Bundled-Payment Penalties, PCSK9 Pricing, MACRA Risk and More

Here’s a roundup of items from around the web that caught the eye of Cleveland Clinic Miller Family Heart & Vascular Institute Chairman Lars Svensson, MD, PhD, in recent days for their implications — clinical and otherwise — for cardiovascular practice.

Lars Svensson, MD, PhD

Bundled payments to spell penalties for high-spend hospitals — Hospitals with above-average spending in cardiology services stand to face penalties under CMS’s proposed bundled-payment program for bypass surgery and heart attacks, finds a new analysis by consulting firm Avalere Health. As reported by Modern Healthcare, the analysis shows that 15 percent of hospitals likely to be required to participate in the program would suffer penalties of at least $500,000 a year. Hospitals with higher cardiac care spending, often because they treat sicker patients without continuum-of-care services, are more likely to struggle to meet proposed CMS targets, the study concludes.

PCSK9 inhibitor pricing pushes limits — $120 billion per year. That’s how much U.S. healthcare spending would rise if PCSK9 inhibitors were used by all eligible patients, according to an economic analysis published in JAMA Aug. 16. U.S. price tags of the two FDA-approved PCSK9 inhibitors would need to be slashed by more than two-thirds to meet standard cost-effectiveness thresholds, the study notes. The corresponding author told Bloomberg News: “We modeled many, many, many scenarios, and this drug class is not cost-effective at the ticket price.”

More harm than good from lung Ca screening guidelines? — In an interesting commentary on Medscape, Kenneth Lin, MD, a family physician at Georgetown University School of Medicine, notes the “varying degrees of success” with which hospitals and medical practices nationwide have implemented the 2013 U.S. Preventive Services Task Force (USPSTF) guidelines for low-dose CT screening for lung cancer in heavy smokers ages 55 to 77. Dr. Lin discusses troubles prompted by the guidelines, especially given the 95 percent false-positive rate of low-dose CT screening reported in the National Lung Screening Trial. He concludes that it remains to be seen whether the guidelines “will end up doing more good than harm.”

Most not ready for Medicare risk under MACRA — Expect a large majority of hospitals, health systems and physician groups to play it safe when choosing between the two possible reimbursement models under the new Medicare Access and CHIP Reauthorization Act (MACRA) scheme for determining Medicare payments starting in 2019. That’s the takeaway of a detailed Modern Healthcare feature, which reports most providers will opt for the Merit-based Incentive Payment System (MIPS), which bases payments on quality measures and use of EHRs, rather than “payment adjustments based on [providers’] performance under already existing alternative payment models.” Nevertheless, the latter option, which the feature says involves bearing “more than nominal financial risk,” is being seriously considered by a few large groups.

Beginning of the end for a dubious distinction? — Cancer has overtaken heart disease as the top cause of death in 12 European nations, according to an analysis of World Health Organization data published Aug. 15 in the European Heart Journal. The shift aligns with dramatic falls in cardiovascular disease mortality over the past decade, with about half the reduction coming from decreased incidence and half from reduced case fatality.