CMS is building its own Superbowl

As I write this, my hometown of Phoenix is getting ready to host the National Football League’s 49^th edition of the Superbowl. What’s grabbing the headlines is not the anticipated matchup (I’ll predict the Patriots and the Packers for the title game), but how much area hotels are spiking their room rates.

Here’s the fun stuff: United Healthcare is sponsoring a special event for 1,200 fourth and fifth graders to land Arizona in the record books by setting the Guinness World Record for the world’s largest game of Red Light, Green Light. That’s probably a lot cheaper for United to sponsor then running an ad during the game, which runs around $1 million for every 10 seconds.

CMS marching down the field

The Centers for Medicare & Medicaid Services seems to preparing its own Superbowl of health care models, with the accountable care organization as its star quarterback. It’s not just the model and its structure that CMS has been running reps with and finetuning with practice squads. The message is if you want to be on the winning team, it needs to have the letters A, C, and O in them.

Here are some league expansion notes:

• Another 89 ACOs joined Medicare’s Shared Savings Program this month. The additions will bring the total number of organizations in the program to 405 and help boost the number of Medicare enrollees who get care from doctors in ACOs to 7.2 million from 4.9 million.

The Shared Savings Program is the kinder, gentler version of the ACO that CMS offers; you have the option of assuming the risk of penalties if you aren’t sure you will deliver savings on health care costs. Only five of the current participants chose that option, and none of the 89 starting in January did so. Still, CMS is tweaking the playbook to spread the risk from three to six years and return more of the savings to the provider’s coffers.

“We're in this for the long haul,” said Centers for Medicare & Medicaid Services director Sean Cavanaugh, in an interview with Modern Healthcare. “This is not a quick hit to get some savings and run.”

That might be the right attitude needed as we slowly move into the renal ACO demonstration, now pushed back to July (see National News). Take the time needed to do it right.

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I asked readers in my December editorial what they would do to improve dialysis if someone handed them $30 million. We published the ideas offered at two previous programs, and asked for others.

Martin Roberts, MD:Funding for an automated wearable kidney. “The patient wears the kidney in a shoulder bag that has a tube to his/her peritoneal cavity. Dialysate is pumped out of the peritoneal cavity, purified in the artificial kidney, and pumped back into the peritoneal cavity. A single button (on/off switch) operates the unit making it easy to learn how to use.

The patient is on dialysis all the time just like our (natural) kidney. Being on dialysis does not interfere with their life style and quality of life. No need for going to a dialysis unit; no need for transportation to and from a dialysis unit. No need to lose three days out of the week for dialysis. No ups and downs in body chemistry.”

Robert is part of a team currently doing animal trials, and he hopes to start human trials in the early part of 2015. Nephrologist Victor Gura, MD, is also working with a team in Los Angeles on a wearable artificial kidney, the ‘WAK.’ His design is based upon hemodialysis instead of peritoneal dialysis. So far, seven patients have joined the trial.

Dori Schatell, MS. “To improve in-center HD outcomes, offer every-other-day in-center treatments (work out the transportation issues) to get rid of the 2-day “killer gap.” Also:

Turn down the ultrafiltration to less than 10mL/Kg/hour to stop stunning people’s organs
Set four hours as a bare minimum for in-center treatments, and offer five hours to those who will do it.

To encourage use of home dialysis:

Expect patients to self-cannulate. Have an “orientation” clinic, like Chris Blagg did at NKC for many years, so the new patients don’t know that everyone doesn’t do that.
Restart in-center, self-care programs. Self-cannulation and in-center self-care are bridges to home HD.”

Deborah Timmins RN, BSN.“After looking at the list developed at the meeting in Chicago, many things started coming to mind.

1. “Focus on CKD education and patient acceptance of the disease process. I find this to be a major issue that needs to be addressed. I would go so far as to take it back a step and include more education on diabetes management education and hypertension/CVD management education. This would mean developing a program that collaborates with PCPs and other specialties to identify patients who have these diagnoses. Then providing an education program that teaches the patient information in increments. Something like a five-week program that is 1.5 hours per session, that covers information step by step.

“I believe that these patients may be very overwhelmed with having to make lifestyle changes and decide it’s easier to do what they are comfortable with. They most likely don’t know or understand the ramifications of the choices they make.

2. “Form a transportation service. I talk with many patients who have a difficult time with transportation. They are on a fixed income, they can no longer drive for various reasons, they lack a social support system, etc.

3. “Add a person to each facility to do coordinated care management. I think this would be very helpful for patients. I believe that those who have been hospitalized and don’t understand discharge instructions would greatly benefit. And those who should be getting yearly eye exams and having a podiatrist appointment would also benefit.

4. HIPPA. This is a major issue that I think most health care workers try to adhere to. However I find it can also be difficult when I’m trying to coordinate care or obtain information to help my patients. We need some kind of system that allows a patient to provide consents across providers. Maybe set up through the insurance provider.

“Thank you for this opportunity to share my thoughts. I’m really excited to see this discussion taking place and look forward to the ideas on how to implement these concepts.”

You’re welcome, Deborah. Let’s hear from more of you. -by Mark E. Neumann