Month: August 2017

 

Researchers find increase in adverse birth outcomes due to high levels of pesticide exposure

Although common opinion holds that exposure to pesticides increases adverse birth outcomes, the existing body of scientific evidence is ambiguous. Logistical and ethical barriers — pesticide use data are not widely available and randomized control trials are impossible — have gotten in the way of more accurate conclusions.

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Research on electrical nerve-block implant aims at treating asthma and heart failure

Biomedical engineering researchers at Case Western Reserve University are refining more than 15 years of work on an electrical nerve-block implant, focusing their next step on new applications related to treating asthma and heart failure.

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Unintended births may lead to depressive symptoms in early adulthood of children

Children from unintended pregnancies tend to experience more depressive symptoms in early adulthood compared to children from intended pregnancies, however there’s little evidence of a causal relationship, according the results of a newly published study by a University at Buffalo sociologist.

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Targeting bone marrow protein could be effective way to improve stem cell transplants

Bone marrow contains hematopoetic stem cells, the precursors to every blood cell type. These cells spring into action following bone marrow transplants, bone marrow injury and during systemic infection, creating new blood cells, including immune cells, in a process known as hematopoiesis.

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LSU Health New Orleans to receive $735,000 for improving heart attack recovery

LSU Health New Orleans will receive $735,000 over two years to study the effectiveness of the first patented drug-eluting guidewire in preventing a complication that can occur following treatment of heart attacks with angioplasty.

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Study captures wide range of diverse sexual behaviors in general population

Researchers at the Indiana University School of Public Health-Bloomington and the Center for Sexual Health Promotion have published a new U.S. nationally representative study of sexual behavior, the first of its kind to capture a wide range of diverse sexual behaviors not previously examined in the general population.

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Trial for PTSD treatment with MDMA-assisted psychotherapy receives FDA go-ahead

The United States Food and Drugs Administration FDA has granted permission for phase 3 trials in PTSD (Post traumatic stress disorder) patients using Ecstasy and psychotherapy in a treatment protocol called MDMA-Assisted Psychotherapy PTSD affects thousands of war veterans and other individuals and often leads to fatal outcomes of self-harm and suicides

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Long-term use of anti-inflammatory drugs can slow muscle growth in young people

The long-term use of over-the-counter (OTC) anti-inflammatory drugs can inhibit muscle growth in young, healthy individuals engaging in weight training, according to a new study from Karolinska Institutet, reporting on the effects of ibuprofen on the skeletal muscles and published in Acta Physiologica.

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Study shows previously unknown dimension of lymphangiogenesis during worm infection

Lymph nodes are small, kidney-shaped organs found throughout the body. Full of immune cells, their function is to clear out foreign objects and support the immune system.

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Mandatory Cardiac Episode Payment Program: CMS Proposes Cancellation

Also Changes Required Participation in the CJR Model

 

On August 15, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule (Proposed Rule) that, if finalized, would (1) reduce the number of Metropolitan Statistical Areas (MSAs) in which there is mandatory participation in the Comprehensive Care Joint Replacement model (CJR) from 67 to 34, and (2) cancel the mandatory Episode Payment Models and Cardiac Rehabilitation incentive payment program.  The action reflects a change in course for CMS, de-emphasizing and significantly reducing mandatory participation in Alternative Payment Programs.

Reduced Mandatory Participation in CJR Model

The CJR model originally became effective on April 1, 2016 and mandated that hospitals in 67 specified MSAs must participate in an episode-based payment program for hip and knee joint replacements.  The Proposed Rule, anticipated to be effective as of February 1, 2018, reduces the mandatory participation in the CJR essentially by one half to 34 MSAs (see Table 1 below taken from the proposed rule for the remaining MSAs).

The remaining MSAs have the highest average wage-adjusted historic episode payments, that is, the counties with the highest average expense cost for the episodes involved. Under the Proposed Rule, hospitals in the other 33 MSAs would no longer be required to participate in the CJR model, but they may elect voluntarily to participate in that program by submitting a participation election letter to CMS by January 31, 2018. In addition, within the 34 MSAs for which participation is mandatory, identified low volume or rural hospitals also would no longer be required to participate, but they may elect voluntarily to do so.

According to CMS, the remaining 34 MSAs for which participation is mandatory will provide sufficient information to evaluate the effects of the CJR model across a broad range of providers.  The higher costs in these MSAs also allows the participating hospitals a greater opportunity for showing improvement through participation in the CJR model.

Cancellation of EPM and Cardiac Rehabilitation Incentive Program

The Proposed Rule also seeks to cancel the Episode Payment Model (EPM), that would have expanded mandatory participation in an episode-based payment to hospitals in a number of MSAs for acute myocardial infarctions, coronary artery bypass grafts and surgical hip/femur fracture treatment, and a Cardiac Rehabilitation Incentive payment model that was to be implemented simultaneously with the EPM. Regulations for both models were originally issued on July 25, 2016 and are described here.

What Does All This Mean?

The Proposed Rule shows CMS does not favor mandatory participation in Alternative Payment Programs. As CMS states in the commentary to the Proposed Rule “requiring hospitals to participate in episode payment models at this time is not in the best interests of the agency or affected providers.”  CMS further explained that large mandatory episode-based payment models “may impede [the] ability to engage providers, such as hospitals, in future voluntary efforts.”

While CMS and the Center for Medicare and Medicaid Innovation have introduced many Alternative Payment Programs which move reimbursement to providers away from fee-for-service reimbursement toward reimbursement models focused on efficiency, delivery of value, and quality care, some have thought the pace of the transition to value-based care has been slower than anticipated.  Since Alternative Payment Models are viewed as an effective way to restrain health care cost increases, some view that such slower pace will mean providers will not be required to take steps necessary to be more efficient and reduce costs.  Cancellation of and reductions in mandatory programs will allow providers to avoid, at least for the near term, preparing themselves for such models given the lack of any requirement to do so.

At the same time, voluntary participation ensures participants in such models are committed to and engaged in the value-based models. The continued evaluation of such models with voluntary participants also helps ensure that access to care, quality, and favorable outcomes are not adversely affected by mandatory participation of providers not ready for such programs.

Commercial payor arrangements and market incentives aimed at helping providers to become more efficient are not directly affected by the Proposed Rule. Their presence may still encourage providers to voluntarily participate in Alternative Payment Models.

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