Know your body, know the signs for ovarian cancer

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Each year, over 22,000 women in the U.S. get ovarian cancer. It’s the fifth leading cause of cancer death among U.S. women. Early diagnosis is the key to survival, and the key to early diagnosis is recognizing the symptoms of ovarian cancer:

Bloating

Pelvic or abdominal pain

Trouble eating or feeling full quickly

Urgency or frequency of urination

Women have unique health concerns, including certain types of cancers and high rates of chronic disease. Medicare covers many services to address these concerns, like a yearly “Wellness” visit, bone mass measurement, cervical cancer screenings, mammograms, and cardiovascular screenings. Medicare also covers other preventive services, so talk to your doctor about risk factors and to schedule your next screening.

Currently there’s no effective screening test for ovarian cancer, and it can be very hard to identify ovarian cancer early. The signs and symptoms of ovarian cancer aren’t always clear and may be hard to recognize. It’s important to pay attention to your body and know what’s normal for you. If you notice any changes in your body that last for 2 weeks or longer, talk to your doctor and ask about possible causes. Symptoms may be caused by something other than cancer, but the only way to know is to see your doctor, nurse, or other health care professional.

Make sure to ask your doctor about your level of risk for ovarian cancer at your “Welcome to Medicare” visit or your next yearly “Wellness” visit.

September is National Ovarian Cancer Awareness Month, a perfect time for you to learn more about this disease and know the symptoms. Visit the Centers for Disease Control for more information on ovarian cancer.

Preventing pneumonia is easy

Did you know that about 1 million Americans go to the hospital with pneumonia every year? Pneumonia is a lung infection caused by pneumococcal disease, which can also cause blood infections and meningitis. The bacteria that causes pneumococcal disease spreads by direct person-to-person contact. There’s a vaccine to help prevent pneumonia, but only 67% of adults 65 and over have ever gotten it.

Medicare can help protect you from pneumococcal infections. The pneumococcal shot is the best way to help prevent these infections. Medicare Part B covers the shot and a second shot one year after you got the first shot.

You may be at a higher risk for these infections if you:

  • Are 65 or older
  • Have a chronic illness (like asthma, diabetes, or lung, heart, liver, or kidney disease)
  • Have a condition that weakens your immune system (like HIV, AIDS, or cancer)
  • Live in a nursing home or other long-term care facility
  • Have cochlear implants or cerebrospinal fluid (CSF) leaks
  • Smoke tobacco

Learn more about Medicare-covered vaccines by watching our video. Protect yourself from pneumonia—get your pneumococcal shot today.

CMS Doubling Down on Health IT; Patients

By Seema Verma, Administrator, Centers for Medicare & Medicaid Services

Americans enjoy the benefits of the best healthcare providers and innovators in the world. Yet while the volume of care consumed by American patients has not increased dramatically comparative to similar economies, the cost of care in the United States has accelerated at an alarming pace. Healthcare costs continue to grow faster than the U.S. GDP, making it more difficult with each passing year for CMS to ensure healthcare to not only its beneficiaries of today, but generations of beneficiaries in the future.

We believe at CMS that a major cause for the cost inefficiency of healthcare is attributable to a failure in the past to make the system about the patient and for the patient. It is the system that has become the centerpiece of policy debates, and it is the system that has become more about sustaining itself than serving patients. If the patient truly is what our healthcare system seeks to serve, then the patient must be the focal point of all policies and private industry decision-making.

CMS is committed to leveraging innovation to truly empower patients with their own data, decisions, and care. Evidence of this commitment can be found in a government-wide initiative launched by CMS and the White House Office of Innovation in March called MyHealthEData— designed to achieve true patient control and interoperability of their health records, and to enable patients to share their data with technology innovators and researchers to accelerate public health. See our new video for a simple explanation of MyHealthEData.

At CMS we are putting patients first, and we are moving to break down silos of patient information that is being captured by the system, and depriving the patient the access to the best quality, and most affordable care. Sustaining our exceptional healthcare depends now more than ever on driving down costs, and a major part of the CMS strategy to drive down costs depends on smart and innovative use of information technology (IT).

