In the News: August 10–16

Patients Support Price Shopping, but Barriers Remain

A Health Affairs article found that only 3% of nonelderly survey respondents with some out-of-pocket spending in their last health care encounter had compared costs across providers. In contrast, 72% of respondents believe that patients should compare costs and/or quality. The common barriers to respondent price shopping included difficulty in obtaining price information (75%), as well as a desire not to disrupt existing provider relationships (77%). That said, the authors also found that price shopping varied across services—respondents were most likely to have compared costs across providers for physical therapy (24%) and for lab tests or imaging services (11%).

Provider systems across the nation feel mounting pricing pressure; however, the jury’s still out on whether pricing yet matters in health care. Despite looming potential, there may be a rush to give up margin too soon. For steps systems can take to recalibrate their pricing approaches to secure market share and appeal to payers and patients, read the Sg2 report: Pricing Strategy.

CMS Proposes Cancellation of Mandatory Bundles

On August 17, CMS published a proposed rule, Cancellation of Advancing Care Coordination through Episode Payment and Cardiac Rehabilitation Incentive Payment Models; Changes to Comprehensive Care for Joint Replacement Payment Model (CMS-5524-P), to the Federal Register. Following 2 earlier delays to the start date, CMS is now proposing to cancel the mandatory episode payment models (ie, bundled payment models for AMI, CABG and SHFFT) and the Cardiac Rehabilitation Incentive Payment Model.

In the proposed rule, CMS also proposes changes to the Comprehensive Care for Joint Replacement (CJR) payment model. CJR is the ongoing mandatory bundled payment model for lower extremity joint replacement that is currently mandatory for hospitals in 67 geographic areas. From 2018, CMS proposes that participation will be voluntary for hospitals in 33 of these geographic areas, as well as for low-volume and rural hospitals in all 67 geographic areas. Affected hospitals would have a one-time opportunity to elect to continue participation. Otherwise, CMS would withdraw these hospitals from CJR participation beginning in performance year 3 (2018). For more details, see Tables 1 to 4 of the proposed rule.

Sg2 will continue to follow this ongoing story and provide updates to our members. As summarized by this Reg Map, the publication of the proposed rule is step 5 of the 9-step federal rulemaking process, and it is important to note that these changes have not yet been finalized.

Despite these proposed changes, episode payment model preparation has not been a waste. In the proposed rule, CMS emphasizes that they expect to develop new voluntary bundled payment models during 2018, building on the BPCI initiative. Moreover, a recent survey featured by Modern Healthcare found that “large employers are increasingly hoping to constrain health insurance cost growth through value-based contracts with providers.” Of all the current payer experiments, Sg2 sees bundles as the variety likely to stand the test of time. Read the Sg2 report: Diving Into Bundled Payment: Prioritizing Clinical Products for Sg2’s prioritization framework and go-to-market advice to mitigate risk while maximizing the potential upside.

AMI = acute myocardial infarction; BPCI = Bundled Payment for Care Improvement; CABG = coronary artery bypass graft; SHFFT = surgical hip/femur fracture treatment.

Health Care Organizations Have Different Cybersecurity Priorities

A 2017 HIMSS survey of cybersecurity professionals at health care organizations found that cybersecurity priorities differed between organizations that employ a senior information security leader, such as a Chief Information Security Officer (CISO), and those that do not. Organizations with a CISO or equivalent were more likely to adopt holistic cybersecurity practices in critical areas including education and training, security frameworks, and penetration testing. The survey also found that the top concerns in medical device security were patient safety, data breaches and spread of malware.

The repercussions of a cyber attack can be costly, potentially resulting in ransom payments, lawsuits and loss of patient data. Sg2 believes that cybersecurity is a disrupter to watch due to the strong potential for continued growth and new emerging technologies in this space, such as blockchain. To learn the latest news in cybersecurity from HIMSS, listen to minute 22:46 to minute 46:00 of Sg2’s Health Tech Weekly netcast: HIMSS Conference News.

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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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