2509_sejda-DYJ.pdf - Chapter 12 References Shurepower 2007...

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Unformatted text preview: Chapter 12 References Shurepower. 2007. Electric-Powered Trailer Refrigeration Unit Demonstration. Prepared for the New York State Energy Research and Development Authority (NYSERDA) and the U.S. EPA SmartWay Transport Partnership by Shurepower, LLC. Agreement No. 8485-3. December 20, 2007. Available at: . (Accessed: March 4, 2018). Siler-Evans, K., I. Azevedo, and G. Morgan. 2012. Marginal emissions factors for the U.S. electricity system. Environmental Science & Technology 46(9):4742−4748. doi:10.1021/es300145v. Silver, J., C. McEwan, L. Petrella, and H. Bagulan. 2013. Climate Change, Urban Vulnerabilitiy and Development in Saint-Louis and Bobo-Dioulasso: Learning from Across Two West African Cities. Local Environment. The International Journal of Justice and Sustainability 18(6):663–677. doi:10.1080/13549839.2013.807787. Silverman, D.T., C.M. Samanic, J.H. Lubin, A.E. Blair, P.A. Stewart, R. Vermeulen, J.B. Coble, N. Rothman, P.L. Schleiff, W.D.Travis, R.G. Ziegler, S. Wacholder, and M.D. Attfield. 2012. The Diesel Exhaust in Miners Study: A Nested Case–Control Study of Lung Cancer and Diesel Exhaust. Journal of the National Cancer Institute. doi:10.1093/jnci/djs034. Available at: . (Accessed: March 4, 2018). Sivertsen, L.K., J.Ö. Haagensen, and D. Albright. 2003. A Review of the Life Cycle Environmental Performance of Automotive Magnesium. Paper SAE 2003-01-0641. March 3, 2003. SAE, International. doi:10.4271/2003-01-0641. Sivinski, R. 2012. Evaluation of the Effectiveness of TPMS in Proper Tire Pressure Maintenance. Available at: . (Accessed: March 4, 2018). Slater, L.J. and G. Villarini. 2016. Recent trends in U.S. flood risk. Geophysical Reseaerch Letters 43 (24):12,428–12,436. doi: 10.1002/2016GL071199. Smith, B. 2002. Statement of Senator Bob Smith, Environment & Public Works Committee Hearing on Transportation & Air Quality. 1d, 110 Session. July 30, 2002. Smith, L.C. and S.R. Stephenson. 2013. New Trans-Arctic shipping routes navigable by mid-century. Proceedings of the National Academy of Sciences of the United States (PNAS) 110(13):E1191-E1195. doi:10.1073/pnas.1214212110. Available at: . (Accessed: February 26, 2018). Smith and Stephenson 2013. citing Brigham, L. 2011. Marine Protection in the Arctic cannot wait. Nature 478(7368):157. Smith and Stephenson 2013. citing Elliot-Meisel, E. 2009. Politics, pride and precedent: The United States and Canada in the northwest passage. Ocean Development & International Law 40(2):204232. Smith and Stephenson 2013. citing Gerhardt, H., P.E. Steinberg, J. Tasch, S.J. Fabiano, and R. Shields. 2010. Contested sovereignty in a changing Arctic. Annals of the Association of American Geographers 100(4):992-1002. 12-98 Mandate for this report: The SUPPORT for Patients and Communities Act of 2018 O n October 24, 2018, the Substance UseDisorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act became law. The SUPPORT Act requires the Medicare Payment Advisory Commission to report on opioid payment, adverse incentives, and data under the Medicare program by March 15, 2019. Specifically, the Act calls for the Commission to provide the following: • a description of how the Medicare program pays for pain management treatments (both opioid and non-opioid pain management alternatives) in both inpatient and outpatient hospital settings; Introduction The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act of 2018 requires the Commission to describe how Medicare pays for both opioid and nonopioid pain management treatments in the inpatient and outpatient hospital settings, any incentives under the inpatient and outpatient prospective payment systems for prescribing opioids and non-opioids, and how opioid use is monitored through Medicare claims data (see text box on the SUPPORT Act). The Commission’s report is due March 15, 2019. To meet the requirement of a mandated report, this chapter reviews how Medicare pays for opioids and non-opioid alternatives in inpatient and outpatient hospital settings. In addition, we present data on the extent to which the inpatient and outpatient prospective payment systems introduce financial incentives for prescribing opioids versus non-opioid alternatives and discuss options for addressing any adverse incentives. We also describe how Medicare