2553_sejda-DYJ.pdf - Chapter 15:  Redesigning...

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Unformatted text preview: Chapter 15:  Redesigning Medicare’s hospital quality incentive programs The Congress should: • Replace Medicare’s current hospital quality programs with a new hospital value incentive program (HVIP) that: • includes a small set of population-based outcome, patient experience, and value measures; • scores all hospitals based on the same absolute and prospectively set performance targets; • accounts for differences in patients’ social risk factors by distributing payment adjustments through peer grouping, and • For 2020, update the 2019 Medicare base payment rates for acute care hospitals by 2 percent. The difference between the update recommendation and the amount specified in current law should be used to increase payments in a new HVIP. Yes: Bricker, Buto, Christianson, Crosson, DeBusk, DeSalvo, M. Ginsburg, P. Ginsburg, Grabowski, Jaffery, Perlin, Pyenson, Ryu, Safran, Thomas, Thompson, Wang Chapter 16: Mandated report: Opioids and alternatives in hospital settings—Payments, incentives, and Medicare data No recommendations 482 Commissioners' voting on recommendations Acronyms Acronyms A–APM advanced alternative payment model CHIP Children’s Health Insurance Program ABIM American Board of Internal Medicine CKD chronic kidney disease ACH acute care hospital CLABSI central line–associated bloodstream infection ACO accountable care organization CMG case-mix group ADL activity of daily living CMI case-mix index AHRQ Agency for Healthcare Research and Quality CMMI Center for Medicare & Medicaid Innovation AKI acute kidney injury CMR comprehensive medication review ALF assisted living facility CMS Centers for Medicare & Medicaid Services ALOS average length of stay CMS–HCC CMS hierarchical condition category ANPRM advance notice of proposed rulemaking CON certificate of need APC ambulatory payment classification COPD chronic obstructive pulmonary disease ASC ambulatory surgical center CPI–U consumer price index for all urban consumers ASCQR ASC Quality Reporting [Program] C–SNP chronic condition special needs plan ASP average sales price CT computed tomography ASP + 6 percent average sales price plus 6 percent DIR direct and indirect remuneration ASPE DMEPOS Assistant Secretary for Planning and Evaluation durable medical equipment, prosthetics, orthotics, and supplies AUC Appropriate Use Criteria [Program] DMP drug management program AWP average wholesale price DoD Department of Defense B billion DRG diagnosis related group BBA Bipartisan Budget Act [of 2015] DSH disproportionate share BBA Bipartisan Budget Act [of 2018] D–SNP dual-eligible special needs plan BLS Bureau of Labor Statistics DUR Drug Utilization Review BMI body mass index DVP Drug Value Program critical access hospital E&M evaluation and management CAHPS Consumer Assessment of Healthcare Providers and Systems® EBITDA earnings before interest, taxes, depreciation, and amortization C–APC comprehensive ambulatory payment classification ED emergency department CARA EDS Encounter Data System Comprehensive Addiction and Recovery Act of 2016 eGFR estimated glomerular filtration rate CARE Continuity Assessment Record and Evaluation EGWP employer group waiver plan CAUTI catheter-associated urinary tract infection EHR electronic health record CBO Congressional Budget Office EMR electronic medical record CC complication or comorbidity ESA erythropoiesis-stimulating agent CCI chronically critically ill ESCO ESRD Seamless Care Organization CCM chronic care management ESRD end-stage renal disease CCP coordinated care plan FAERS FDA Adverse Event Reporting System CCR continuing care retirement FDA Food and Drug Administration CDC Centers for Disease Control and Prevention CAH ® CDS clinical decision support CEC Comprehensive ESRD Care [Model] CHC continuous home care FFS fee-for-service FIMTM Functional Independence MeasureTM FY fiscal year GAO Government Accountability Office Report to the Congress: Medicare Payment Policy  |  March 2019 485 ...
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