Healthcare Dive

An influential group that helps shape the nation’s Medicare policy resoundingly advocated for rethinking the program’s advanced alternative payment models, which have largely failed to achieve significant cost savings.

Many members of the Medicare Payment Advisory Commission expressed a desire to condense the sheer number of models during a virtual meeting Friday. The group also expressed an interest at taking a broader look at the program and creating more long-term goals.  One problem is that many of these models have not produced the results stakeholders and policymakers were hoping for, MedPAC staff told commissioners.

Overall, the goal of these payment programs is to either reduce spending without reducing care quality or improve quality without increasing spending.

In evaluating the models over time, MedPAC staff said there were no net savings for Medicare in most models when factoring in performance payments.  Commissioners expressed concern that the models create conflicting incentives, and with the large number, it’s hard to measure what’s working due to any one specific model.  MedPAC Chairman Michael Chernew raised that specific issue in his comments Friday.

“If you’re running 40 models, which is roughly what are being run, and you test all of them supposedly against doing none of the models … the results you get is not just the sum of the results from all of the individual tests because the models interact with each other,” he said. “So, I think, basically CMS has a portfolio problem, and has to come up with a set of models that will work well together.”

Others also supported reducing the number of models. “I’m very much in favor of moving to fewer models. Medicare’s approach to date has been to put a whole lot of shots on goal by implementing lots of different models, Commissioner David Grabowski said. “The idea is that if you take enough shots, something is bound to go in. Unfortunately, as we’ve been discussing, there’s lots of unintended consequences to this approach.”

What was clear from Friday’s discussion is that commissioners are focused on condensing the models and drafting a strategy on how they can fit together. What was less clear was whether those models should be mandatory or voluntary. Members seemed split on this issue, as well as on whether some of those models should be condition-specific.

Others expressed a frustration that the models are built on top of a fee-for-service structure and that some clinicians can continue relying on being paid for volume rather than value.  “We need to send a message that fee-for-service isn’t going to be business as usual,” Commissioner Brian DeBusk said. “We need to create a vision for what fee-for-service is going to look like as the trust fund depletes.”  He suggested, for example, capping all FFS rates in 2027. “Maybe we don’t do updates to fee-for-service rates after a certain date,” DeBusk said.

In prior years, MedPAC has voiced similar concerns and noted the importance of moving away from incentives that reward volume over value. This year, the COVID-19 pandemic has also accelerated some of those worries in the larger industry as providers were forced to stop services. The resulting revenue decline put them in an untenable financial condition.

The Affordable Care Act was an important piece of legislation in teeing up ways to reimburse providers using alternative methods. The ACA also created the Center for Medicare and Medicaid Innovation, which is tasked with testing and creating APMs.

In 2015, the Medicare Access and CHIP Reauthorization Act went further and paved the way for advanced APMs that created 5% bonuses for physicians who participated. As of 2018, 183,000 clinicians participated in one of those models, up from 99,000 the year before.

The “Tracking Invasive Species with Pennsylvania iMapInvasives” newsletter is a triannual newsletter featuring stories written by natural resource professionals and citizen scientists from Pennsylvania who are doing work related to surveying, reporting, and managing invasive plants, animals, and insects in the state. Each story includes a connection to the Pennsylvania iMapInvasives Program, which operates iMapInvasives, an online reporting and data management tool used to track occurrences of invasive species. The goal of the Pennsylvania iMapInvasives Program is to assist natural resource professionals and citizen scientists by advancing their knowledge of species distributions in the state Pennsylvania and to provide a tool which stores both location and management details. Learn more by going to www.paimapinvasives.org. The Pennsylvania iMapInvasives Program is administered by the Pennsylvania Natural Heritage Program.

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The NIOSH Center for Motor Vehicle Safety’s (CMVS) strategic plan for 2020–2029 is now available. The plan identifies research needs for four priority industry sectors and describes how we envision those stakeholders will put research results into practice. The purpose of the strategic plan is to guide NIOSH-funded research to prevent work-related motor vehicle crashes—the leading cause of workplace deaths in the U.S.—and encourage collaboration between the CMVS and external partners.

