In recent years, scientists have shown that financial incentives can drive short-term behavioral changes that are associated with improved health; things like losing weight and quitting cigarettes, for example. The rewards in these studies include direct cash incentives, gift cards and so on.

Recently, the Centers for Medicare and Medicaid Services announced plans to leverage this strategy with a $100 million initiative that permits states to offer incentives to Medicaid enrollees for adopting healthy behaviors.

Called a “demonstration program,” the CMS initiative is designed to figure out which strategies produce long-term behavioral changes. It should also help CMS determine the extent to which special populations (like adults with disabilities or children with special needs) can participate in the program, the level of satisfaction with the program, and the administrative costs incurred by State agencies that administer the program.

The program is funded by the new health care law (known as the Affordable Care Act). It invites each state to submit one proposal . Grant Applications are due to CMS by May 2, 2011. There are no state cost-sharing requirements.

According to CMS, the proposals must be “comprehensive, evidence-based, widely available, and easily accessible.” When states prepare their proposals, CMS recommends that they rely on evidence-based research which can be found in documents like the Guide to Community Preventive Services, the Guide to Clinical Preventive Services, and the National Registry of Evidence-based Programs.

“Keeping people healthy is an important goal of the Affordable Care Act,” HHS Secretary Kathleen Sebelius said in a press release. “One way to reach that goal is to encourage all Americans to make better choices about diet, exercise and smoking to avoid potentially disastrous outcomes down the road like heart disease, cancer or diabetes.” (more…)

The Centers for Medicare and Medicaid Services recently released quality ratings for the 15,800 nursing homes that receive reimbursement from the 2 entitlement programs.

The ratings feature a 5-star scale with a one being poor and a 5 being well above average. They’re based on a combination of staffing information, results from health inspection surveys and a compendium of quality measures. Plans are to update them monthly.

The ratings can be found by clicking on the Nursing Home Compare feature at www.medicare.gov.

“Our goal in developing (the) quality rating system is to provide…a straightforward assessment of nursing home quality, with meaningful distinctions between high and low performing homes,” said CMS Acting Administrator Kerry Weems in a press release. 

Inspectors survey nursing homes annually to assure compliance with federal and state rules.  Information from the last 3 years worth of surveys was used to develop the ratings. 

The quality measurement system features 10 metrics including the percent of at-risk residents that developed pressure ulcers and the number whose mobility worsened after admission.

Staffing information relies on one metric—the severity-adjusted number of hours of nursing and other staff care, per patient-day.

In the first data release, 12% of the nation’s nursing homes received a 5-star rating, while 22% scored one star.  The remaining facilities were distributed evenly among the other rankings.

Thomas Hamilton, director of the CMS Survey and Certification Group reminded users that the ratings should be used in conjunction with other information sources.

“Families should also consult with their physician, talk to the state’s nursing home ombudsman or the state’s survey and certification office and, most importantly, visit the nursing home themselves,” he said.

Last week, the Centers for Medicare and Medicaid Services announced an incentive plan for physicians and other prescription writers that should accelerate the adoption of e-prescribing, a technique believed to reduce medication errors and costs.

Providers will receive a 2% bonus on total Medicare charges during 2009 for using qualified e-prescribing systems. The incentive would be on top of the 2% bump received by physicians who provide data using the Physician Quality Reporting Initiative (PQRI), and the 1.1% fee schedule increase mandated by the Medicare Improvements for Patients and Providers Act of 2008.

To capture the bonus, providers must use e-prescribing systems that:
-Communicate electronically with the patient’s pharmacy,
-Remind physicians about cheaper alternatives (if available),
-Provide Medicare formulary information, and
-Alert prescribers about allergies, improper dosing and drug interactions.

“E-prescribing can greatly reduce the number of medication errors that jeopardize the health and safety of Medicare patients and waste precious healthcare dollars treating conditions that never should have happened,” said CMS Acting Administrator Kerry Weems.

The literature appears to back-up Mr. Weems’ claim. Scientists recently reviewed published studies regarding the effectiveness of computerized physician order entry systems. They found that 23 of the 25 studies of the matter concluded that the systems reduce medication errors or adverse events. In these studies, the relative risk of a medication error was reduced by an amount ranging between 13% and 99%.