Through MyHealthEData, CMS envisions a future in which all patients have access to their own health data and use it to make the right decisions for themselves and to get the best value. We see health IT systems that work seamlessly with each other, and a government that supports secure data sharing and emerging technologies so that healthcare in America is better and less expensive.

To achieve these goals, CMS fully acknowledges that we cannot operate in a “way-we-have-always-done-it” manner and hope for different results. That is why CMS created the new role of CMS Chief Health Informatics Officer (CHIO) and has begun the process of filling this new role with a leading healthcare IT talent. The CHIO will drive health IT and data sharing to enhance healthcare delivery, improve health outcomes, drive down costs, and empower patients. Through this new function, CMS will effectively engage stakeholders from all parts of the healthcare market, including our Federal partners and industry leaders.

As CMS Administrator, I am deeply committed to programs, policies, and systems that put patients first. It’s 2018—most doctors are using electronic health records (EHRs) and most patients have access to the Internet and a smartphone, providing many ways to view healthcare data securely. Patients should expect health IT that enhances their care coordination instead of disrupting it. Their information should automatically follow them to all of their healthcare providers, so that everyone stays informed and can provide the best treatment. Patients also should know how much a health service costs so they can decide whether they want it, and “shop around” for where to get it.

Another reason behind our decision to create a CHIO role is that today at CMS, we are focused on data, not only to inform our strategy, but also to promote patient choice and drive down cost. We are evaluating the data we have and how best to apply it to our mission. We also are thinking about an Application Programming Interface (API) strategy across the entire agency that will allow us to securely provide data so that software developers, researchers, and others can design useful products (such as apps) powered by it, just as so many companies do to enhance their customer experience.

If we can solve these health IT challenges, not only will patients benefit, but so too will providers and payers. We are closer than ever to realizing these goals, but we are not there yet.

The truth is, as the largest healthcare payer in the country, CMS should have had a CHIO function long ago. Despite today’s amazing technology and decades of promises, we are not where we should be. The CHIO role will enhance my leadership team, working across CMS, with federal partners including the U.S. Digital Service, and alongside private industry and researchers to lead innovation and help inform CMS’s health IT strategy. The challenge is great, but so is the reward—building the next generation of interoperable health systems for millions of Americans and affecting national and global health IT for good.

We now have the momentum and focus to make this happen.

Although we will refine specific responsibilities, we anticipate the CHIO role will help drive forward the many health IT initiatives we have begun this year, including the Medicare Blue Button 2.0 program—a universal digital format for personal health information—and our overhaul of the CMS EHR Incentive Programs to focus on interoperability.

I look forward to meeting qualified CHIO candidates who wish to step up to this challenge and join the team that will lead CMS health IT over the “finish line” so that we can drive down costs and save lives. The time is now to realize the true potential of health IT for America’s patients.

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Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter CMS Administrator @SeemaCMS, @CMSgov, and @CMSgovPress

Take charge, get tested for HIV

Did you know that 1 in 7 of the more than 1.1 million Americans living with Human Immunodeficiency Virus (HIV) don’t know they have it?

Getting medical care, support, and maintaining safe behaviors can help improve the health and lives of people living with HIV. Medicare can help.

Medicare covers HIV screenings for people with Medicare of any age who ask for the test, pregnant women, and people at increased risk for the infection (such as gay and bisexual men, injection drug users, or people with multiple sexual partners).

HIV is the virus that can lead to Acquired Immunodeficiency Syndrome, or AIDS. There have been many advances in treatment, but early testing and diagnosis play key roles in reducing the spread of the disease, extending life expectancy, and cutting costs of care.

Get tested. Take charge. Visit Health & Human Services’ HIV.gov website to learn more about National HIV Testing Day, June 27, and watch our video.

Working Together for Value

June 20, 2018

By Seema Verma, Administrator, Centers for Medicare & Medicaid Services

Working Together for Value

Over the past year, the Centers for Medicare & Medicaid Services (CMS) has engaged with the provider community in a discussion about regulatory burden issues. This included publishing a Request for Information (RFI) soliciting comments about areas of high regulatory burden. One of the top areas of burden identified in the over 2,600 comments received was compliance with the physician self-referral law (often called the “Stark Law”) and its accompanying regulations. In response to these concerns, CMS undertook a review of the existing regulations to determine where the agency could consider potential areas for burden reduction. In coordination with HHS Deputy Secretary Eric Hargan, CMS is now soliciting specific input on a range of issues identified with the Stark Law to help the agency better understand provider concerns and target its regulatory efforts to address those concerns.

