IHA Daily Briefing: Aug. 10

CMS Proposes Major Changes to ACOs
Pregnant Women with Opioid Use Disorder Surges
Notifying Doctors of OD Deaths Reduces Opioid Prescribing
Briefly Noted

CMS Proposes Major Changes to ACOs
The Centers for Medicare & Medicaid Services (CMS) Thursday issued a proposed rule that would overhaul the Medicare Shared Savings Program (MSSP) and could lead to a substantial reduction in the number of participating healthcare providers.

CMS says it would redesign the participation options available under the program to “encourage Accountable Care Organizations (ACOs) to transition to two-sided models (in which they may share in savings and are accountable for repaying shared losses), increase savings for the Trust Funds and mitigate losses, reduce gaming opportunity and increase program integrity, and promote regulatory flexibility and free-market principles.”

CMS would phase out the no-risk model beginning in 2020. Existing ACOs will have one year to switch to a model accepting financial risk. New ACOs will have two years. Currently, ACOs have up to six years to shift to a model where they share in financial risk.

AHA issued a statement expressing concerns about the changes. "The proposed rule fails to account for the fact that building a successful ACO, let alone one that is able to take on financial risk, is no small task; it requires significant investments of time, effort and finances," said AHA Executive Vice President Tom Nickels. "Hospitals and health systems must build upon their current infrastructure, which entails forming new and different contractual relationships and incentivizes successful strategies. While some have already taken significant steps toward achieving such alignment, others are not as far down this path. A more gradual pathway is critical for hospitals and health systems that are interested in participating in risk-bearing models – particularly those that are exploring such models for the first time."

See CMS’ fact sheet, which summarizes the major changes in the proposed rule. There will be a 60-day public comment period, closing on Oct. 16, 2018. Comments can be submitted at: https://www.regulations.gov/ (refer to file code CMS-1701-P).

Pregnant Women with Opioid Use Disorder Surges
The number of pregnant women with opioid use disorder (OUD) at labor and delivery more than quadrupled from 1999 to 2014, according to a new analysis by the Centers for Disease Control and Prevention (CDC). The first-ever multi-state analysis of trends – published Thursday in CDC’s Morbidity and Mortality Weekly Report – shows significant increases in 28 states (Illinois was not part of this analysis).

Using data from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project, researchers found that the national prevalence rate of OUD increased from 1.5 per 1,000 delivery hospitalizations in 1999 to 6.5 in 2014. Over the study period, the average annual rate increases were lowest in California and Hawaii (growth of less than 0.1 cases per 1,000 each year) and highest in Maine, New Mexico, Vermont, and West Virginia (all with growth of more than 2.5 cases per 1,000 each year).

"These findings illustrate the devastating impact of the opioid epidemic on families across the U.S., including on the very youngest,” said CDC Director Robert Redfield, M.D. “Untreated opioid use disorder during pregnancy can lead to heartbreaking results. Each case represents a mother, a child, and a family in need of continued treatment and support.”

The CDC says some recommended strategies for addressing OUD among pregnant women include:
--Ensuring appropriate opioid prescribing, in line with the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain;
--Maximizing and enhancing prescription drug monitoring programs;
--Implementing universal substance use screening at the first prenatal visit, as recommended by the American College of Obstetricians and Gynecologists;
--Ensuring pregnant women with OUD have access to medication assisted therapy and related addiction services; and
--Ensuring mothers with OUD receive adequate patient-centered postpartum care, including mental health and substance use treatment, relapse-prevention programs, and family planning services.

Notifying Doctors of OD Deaths Reduces Opioid Prescribing
Clinicians were more likely to reduce the number and dose of opioid drugs they prescribed after learning that one of their patients had died from an overdose from a controlled substance than those not notified, according to a recent study in the Aug. 10 issue of Science.

Jason Doctor, Ph.D., of the Schaeffer Center for Health Policy & Economics at the University of Southern California, Los Angeles, and colleagues found that physicians in San Diego County who received a letter from the chief deputy medical examiner informing them of the overdose death of one of their patients reduced the number of opioids prescribed by 9.7 percent in the three months following the intervention.

"This finding could be very useful in the effort to reduce inappropriate prescribing of opioids without severely restricting availability of legally prescribed opioids for patients who should be getting them," said National Institute on Aging Director Richard Hodes, M.D. "It shows that physicians respond to information about adverse outcomes.”Behavioral ‘nudges’ like these letters could be a tool to help curb the opioid epidemic."

Briefly Noted
The Sargent Shriver National Center on Poverty Law has launched a new website, Get Care Illinois, offering low-income individuals and families a roadmap to finding, obtaining, and using healthcare coverage in Illinois. Available in both English and Spanish, Get Care Illinois is designed to help individuals navigate and understand the options available to them through the ACA Marketplace and Medicaid to get their families the healthcare that they need.

Illinois is 24th overall in WalletHub’s 2018 Best & Worst States for Health Care. To determine where Americans receive the best and worst health care, WalletHub compared the 50 states and the District of Columbia across 40 measures of cost, accessibility and outcome. Illinois ranked 20th on cost, 16th on access, and 31st on outcomes. In one subcategory, Illinois ranked 5th on highest percentage of insured children.