monitors opioid use through claims and other data in Part D. Finally, we discuss policy options for monitoring opioid use in Part A and Part B. • the identification of incentives under the hospital inpatient prospective payment system and incentives under the hospital outpatient prospective payment system for prescribing opioids and incentives under each system for prescribing nonopioid treatments, and recommendations as the Commission deems appropriate for addressing any of such incentives that are adverse incentives; and • a description of how opioid use is tracked and monitored through Medicare claims data and other mechanisms and the identification of any areas in which further data and methods are needed for improving data and understanding opioid use. ■ How Medicare pays for opioids and non-opioid alternatives in hospital settings Medicare uses bundled payments to pay for pain management drugs and services in both the inpatient and outpatient settings. Bundled payments are applied differently in the two settings. The inpatient prospective payment system (IPPS) assigns stays to categories on the basis of patients’ conditions and sets payment bundles that reflect the average costs of providing all items and services supplied during the stay. In contrast, the outpatient prospective payment system (OPPS) groups services into categories on the basis of clinical and cost similarity and sets payment bundles to cover the costs of providing integral items and services along with the primary service. Additional items and services are paid separately or are not paid under the OPPS. Inpatient hospital payment for opioids and non-opioid alternatives Medicare Part A pays for drugs and other pain management services administered during an inpatient hospital stay through the IPPS. The IPPS sets payment Report to the Congress: Medicare Payment Policy  |  March 2019 455 Chapter 12 References Smith and Stephenson 2013. citing Liu, M. and J. Kronbak. 2010. The potential economic viability of using the Northern Sea Route (NSR) as an alternative route between Asia and Europe. Journal of Transport Geography. 18(3): 434-444.Spitzley, D.V., and G.A. Keoleian. 2001. Life Cycle Design of Air Intake Manifolds. In: Phase II: Lower Plenum of the 5.4 : F-250 Air Intake Manifold, Including Recycling Scenarios. [US Environmental Protection Agency (Eds.)]. National Risk Management Research Laboratory: Cincinnati, OH. Available at: . (Accessed: April 10, 2018). Sproesser, G., Y. Chang, A. Pittner, M. Finkbender, and M. Rethmeier. 2015. Life Cycle Assessment of welding technologies for thick metal plate welds. Journal of Cleaner Production 108:46-53. doi:10.1016/j.jclepro.2015.06.121. Staudinger, M.D., S.L. Carter, M.S. Cross, N.S. Dubois, J.E. Duffy, C. Enquist, R., Griffis, J.J. Hellmann, J.J. Lawler, J. O'Leary, S.A. Morrison, L. Sneddon, B.A. Stein, L.M. Thompson, and W. Turner. 2013. Biodiversity in a changing climate: a synthesis of current and projected trends in the US. Frontiers in Ecology and the Environment 11:465–473. doi:10.1890/120272. Available at: . (Accessed: April 10, 2018). Staudinger et al. 2013. citing Hoffmann, A.A. and C.M. Sgro. 2011. Climate change and evolutionary adaptation. Nature 470:479-485. doi:10.1038/nature09670. Staufenberg, J. 2016. Climate change: Netherlands on brink of banning sale of petrol-fuelled cars. Independent. Available at: . (Accessed: February 15, 2018). St. Jacques, J.-M., S. Lapp, Y. Zhao, E.M. Barrow, and D.J. Sauchyn. 2013. Projected Northern Rocky Mountain Annual Streamflow for 2000–2099 under the B1, A1B and A2 SRES Emissions Scenarios. Quaternary International 310 (Complete). doi:10.1016/j.quaint.2013.07.114. Available at: . (Accessed: March 5, 2018). Steinbrecht, W., L. Froidevaux, R. Fuller, R. Wang, J. Anderson, C. Roth, A. Bourassa, D. Degenstein, R. Damadeo, J. Zawodny, S. Frith, R. McPeters, P. Bhartia, J. Wild, C. Long, S. Davis, K. Rosenlof, V. Sofieva, K. Walker, N. Rahpoe, A. Rozanov, M. Weber, A. Laeng, T. von Clarmann, G. Stiller, N. Kramarova, S. Godin-Beekmann, T. Leblanc, R. Querel, D. Swart, I. Boyd, K. Hocke, N. Kampfer, E.M. Barras, L. Moreira, G. Nedoluha, C. Vigouroux, T. Blumenstock, M. Schneider, O. Garcia, N. Jones, E. Mahieu, D. Smale, M. Kotkamp, J. Robinson, I. Petropavlovskikh, N. Harris, B. Hassler, D. Hubert, and F. Tummon. 