The Stark Law was enacted in the 1980s to help protect Medicare and its beneficiaries from unnecessary costs and other harms that may occur when physicians benefit from referring patients to health care entities with which they have a financial relationship. The law prohibits a physician from making referrals for certain health care services to an entity with which he or she (or an immediate family member) has a financial relationship. There are statutory and regulatory exceptions, but in short, a physician cannot refer a patient to any service or provider in which they have a financial interest.

Stark also prohibits the entity from filing claims with Medicare for services resulting from a prohibited referral and Medicare cannot pay if the claims are submitted. In its current form, the physician self-referral law may prohibit some relationships that are designed to enhance care coordination, improve quality, and reduce waste.

To achieve a truly value-based, patient-centered health care system, doctors and other providers need to work together with patients. Many of the recent statutory and regulatory changes to payment models are intended to help incentivize value based care and drive the Medicare system to greater value and quality. This has been a priority of CMS and HHS and is reflected in many of our current ongoing initiatives. Medicare’s regulations must support this close collaboration. The Stark Law and regulations, in its current form, may hinder these types of arrangements. To help better understand the impediments to better coordinated care caused by existing regulatory efforts, this RFI seeks to obtain input about how to address those concerns.

We invite you to share your ideas and suggestions as we work together for coordinated care and a better health care system for all Americans. The RFI can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection/.

Travelling abroad? Check your health coverage first!

If you’re travelling abroad, there’s a lot to do before you leave. There are suitcases to pack, an itinerary to plan, and perhaps a passport to renew. We want you to have a fun, relaxing trip—so don’t forget to include health coverage on your to-do list.

If you have Original Medicare, Medicare covers your health care services and supplies when you’re in the U.S., which includes Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.

But, if you plan to travel overseas or outside the U.S. (including to Canada or Mexico), it’s important to know that in most cases, Medicare won’t pay for health care services or supplies you get outside the U.S. (except in these rare cases).

That doesn’t mean you have to travel without coverage. There are several ways you can get health coverage outside the U.S.:

  1. If you have a Medigap policy, check your policy to see if it includes coverage outside the U.S.
  2. If you get your health care from another Medicare health plan (rather than Original Medicare), check with your plan to see if they offer coverage outside the U.S.
  3. Purchase a travel insurance policy that includes health coverage.

Check with your policy or plan before traveling and make sure you understand what’s covered outside the U.S. For information on other foreign travel situations (like a cruise, dialysis, or prescription drugs) you can watch this video.

Taking the time to plan out your health coverage before you travel abroad will help you to have a more enjoyable and relaxing trip. For more information on how to stay healthy abroad, visit the Centers for Disease Control’s Traveler’s Health page.

CMS Opioids Roadmap

June 11, 2018

CMS Opioids Roadmap

Although some progress has been made in efforts to combat the opioid epidemic, the latest data from the Centers for Disease Control and Prevention indicate the crisis is not slowing down. However, it is important for our beneficiaries across the country to know that the Centers for Medicare & Medicaid Services (CMS) is exploring all of our options to address this national crisis.

As evidence of our commitment to the health and well-being of patients, CMS is publishing a roadmap outlining our efforts to address this issue of national concern. In this roadmap, we detail our three-pronged approach to combating the opioid epidemic, focusing in on prevention of new cases of opioid use disorder (OUD), the treatment of patients who have already become dependent on or addicted to opioids, and the utilization of data from across the country to target prevention and treatment activities.

