A Medical Device Daily

The pay-for-performance pilot rolled out by the Centers for Medicare & Medicaid Services has cast a positive light on value-based purchasing (VBP), and although participating hospitals may not be making money on it, CMS is nonetheless encouraged by the latest results.

Earlier this week, the agency posted a statement that the most recent data for 2006, the last year of the first three-year pilot "show dramatic across-the-board improvement in the performance of participating hospitals." According to CMS, average composite scores for the 250 participating hospitals for acute myocardial infarction rose from 87% of hospitals administering standards of care to 96%.

Improvement in care for coronary artery bypass procedures was better, from 85% to 97%, but the greatest improvement came for care of heart failure, for which aggregate scores rose from 64% to 89%.

Acting CMS administrator Kerry Weems said "given these results, it is time to take the next step and implement hospital value-based purchasing fore the Medicare program" as a whole.

One question is whether hospitals across the nation will like the idea, given that the P4P demo cost some hospitals more than CMS paid them (Medical Device Daily, Feb. 2, 2007). CMS has paid the 250 participating hospitals a total of more than $24 million in the first three years, but only $7 million of that total was paid out in 2006, and only 112 of the participating institutions received any of those 2007 monies.

CMS extended the P4P program for another three years, adding new measures such as length of stay in order to beef up the data and give a more accurate picture of the effect of VBP on costs. The agency said that it proposed to Congress last November "to implement Medicare VBP" for all hospitals that would make payments only partly "contingent on the hospital's actual performance on a specific set of measures." Congress has yet to act on the proposal, and the agency cannot unilaterally implement VBP.

CMS adds nursing home compare to site

CMS announced earlier this week that it will soon launch a five-star rating system on its web site for comparisons of quality scores for nursing homes. According to the June 18 announcement, CMS is still looking for input on the design of the site pursuant to launch by December, which will rate facilities on a scale of one to five stars.

At present, the Nursing Home Compare site posts quality data, but visitors to the site must comb through multiple pages for each nursing home in order to obtain information, making comparisons cumbersome, especially for web novices.

Acting CMS administrator Kerry Weems said in the statement that "more than three million Americans rely on services provided by a nursing home at some point during the year," a figure that is bound to rise over the next few decades.

The move comes shortly after the agency boosted the content of its Hospital Compare web site (MDD, April 1, 2008), and Weems said that the site "will also provide an incentive for nursing homes to strive toward a five-star rating."

FTC drops complaint against Inova

Inova Health Systems (Falls Church, Virginia) ran into a buzzsaw of governmental opposition in its bid to merge with nearby Prince William Health Systems (Manassas, Virginia), but the larger chain recently opted to drop the matter (MDD, June 12, 2008) after the Federal Trade Commission and the Virginia State Attorney's Office objected.

According to the June 17 announcement, FTC has dropped its complaint "without prejudice, as the respondents publicly announced their mutual decision to terminate the proposed acquisition agreement," relieving the need "for further administrative litigation."

ACR weighs in on coverage analysis

Colon cancer is a growing burden on healthcare and CMS recently initiated a national coverage analysis on computed tomography colonography (CTC) to screen for colorectal cancer, partly because of recent discussions by the American Cancer Society (ACS; Atlanta) and the American College of Radiology (ACR; Reston, Virginia).

The latter association chimed in recently with an opinion on the matter, urging CMS to cover screening for the disease, reminding CMS that it is "the second leading cause of death of cancer" for both sexes.

According to the statement, which was co-signed by the Society for Computed Body Tomography & Magnetic Resonance (Reston, Virginia) and the Society of Gastrointestinal Radiologists (Houston), ACS and ACR "recently released their joint guideline" based on sufficient data to conclude "that there is compelling evidence to support CTC for screening for adenomatous polyps and cancers in average-risk patients over age 50 years."

The statement noted that a meta-analysis of several trials indicated that the test is not particularly specific for polyps less than 10 mm in length and that optical colonoscopy is still a more effective mode for detection. Still, CTC would be useful "as an alternative for colon cancer screening in asymptomatic adults age 50 or over" and "for those unwilling to undergo other primary screening modalities."