The Rundown | Week of 3.18.2019

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Small, Physician-Led ACOs Leaving MSSP

Physician-led accountable care organizations (ACOs) are leaving the Medicare Shared Savings Program (MSSP) at a higher rate than hospital ACOs, even though they tend to earn more on average. The departures come before this year’s shift to the new Pathways to Success model. “Hospital-led ACOs and large ACOs regardless of type have low dropout rates at the end of 2018,” according to Health Affairs. “One of the goals of the program overhaul was to move larger organizations into downside risk contracts.” Low revenue — which comprised 42 percent of physician-led ACOs — was not tied to dropout rate, nor were size or leadership type. While Pathways to Success was designed to afford ACOs more flexibility and predictability, many members felt the changes were too sudden. Constructing the capabilities and frameworks needed for an ACO to thrive may take three years; “It takes time to build sufficient infrastructure and redesign care processes,” the authors noted.
>> Read More: Following Medicare’s ACO Program Overhaul, Most ACOs Stay—But Physician-Led ACOs Leave At A Higher Rate

Public Still Unsure of EHRs

A report from the Kaiser Family Foundation found the public remains concerned about privacy issues pertaining to EHRs. Of the 88 percent of respondents whose provider used an EHR, nearly half “say that their physician’s use of an EHR has made the quality of care they receive and their interactions with their physician ‘better.’” Younger respondents were particularly likely to compliment the quality of care associated with EHR adoption. However, 54 percent of respondents were “very” or “somewhat” concerned that an unauthorized user may access confidential medical information. This percentage dropped from 60 percent in 2016. Another concern is incorrect medical information. One in five responded they or a family member noticed a medical error in their EHR. The most common mistakes were medical history, personal information, lab results, medication information, and billing errors.
>> Read More: Data Note: Public’s Experiences With Electronic Health Records

End Surprise Billing, Groups Tell Congress

Payers and employer groups penned a letter requesting Congress eliminate surprise billing for emergency or involuntary care and “reign in out-of-control” healthcare costs. Signatories include America’s Health Insurance Plans, BlueCross BlueShield Association, and others. The letter also asked for legislation to “inform patients of their doctors’ network status and possible options for seeking care from a different doctor” and “avoid the use of complex, costly, and opaque arbitration processes.” Furthermore, the authors proposed tethering reimbursement rates to market rates “determined by reasonable, contracted amounts paid by health insurance providers to similar doctors in a geographic area.”
>> Read More: Letter to Congress on Surprise Medical Bills

Light Exercise Still Heart-Healthy

A recent report associated regular, “light physical activity” with a lower incidence of cardiovascular disease (CVD) and coronary heart disease (CHD). The prospective cohort study, published in JAMA Network Open, measured exercise among 5,861 women with a mean age of 78.5 and a mean follow-up of 3.5 years. Accelerometers calculated the level of metabolic equivalent tasks; activities like walking or low-speed stationary bicycling that measured less than three MET were considered “light.” Examples include. For every hour of light activity, participants experienced a 14 percent reduction in risk for CHD and 8 percent for CVD.
>> Read More: Association of Light Physical Activity Measured by Accelerometry and Incidence of Coronary Heart Disease and Cardiovascular Disease in Older Women

Dietary Cholesterol Linked to Heart Problems

A recent study found “higher consumption of dietary cholesterol or eggs was significantly associated with higher risk of incident CVD and all-cause mortality.” Researchers pooled 29,615 adults from six prospective cohort studies and found that each additional 300 mg of daily dietary cholesterol intake — an egg has approximately 200 mg — increased the risk of CVD and all-cause mortality. This “dose-responsive” model translates into a 3.24 percent increase in CVD for each additional 300 mg/day. However, the study relied on self-reported data that was not tracked continuously, which some believe undermines the accuracy of the conclusions. Furthermore, the 17-year timeline of the study did not account for variations in diet over the period.
>> Read More: Associations of Dietary Cholesterol or Egg Consumption With Incident Cardiovascular Disease and Mortality