Current estimates show that over two million[i] people suffer from opioid use disorder, with a prevalence in Medicare of 6 out of every 1,000 beneficiaries.[ii] In order to decrease that number, it is crucial that Medicare beneficiaries and providers are aware that there are options available for both prevention of developing new cases of OUD and the treatment of existing cases. CMS is working to ensure that beneficiaries are not inadvertently put at risk of misuse by closely monitoring prescription opioid trends, strengthening controls at the time of opioid prescriptions, and encouraging healthcare providers to promote a range of safe and effective pain treatments, including alternatives to opioids. We are also working on communications with beneficiaries to explain the risks of prescription opioids and how to safely dispose of them, so they are not misused by others. These are just some of the ways we are looking to protect and care for people with Medicare.

CMS also recognizes that the opioid epidemic has affected people covered by Medicaid across the country in different ways – an estimated 8.7 out of 1,000 Medicaid beneficiaries are impacted by OUD. We believe one crucial effort to help on the treatment front is encouraging states to tailor programs to their populations by taking advantage of flexibilities that are available through Medicaid Section 1115 substance use disorder (SUD) demonstrations that improve OUD treatment. CMS has worked with seven new states since October 2017 to approve waivers to tackle the opioid epidemic in their state. With each state having a unique population, we recognize the challenges that states face in creating programs to help, and we are committed to providing the support necessary to help states achieve positive results for their populations.

Beyond Medicare and Medicaid, CMS is also looking across our other programs to use all the tools at our disposal to address the opioid crisis. We are working to ensure that the private plans offering coverage on the Health Insurance Exchanges also provide options for treating OUD, and we are examining our quality standards across our programs to encourage providers to follow best practice guidelines related to opioid misuse diagnosis and treatment. Further, while we have initiatives specific to Medicare and Medicaid, we are also reviewing all of our programs to find solutions that are working at the local level with states, providers, and payers so that we can disseminate successful ideas as quickly as possible to help our partners know that they do not have to solve this alone.

CMS believes we can make progress in addressing the many aspects of the opioid epidemic in partnership with states and other stakeholder organizations. Every day this crisis claims the lives of loved ones and, in many areas in our country, we have yet to turn the tide. This roadmap is only a start, and as we begin to implement many of our plans and programs, it will continue to evolve. But the roadmap is also a demonstration of CMS’ commitment to explore and offer viable options to address the crisis, to share the information we collect with other agencies and organizations, and to protect our beneficiaries and communities affected by the crisis.

[i] https://www.hhs.gov/opioids/about-the-epidemic/index.html

[ii] https://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/Downloads/CMS-Opioid-Misuse-Strategy-2016.pdf

A New Era of Accountability and Transparency in Medicaid

By: Administrator, Seema Verma, Centers for Medicare & Medicaid Services

In his first 500 days in office, President Donald J. Trump has achieved results both at home and abroad for the American people, working to ensure government is more accountable to the American people. One of the many promises the Trump Administration has made and kept is improving accountability and transparency in Medicaid.

Medicaid provides healthcare for more than 75 million Americans, including many of our most vulnerable citizens, at an annual cost of over $558 billion. It has grown significantly over the years, consuming an every greater share of our public resources – from 10 percent of state budgets in 1985 to nearly 30 percent in 2016. Medicaid should improve the lives of those it serves by delivering high quality health care and services to eligible individuals at a maximum value to American taxpayers. As the administrators of the program, states, along with their local healthcare professionals who care for their neighbors, know best the unique healthcare needs of their community. Our success on delivering on Medicaid’s promise hinges on the critical role they play in managing the precious state and federal resources with which we are entrusted.

That’s why we have committed to resetting the state-federal partnership by ushering in a new era of state flexibility. We’ve approved groundbreaking Medicaid demonstration projections, including reforms to test how Medicaid can be designed to improve health outcomes and lift individuals from poverty by connecting coverage to community engagement. We are streamlining our internal processes and breaking down regulatory barriers that force states to commit too much of their time and resources to administrative tasks rather than focusing on delivering better care.

But with that commitment to flexibility must come an equal pledge to improve transparency and accountability. Too often we have struggled to articulate our collective performance in executing on our immense responsibility. This is best reflected in the fact that Medicaid is responsible for approximately half of the nation’s births, yet no one will argue that we are achieving the birth outcomes our future generations deserve. As we return power to states, we must shift our oversight role at CMS to one that focuses less on process and more on holding us all collectively accountable for achieving positive outcomes.

