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CRE: CMS’ Five-Star Quality Rating System is a Violation of Medicare and APA Rulemaking Requirements
CMS’s Five-Star Quality Rating System for Part C and D Medicare is laudible concept for using informed consumer choice rather than command-and-control regulation to improve the healthcare market. However, because the Star Rating System is now used to determine bonuses, rebates, and eligibility, CMS is statutorily required to implement the ratings through Federal Register notice-and-comment rulemaking proceedings.
In the letter to CMS attached here, the Center for Regulatory Effectiveness explains the deficiencies in how the ratings were developed. CRE concludes that CMS should
- Follow Federal Register notice-and-comment rulemaking proceedings for the star ratings programs.
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Medicare Rankings Favor Small, For-Profit Hospitals
From: The Hospitalist
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The decision has not been met without controversy, particularly given the fact that just 251 hospitals out of more than 3,500 received five stars, and only two major teaching hospitals achieved the highest rating. Some professional groups, like the American Hospital Association (AHA), which issued a statement the day CMS released its ratings, believe the rankings risk “oversimplifying the complexity of quality care or misinterpreting what is important to a particular patient, especially since patients seek care for many different reasons.”
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Medicare’s Hospital Compare adds star rating but fails to score with critics
From: Senior Journal
Editor’s note: New star rating system gets some hoarse criticism at Kaiser Health News
April 16, 2015 – Medicare’s Hospital Compare website may have added the star rating system today but the new service – well, even the earlier service – is not getting five stars from Jordan Rau of Kaiser Health News. His article published today is below. It is a “must read” for senior citizens planning on using the service to choose a hospital.
Only 251 Hospitals Score Five Stars in Medicare’s New Rating
By Jordan Rau, Kaiser Health News
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What Do CMS Five Star Ratings Really Mean?
In their report, Chemical Restraints: Anti-psychotic meds given to elderly despite warnings, ABC News 10 in Sacramento, CA reports that,
As documented in a coroner’s investigative report, Conover also said she thinks the drugs contributed to her mom’s death just 12 days after she was admitted to Roseville Point Health and Wellness Center.
She was as assessed when she entered Roseville Point as a well developed, well nourished 82-year-old female complaining of back pain to being triaged to Kaiser 10 days later as ill-appearing, obtunded, which is a medical term for being in a vegetative state.
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CRE Informs the Media that CMS Star Ratings Could Violate the Data Quality Act
Editor’s Note: CRE has informed Inside CMS, a premier media organization, of potential deficiencies in the CMS Star Rating program.
Editor: Inside CMS
The following email was sent to a number of individuals associated with the CMS Star Rating System as applied to hospitals.
Respectfully,
Jim Tozzi
Center for Regulatory Effectiveness
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Dear___:
I am with the CRE, the Center for Regulatory Effectiveness, a regulatory watchdog which intervenes in regulatory proceedings when it appears that government regulations are not science based.
We work to ensure compliance with the Data Quality Act; see the following article from the New York Times http://www.thecre.com/quality/20020321_nytimes.htm
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Regulatory Conflicts in CMS’s Proposed Medicaid Rule May Strip Same-Sex Spouses of Federal Financial Protections
CMS’s proposed Medicaid rule on patient protections for beneficiaries in nursing homes (if finalized as drafted) would create a conflict for Long-Term Care facility (nursing home) operators. The conflict would be between CMS’s proposed new regulatory requirements for LTC facilities and the exercise by some state Medicaid programs of their CMS-granted authority that permits the programs to not recognize same-sex marriages.
At issue is whether or not CMS is requiring LTC facility operators in states that do not recognize same-sex marriages to provide Medicaid’s federal “spousal impoverishment” (42 U.S.C. 1396r–5) financial protections to the same-sex spouses of beneficiaries irrespective of where they reside.
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CMS Exceeds Its Authority in Doubling Down on Discrimination
CMS has substantial discretion in how it implements the Supreme Court’s Windsor decision. The agency’s discretion is not, however, unlimited. Thus, even though Windsor doesn’t obligate CMS to force state Medicaid programs to recognize the out-of-state marriage licenses of gay couples, neither does it grant CMS the authority to nullify federal fair housing protections for Medicaid beneficiaries by accommodating the preference of states that refuse to honor the marriage licenses of gay couples.
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The Diabetes Test Strips Crisis: How Cutting Costs Is Robbing Your Health
From: A Sweet Life
Riva Greenberg
Medicare and the FDA (Food and Drug Administration) are choosing to lower costs at the expense of your health. They are allowing cheap and faulty diabetes test strips into the marketplace. Test strips that have been proven — the FDA admits – to give inaccurate glucose readings.
This is dangerous for anyone who has diabetes, no matter what your age. We cannot allow this to continue and, together, we can stop it — and we must.
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Roche to cut local jobs after diabetes-care sales plunge
From: Indianapolis Business Journal
Plunging revenue from its blood-glucose monitors has forced Roche Diagnostics Corp. to cut its staff, the company informed its workers last week.
Roche, which operates its North American headquarters in Indianapolis, suffered a 14-percent decline in revenue in its diabetes care unit during the first six months of
the year. Roche has reportedly put that unit up for sale, according to a May report by the Reuters news agency. -
Controversial Medicare Bid Program Takes Next Step
From: KCUR.org 893.FM Kansas City Public Media
By Bryan Thompson
Medicare patients who have diabetic testing supplies delivered to them experienced some changes this week.
It’s all part of an effort by the Medicare program to save money and cut down on fraud. But some people are worried about unintended consequences.
A public services announcement issued by Medicare attempts to lay out the changes for diabetic Medicare recipients:
“If you are covered by Original Medicare, and have diabetic testing supplies delivered to your home,” the narrator says. “You should know about a new mail-order program for diabetic testing supplies. It will allow you to continue getting quality supplies, while saving money.”