In the News: April 6–12

Sg2 is dedicated to helping our clients interpret the latest news and trends in health care. Below you’ll find our analysis of this week’s key industry headlines, along with links to related Sg2 resources.

MedPAC Recommends Early Implementation of Unified Post-Acute Care Payment System

In their April meeting, the Medicare Payment Advisory Commission (MedPAC) unanimously approved the recommendation to implement a unified post-acute care (PAC) payment system as early as 2021. Currently, Medicare pays for PAC via 4 separate payment systems—1 for each site of care—which results in different payments for the same service, regardless of outcome. A unified PAC prospective payment system would base payments on patient characteristics rather than the setting where services are rendered.

This recommendation follows MedPAC’s 2016 report—mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014—which confirmed the feasibility of a single payment system spanning all PAC settings. For Sg2’s perspective on changes in the post-acute environment, read the Sg2 Expert Insight: Unified Payment System for Post-Acute Care: What Hospitals Should Know.

Portion of US Adult Deaths Attributed to Diabetes

A recent PLOS study explored the impact of diabetes on US adult mortality by analyzing 2 independent mortality data sets for adults aged 30 to 84. Using a population attributable fraction that combines the prevalence of diabetes among deaths with the excess mortality risk among people with diabetes, researchers discovered that approximately 12% of deaths are attributed to diabetes. Often, diabetes is only considered in mortality when it is recorded as the underlying cause of death (3.3% to 3.7%), which may exclude instances where diabetes is present with other diseases or disabilities, such as cardiovascular or renal disease.

Diabetes has significant financial and clinical impact on health systems and patients alike, with wound care as one often-overlooked aspect of diabetes management. Given the direct cost ($58 billion) and loss of patient quality of life due to diabetes wounds, Sg2 believes that health systems can develop a comprehensive wound care program to reduce these complications. For guidance on key elements and strategies for eliminating this gap in care, read the Sg2 Expert Insight: Close the Gap in Diabetes Care With a Comprehensive Wound Care Program.

Americans Try to Compare Multiple Providers’ Cost Prior to Care

With the rise of high deductible health plans, consumers have started to think more critically about their health care costs. Insurers, state governments and employers have tried to enhance pricing transparency in recent years, but a recent study found that there are still challenges to obtaining this information. Public Agenda research found that 50% of Americans have tried to find medical pricing before seeking care; 63% say there is insufficient cost information for medical services; and 70% prefer doctors discuss prices with them before ordering tests and procedures. These findings emphasize how important it is for health care stakeholders to review pricing strategies, as well as provide implications and questions for the groups to consider.

As part of the shift to health care consumerism, provider systems will continue to experience pressure to define more strategic pricing and transparency for patients. Read the Sg2 report Pricing Strategy to learn tools, tips and competencies for health systems to reevaluate their pricing approaches and continue to secure market share in an increasingly competitive health care environment.

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As of February 11, 2016, Vizient, Inc. has completed its purchase of MedAssets Sg2 and spend and clinical resource management segments from Pamplona Capital Management, LLC. MedAssets revenue cycle business will continue to operate as a wholly-owned subsidiary of Pamplona Capital Management LLP.

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