2017. An Update on Ozone Profile Trends for the Period 2000 to 2016. Atmospheric Chemistry and Physics 17:10675-10690. doi:10.5194/acp-17-10675-2017. Available at: . (Accessed: March 5, 2018). Sternberg, A. and A. Bardow. 2015. Power-to-What?–Environmental assessment of energy storage systems. Energy & Environmental Science 8.2(2015): 389-400. 12-99 New medical services and technology payments T he inpatient prospective payment system includes a design feature to accommodate hospitals’ adoption of innovative, expensive pain treatments. If a new pain drug or other pain management service is too costly to be assigned to an existing Medicare severity–diagnosis related group (MS–DRG), there is a mechanism for a special (additional) payment. Hospitals using certain costincreasing medical services and technologies can apply for and receive add-on payments for new technologies. CMS evaluates applications by technology firms rates to reflect the average costs that hospitals incur in furnishing care.1 These costs include the provision of all items and services supplied by the hospital during the stay, including pain management.2 To account for the patient’s needs, Medicare assigns discharges to Medicare severity–diagnosis related groups (MS–DRGs), which group patients with similar clinical conditions that are expected to require similar amounts of hospital resources. Each MS–DRG has a relative weight that reflects the expected relative costliness of inpatient treatment for patients in that group. Providers then have flexibility in determining the mix of items and services to provide for each stay. CMS annually reviews the MS–DRG definitions to ensure that each group continues to include cases with clinically similar conditions requiring comparable amounts of inpatient resources. When the review shows that subsets of clinically similar cases within an MS–DRG consume significantly different amounts of resources, CMS can reassign them to different MS–DRGs with comparable resource use or create a new MS–DRG. There are special payments for services with insufficient data for CMS to assign them to an MS–DRG (see text box on new medical services and technology payments). Outpatient hospital payment for opioids and non-opioid alternatives Any covered nondrug pain management services employed during an outpatient visit are paid under 456 and others for add-on payments based on criteria of newness, substantial clinical improvement, and the costliness of the service or technology beyond the level of the current MS–DRG payment amount. Newtechnology payments are additional to the MS–DRG payment and thus are not budget neutral. To date, there have been no opioid or non-opioid drugs included on the inpatient new-technology add-on payment list. ■ Part B through the OPPS. The OPPS sets payments for individual services (identified by Healthcare Common Procedure Coding System (known as HCPCS) codes) using a set of relative weights, a conversion factor (which translates the relative weights into dollar payment rates), and adjustments for geographic differences in input prices. CMS classifies individual services into ambulatory payment classifications (APCs) on the basis of clinical and cost similarity. All services included in an APC have the same payment rate. In each APC, CMS “packages” services and items integral to the primary service to create a global payment rate. In deciding which services to package, CMS considers comments from hospitals, hospital suppliers, and others. In response to these comments, CMS pays separately for corneal tissue acquisition costs, blood and blood products, and many drugs. Over time, CMS has expanded the number of services that are included in APC payments for associated primary services. For example, beginning in 2014, CMS added certain clinical diagnostic laboratory tests and drugs, biologicals, and radiopharmaceuticals that function as supplies when used in a diagnostic test or surgical procedure to the list of OPPS packaged items and services. The intent of expanded packaging was to make hospitals more cost conscious regarding the services used in an outpatient visit. In a system that packages related services under a single global payment, hospitals have a financial incentive to furnish services most efficiently and to manage their resources with maximum flexibility.3 Mandated report: Opioids and alternatives in hospital settings—Payments, incentives, and Medicare data ...
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