Becker's ASC Review

59 HEALTHCARE NEWS A breakdown of 10 recent CMS actions By Morgan Haefner C MS issued several notices, actions and plans since March 1. e actions include updates on telehealth coverage, Medicare rules and payment models. Here's a breakdown of the 10 actions, beginning with the most recent: 1. CMS released a notice March 17 walking back four telehealth service codes that the agency said were inadvertently included on its final list because of technical errors. 2. CMS will not move forward with two changes to its Part D Payment Modernization Model, the agency said March 16. 3. CMS delayed a final rule that aims to speed up the FDA approval process for Medicare coverage of new medical devices and technologies. 4. CMS on March 16 made available its applica- tions for the second cohort of its Primary Care First payment model. 5. CMS increased the amount Medicare will pay to providers for administering the COVID-19 vaccine to $40 for each dose. 6. CMS finalized its list of participants March 12 for its new payment model for emergency care, naming 184 ambulance providers. 7. Nursing homes should allow responsible indoor visitation for residents, according to CMS guidance updated March 10. 8. CMS is pushing back the start of the first performance year for its Kidney Care Choices payment model until Jan. 1, 2022, according to an update. 9. CMS is reviewing the Geographic Direct Contracting Model, a voluntary payment model that aims to test if a geographic-based approach to care delivery can improve health outcomes and lower costs for Medicare beneficiaries. 10. CMS will implement an automatic extreme and uncontrollable circumstances policy for some clinicians participating in the Quality Pay- ment Program's Merit-based Incentive Payment System. n Moderna COVID-19 vaccine may be more effective than Pfizer, J&J shots at preventing hospitalization, study finds By Maia Anderson M oderna's COVID-19 vaccine was more effective at preventing hospitalizations caused by the virus than Pfizer and Johnson & Johnson's vaccines in a study released Sept. 10 by the CDC. The study found that all three vaccines were collectively 86 percent ef- fective at preventing hospitalization, with Moderna's being 95 percent effective, Pfizer's being 80 percent effective and Johnson & Johnson's being 60 percent effective. The results were based on the largest U.S. study to date of real-world effectiveness of the three vaccines, according to The Washington Post. It included 32,000 people treated in hospitals, emergency departments and urgent care clinics in nine states between June and early August. The CDC didn't give any reasons as to why Moderna's shot may offer better protection against hospitalization, but a possibility is that Mod- erna's vaccine dose is three times higher than Pfizer's and that there is a longer interval between shots, the Post reported. A smaller study conducted by Rochester, Minn.-based Mayo Clinic in August showed Moderna's shot was more effective than Pfizer's at preventing infections during the delta surge, the Post reported. Public health officials still urge the public to get whichever vaccine is available rather than wait to get a specific one, according to the Post. n Physician 'gold card' law to reduce prior authorization delays in Texas By Katie Adams A new Texas law took effect in September seeking to cut prior authorization delays by rewarding physicians with high prior authorization approval rates, according to the American Medi- cal Association. Under the law, physicians who have a 90 percent prior authorization approval rate over a six-month period on certain services are exempt from prior authorization requirements for those services. Their exemption is referred to as their "gold card." Since physicians with gold card status consistently meet prior authorization requirements for cer- tain services, state-regulated insurers won't delay care for those services. Gold carding is a prior authorization reform supported by numerous medical associations, including the American Medical Association, American Hospital Association, American Pharmacists Association and American Academy of Family Physicians. n

• Cover