Pennsylvania Agriculture Secretary Russell Redding and State Veterinarian Dr. Kevin Brightbill were joined by industry experts at Country View Family Farms of Hatfield Quality Meats to remind farmers the importance of written biosecurity and continuity of operations plans, and following them strictly, to the overall health and wellbeing of both their business operations and food security of the nation.

“If we’ve learned anything over the past seven months, it’s that disease travels quickly, its effects are widespread, and minimizing risk is paramount,” said Redding. “We’ve also learned that the food supply chain has many points of susceptibility.

“Farmers: your biosecurity and continuity of operations plans are the first line of defense,” added Redding. “Providing a sustainable, safe, and secure food supply for our commonwealth and beyond starts with you.”

From the beginning of the pandemic in Pennsylvania, the agriculture industry was deemed essential for a secure food supply. While the department issued guidance for the industry to safely continue operations as COVID-19 washed across Pennsylvania – including guidance for Farms and On-Farm Deliveries and Farmers Markets and On-Farm Markets – the industry was no stranger to managing operations in a manner that presented with the least risk possible.

In agriculture, biosecurity means doing everything you can to reduce the chances of an infectious disease being carried onto your farm by people, animals, products, equipment, or vehicles. It also means doing everything you can to reduce the chance a disease leaving your farm. The health of local herds and flocks contributes to the health of our nation’s animal agriculture industry, and the health of the agriculture industry determines the safety, availability, and affordability for food.

 Agricultural biosecurity plans include the following commonsense measures:

• Keep distance – restrict access to property and livestock or poultry and do not allow visitors near animals unless absolutely necessary;
• Keep it clean – farm manager, staff, and family should follow biosecurity procedures for cleanliness including wearing clean clothes, scrubbing shoes with disinfectant, thoroughly washing hands, and keeping equipment clean;
• Don’t borrow disease from your neighbor – avoid sharing equipment, tools, or other supplies with neighbors; if you do borrow, clean and disinfect before they reach your property;
• Always be on the lookout for infectious diseases – know what diseases are of concern and monitor animals for signs or behavior consistent with disease; early detection is critical;
• Report sick animals – always report serious or unusual animal health problems to your veterinarian, local extension office, and Department of Agriculture. The Department of Agriculture State Animal Health Official can be reached 24/7 by calling (717) 772 -2852 and pressing option 1 to report an increased morbidity or mortality in your herd or flock that is unusual and could be associated with a potential foreign animal or high consequence disease.

“Don’t wait for tomorrow – take steps today to prevent catastrophic loss of your herd, your flock, and your livelihood,” said Brightbill. “Review your biosecurity plans, strengthen them, and retrain your farm hands by working with your herd or flock veterinarian. It’s game day and all 12 million Pennsylvanians are counting on you. With less than 2 percent of America feeding the world, we cannot afford to lose even one of you.”

In addition to biosecurity plans, all farms are encouraged to have Continuity of Business plans to keep operations running smoothly in case of disruption, such as illness or incapacitation of farm owner or team member, natural disaster, disease outbreaks or supply chain disruptions. While such plans are critical for all operations, small farms are at greater risk of catastrophic failure because the owner may be the sole caretaker.

Continuity of Business plans should include:

• General farm ID including fields and acres, key suppliers, key markets for product, and next of kin;
• Crop-based specifics, including crop rotation schedule, soil tests/records, pest management programs, key workers, and equipment; and
• Animal-based specifics including state and federal premise ID number, barn layouts, field grazing capacity, animal inventory, breeding records, feeding and nutrition records, standard operating procedures for animal care, veterinary treatment records and a biosecurity plan that is reviewed and updated at least once annually.

Producers with questions about biosecurity planning are encouraged to contact Pennsylvania’s Center for Poultry and Livestock Excellence, a result of Governor Tom Wolf’s 2019 Pennsylvania Farm Bill, for resources.

For more information about the PA Farm Bill and investments to support Pennsylvania’s leading industry, visit agriculture.pa.gov or follow the department on Facebook or Twitter. For information as it relates to agriculture during COVID-19 mitigation in Pennsylvania visit agriculture.pa.gov/COVID.