That is precisely why, last November, I announced that we would create the first ever CMS Medicaid and CHIP Scorecard to increase public transparency about the programs’ administration and outcomes. The data offered within the Scorecard begins to offer taxpayers insights into how their dollars are being spent and the impact those dollars have on health outcomes. The Scorecard includes measures voluntarily reported by states, as well as federally reported measures in three areas: state health system performance; state administrative accountability; and federal administrative accountability. As states continue to seek greater flexibility from CMS, the Scorecard will serve as an important tool in ensuring that CMS is able to report on critical outcome metrics.

The first version of the Scorecard is foundational to CMS’s ongoing efforts to enhance Medicaid and CHIP transparency and accountability. We’ve begun this initiative by publishing selected health and program indicators that include measures from the CMS Medicaid and CHIP Child and Adult Core Sets along with federal and state accountability measures. For the first time, we are publicly publishing measures that show how we are doing in the business of running these immense programs, including things like how quickly we review state managed care rate submissions or approve state section 1115 Medicaid demonstration projects. Our stakeholders, including beneficiaries, providers, and advocates, deserve to have this information available to them.

And we’re just getting started. Public reporting of meaningful quality and performance metrics is an important and ongoing responsibility of states and the federal government given Medicaid’s vital role in covering nation’s children and as the single greatest payer for long-term care services for the elderly and people with disabilities.

That’s why, in future years, the Scorecard will be updated annually with new functionality and new metrics as data availability improves, including measures that focus on program integrity as well as opioid and home and community-based services quality metrics. Over time, we plan to add the ability for users of the Scorecard to generate year-to-year comparisons on key metrics, as well as to compare states on measures of cost and program integrity. While some variation may be inherent based on geographic, population, reporting or programmatic differences, the public should have access to information that allows them to understand how and why costs and outcomes can vary from state to state for the same populations. Then we can begin to ask important questions about what may really be driving differences in quality and efficiency.

CMS recognizes that continued insight from our state partners is a critical component in the maintenance of the Scorecard. I want to thank all the states for their assistance in the creation of this first iteration, particularly the 14 states that served on the National Association of Medicaid Director’s workgroup over the last six months. Many of the measures are only possible because of the commitment from states to collect and report on these important metrics. Through this partnership with states, CMS will continue to advance policies and projects that increase flexibility, improve accountability and enhance program integrity and are designed to fulfill Medicaid’s promise to help Americans lead healthier, more fulfilling lives.

Even “healthy” guys need health screenings

Are you the type of guy who puts off doing a task and later wishes he’d just done it? Do you think that if you don’t feel ill, then everything must be fine? If you’re a man with Medicare, now’s the time to talk with your doctor about whether you should get screened for prostate cancer, colorectal cancer, or both. Screening tests can find cancer early, when treatment works best.

Don’t put off screenings if you’re worried about the cost—if you’re a man 50 or over, Medicare covers a digital rectal exam and a prostate specific antigen (PSA) test once every 12 months. Also, Medicare covers a variety of colorectal cancer screenings—like the fecal occult blood test, flexible sigmoidoscopy, or colonoscopy—and you pay nothing for most tests.

Prostate cancer is the most common cancer in men, second only to lung cancer in the number of cancer deaths. Not sure whether you should get screened? You’re at a higher risk for getting prostate cancer if you’re a man 50 or older, are African-American, or have a father, brother, or son who has had prostate cancer.

Colorectal cancer is also common among men—in fact, it’s the second leading cause of cancer-related deaths in the United States among cancers that affect both men and women. If everyone 50 to 75 got screened regularly, we could avoid as many as 60% of deaths from this cancer.

In most cases, colorectal cancer develops from precancerous polyps (abnormal growths) in the colon or rectum. Fortunately, screening tests can find these polyps, so you can get them removed before they turn into cancer. If you’re 50 or older, or have a personal or family history of colorectal issues, make sure you get screened regularly for colorectal cancer.

June is Men’s Health Month. It’s the perfect time for you to take the steps to live a safer, healthier life. Watch our video on how Medicare has you covered on colorectal cancer screenings, and visit the Men’s Health Network website on Men’s Health Month for more information.

