clinical processes of care and patient satisfaction.  This funding will be taken from what Medicare otherwise would have spent, and the size of the fund will gradually increase over time, resulting in a shift from payments based on volume to payments based on performance. 
Some of these measures will assess whether hospitals:

• Ensure that patients who may have had a heart attack receive care within 90 minutes;

• Provide care within a 24-hour window to surgery patients to prevent blood clots;

• Communicate discharge instructions to heart failure patients; and

• Ensure hospital facilities are clean and well maintained.

The measures to determine quality in the Hospital Value-Based Purchasing Program focus on how closely hospitals follow best clinical practices and how well hospitals enhance patients’ experiences of care. When hospitals follow these types of proven best practices, patients receive higher quality care and see better outcomes.  And helping patients heal without complication can improve health and ultimately reduce health care costs.  For example, ensuring heart failure patients receive clear instructions when they are discharged on their medications and other follow-up activities reduces the likelihood that they will suffer a preventable complication that would require them to be readmitted to the hospital. 

The better a hospital does on its quality measures, the greater the reward it will receive from Medicare.  The measures selected for the Hospital Value-Based Purchasing program in FY 2013 have been endorsed by national bodies of experts, including the National Quality Forum.  Hospitals have been reporting on quality measures through the Hospital Inpatient Quality Reporting Program since 2004, and that information is posted on the Hospital Compare website. For a complete list of quality measures, visit www.HealthCare.gov/news/factsheets/valuebasedpurchasing04292011b.html.

Modern Healthcare reports that industry reaction to the new rule is mixed.  HHS explains in the press release that this rule helps achieve the patient safety and quality improvement objectives of the public/private Partnership for Patients initiative.  The AMA News reports on the medical profession's favorable reaction to that initiative.