February 1, 2013
By Allison Cohen*
Third Round of Slots Awarded under the ACA Section 5506 Closed Hospital Residency Slot Redistribution Program
CMS Medicare Provider e-News (1/31) reports that the Centers for Medicare & Medicaid Services (CMS) announced the teaching hospitals that will receive Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) slots under the third round of awards under Section 5506 of the Affordable Care Act (ACA). Section 5506 required CMS to establish a program that permanently redistributes all of the DGME and IME residency slots from hospitals that closed on or after March 23, 2008. Hospitals are given priority to receive these increases to their full-time equivalent resident caps based on certain criteria, including being in the same geographic region as the closed hospital, assuming the entire program, and taking in displaced residents. The third round of slots was redistributed from Hawaii Medical Center East in Honolulu, HI, Oak Forest Hospital in Oak Forest, IL, and Huron Hospital in Cleveland, OH.
Hastings Center Report Addresses Ethics and Oversight of Clinical Research and Clinical Practice
The Hastings Center published a supplement to the January-February 2013 Hastings Center Report, which features articles from a team of scholars challenging the distinction that is often made between ethical oversight of clinical research and clinical practice. The special report raises moral, empirical, and conceptual problems with this approach. The scholars propose a new ethics framework to be applied to "learning health care systems" that the Institute of Medicine calls for as a way to integrate clinical effectiveness studies, quality improvement research, and implementation science. This report takes on challenging questions about the ethical oversight of data collection and monitoring, and when these activities at the heart of learning health systems should be characterized as research.
CMS Announces Bundled Payments for Care Improvement Initiative
Modern Healthcare (1/31) reports that the Centers for Medicare & Medicaid Services (CMS) announced its Bundled Payments for Care Improvement initiative to pilot a new payment model to determine whether bundling services into a single episode of care could improve quality and lower costs. More than 450 healthcare organizations including academic medical centers, nonprofit and for-profit hospitals, physician-owned facilities, and post-acute care providers will participate. Awardees for Model 1 will start testing bundled payments in April. Model 1 participants have agreed to a discount from their expected Part A hospital inpatient payments for an episode of care and will share in any gains that come from their strategies to improve health outcomes and lower costs. CMS is planning to announce another opportunity for providers to participate in Model 1 beginning in early 2014. The other healthcare organizations announced will begin phase 1 of Models 2, 3, and 4 during which they will receive CMS data on care patterns and engage in shared learning on improving care. After an approval process, these participants can assume financial risk for episodes of care in July 2013. Model 2 and 3 awardees will participate in a retrospective bundled arrangement and Model 4 will be a prospective bundled arrangement.
Study Shows that Increasing Workloads for Hospital Doctors May Result in Suboptimal Care and Increased Costs
Bloomberg News (1/29) reports that a survey conducted by Johns Hopkins University researchers found that nearly half of doctors who primarily care for patients in a hospital setting say they routinely see more patients than they can safely manage. According to the survey, this workload can sometimes lead to unnecessary tests, medication errors, and deaths. A research letter released by the Journal of the American Medical Association Internal Medicine suggests that doctors are taking on more patients to cut costs as health insurers pay less and this trend will continue due to expanded coverage under the Affordable Care Act. According to the researchers, the increasing caseloads result in less patient care time and could reduce safety and quality of care. As a result, taking on more patients to compensate for cuts in payment may actually result in higher healthcare costs.
A Coalition of Medical Specialties Support IPAB Repeal Bill
The Hill (1/29) reports that the Alliance of Specialty Medicine (Alliance) wrote a letter to Representatives Phil Roe (R-TN) and Alyson Schwartz (D-PA) expressing support for their recently introduced bill to repeal the Independent Payment Advisory Board (IPAB). IPAB would have broad authority under the Affordable Care Act to make targeted cuts to provider reimbursement if Medicare's costs grow faster than a specified rate. These cuts would go into effect unless Congress votes to block IPAB's proposals in a brief period of time and propose alternative cuts from other parts of the federal budget. The Alliance letter states that "[s]ignificant health care decisions must not be made by a group of unelected, unaccountable individuals with little or no clinical expertise or the oversight required to protect access to care for America's seniors." IPAB faces other challenges including strong Republican opposition and unwillingness to uphold the law's constraints on voting timeframes, as well as difficulties finding willing nominees to serve on the board.
Mayo Clinic Announces Plans for Destination Medical Center Initiative
Minneapolis Star Tribune (1/31) reports that Mayo Clinic announced plans for a 20-year, $6 billion dollar initiative for its Minnesota-based hospital complex. Mayo plans to invest $3.5 billion over two decades with the goal of transforming its hospital complex in Rochester, MN, into a world-renowned medical center. Mayo seeks $585 million from the state along with private investments to support the public infrastructure needed for the transformative initiative. A measure was introduced to collect this state funding and it has garnered bipartisan support. If it is approved, it would allow taxes to be collected from a designated district around the Mayo Clinic campus and would also capture some of the tax dollars arising from the initiative's capital improvements.
*We would like to thank Allison M. Cohen, Esquire (Association of American Medical Colleges, Washington, DC), for providing this week's update.