Quality Payment Program Exceeds Year 1 Participation Goal

By: Administrator, Seema Verma, Centers for Medicare & Medicaid Services

Quality Payment Program Exceeds Year 1 Participation Goal

I’m pleased to announce that 91 percent of all clinicians eligible for the Merit-based Incentive Payment System (MIPS) participated in the first year of the Quality Payment Program (QPP) – exceeding our goal of 90 percent participation. Remarkably, the submission rates for Accountable Care Organizations and clinicians in rural practices were at 98 percent and 94 percent, respectively. What makes these numbers most exciting is the concerted efforts by clinicians, professional associations, and many others to ensure high quality care and improved outcomes for patients.

Meeting the Challenges Ahead

Even with this high rate of participation, we are committed to removing more of the regulatory burdens that get in the way of doctors and other clinicians spending time with their patients. After only eight months, we’ve made significant progress through our Patients over Paperwork initiative: streamlining our regulations, increasing efficiencies, and improving care for patients. At the same time, we continue to put patients first by protecting the safety of our beneficiaries and strengthening the quality of healthcare they receive.

For example, we reviewed many of the MIPS requirements and developed policies for 2018 that continue to reduce burden, add flexibility, and help clinicians spend less time on unnecessary requirements and more time with patients.

In particular we have:

  • Reduced the number of clinicians that are required to participate giving them more time with their patients, not computers.
  • Added new bonus points for clinicians who are in small practices, treat complex patients, or use 2015 Edition Certified Electronic Health Record Technology (CEHRT) exclusively as a means of promoting the interoperability of health information.
  • Increased the opportunity for clinicians to earn a positive payment adjustment.
  • Continued offering free technical assistance to clinicians in the program.

Under the Bipartisan Budget Act of 2018 we have additional authority to continue our gradual implementation of certain requirements for three more years to further reduce burden in areas of MIPS.

We’re also eager to improve the clinician and patient experience through our Meaningful Measures initiative so that clinicians can spend more time providing care to their patients and improving the quality of care their patients receive. Within MIPS, we are adopting measures that improve patient outcomes and promote high-quality care, instead of focusing on processes.

Working with the Healthcare Community

We want to express our gratitude to all of the clinicians who collaborated with us as part of the voluntary Clinician Champions Program and the Clinician Voices initiative. We also want to thank all of you who participated in our various listening sessions and user groups throughout the year. Your input and feedback opened a dialogue, highlighted opportunities for improvement, and helped us identify ways to continue to reduce burden within the Quality Payment Program.

We deeply appreciate the contributions professional associations, consumer advocates and other important stakeholders have made to help engage their members and prepare them for success. We also want to acknowledge the networks supporting the free technical assistance available to clinicians, specifically the Small, Underserved, and Rural Support initiative, Quality Innovation Networks, and the Transforming Clinical Practice Initiative, who worked tirelessly to help clinicians familiarize themselves with the program so they can successfully participate. Together with our stakeholders and technical assistance networks, we hosted over 6,000 Quality Payment Program events last year. We used these events to describe requirements, offer tips, listen to you, and act on your feedback.

And, we’re proud to announce that our free technical assistance received a 99.8 percent customer satisfaction rating by over 200,000 clinicians and practice managers. The technical assistance networks also responded to 98.7 percent of initial referrals for additional support from the Quality Payment Program Service Center and Centers for Medicare & Medicaid Services (CMS) Regional Offices within 1-business day. We believe that there is an obligation to respond quickly, so clinicians can spend less time trying to figure out the program and more time with their patients.

Additionally, our Quality Payment Program Service Center complemented the technical assistance effort by fielding more than 130,000 inquiries and delivering world class customer support.

Better yet, all of the free and customized support from the technical assistance networks and the Quality Payment Program is still available to clinicians in the 2018 performance year!

Moving Forward Together

While we’re proud of what has been accomplished, there is more work to be done. CMS remains committed to listening to the healthcare community and exploring ways to reduce clinician burden, strengthen quality, introduce new payment models, develop meaningful measures including for patient safety, and promote interoperability. We look forward to continuing to hearing from you to make sure that we focus on patients, not paperwork.

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