iqtsupport, Author at DeBrunner & Associates

More Hospitals Gain Than Lose in FY 2020 Value-Based Purchasing Program

Medicare’s value-based purchasing program will reward more hospitals than it will penalize in FY 2020 through its value-based purchasing program. The program, in which 2700 hospitals are scored in four domains – clinical outcomes, safety, person and community engagement, and efficiency and cost reduction – will distribute $1.9 billion in bonus payments to 1500 hospitals. Bonus payment average 0.6 percent, with a high of 2.93 percent. Penalties average -0.39 percent, with a high of -1.72 percent. Overall, rural hospitals performed better in the safety, person and community engagement, and efficiency and cost reduction categories and had a higher average score [...]

iqtsupport2019-10-30T15:15:04-04:00October 30, 2019|hospitals, Medicare, Medicare reimbursement policy|

Tools for Controlling Cost Growth Limited

Employers and insurers sometimes have limited means of reducing growth in health care costs, a new study has found. While hospitals can take incremental steps to manage rising costs, those efforts will be outstripped in geographic markets that have undergone a great deal of consolidation, according to a new analysis from the Georgetown University Health Policy Institute. In areas of such consolidation, the study found, insurers can be reluctant to negotiate hard with hospitals and health systems or to threaten to exclude those providers from their networks and businesses, rather than backing insurers or pressuring providers, are more likely to [...]

iqtsupport2019-10-30T06:00:25-04:00October 30, 2019|hospitals|

Hospitals Advocate Losing Chargemaster

Hospitals would no longer need to post their chargemaster prices under a new approach to Medicare payments being advocated by a new hospital lobbying group. The small group, calling itself the Chargemaster Alternatives for Medicare Payment Alliance, wants Medicare to eliminate payment formulas based on chargemaster prices and base them instead on actual costs. Acting in response to a new proposal that hospitals be required to post their chargemaster prices, the group argues that chargemaster prices are irrelevant for all but a few consumers. Learn more about the group, its members, and its argument for ending use of chargemaster prices [...]

iqtsupport2019-10-28T06:00:54-04:00October 28, 2019|Medicare, Medicare reimbursement policy|

It’s Hospitals’ Turn to Sue Opioid Makers

Hospitals are now joining cities and states in suing opioid makers for the financial damages their products have caused. In Arizona, Florida, Kentucky, Mississippi, Tennessee, Texas, and West Virginia, hundreds of hospitals are now suing opioid makers in state courts to seek compensation for the unreimbursed costs they incurred caring for uninsured patients who came to them suffering from overdoses and addiction. For the most part, the most prominent hospitals and health systems in these states have not joined the suits. According to court documents, the suing hospitals estimate that it cost them an average of $107,000 to treat complicated [...]

iqtsupport2019-10-26T06:00:04-04:00October 26, 2019|hospitals|

Use of APMs, Value-Based Payments Continues to Increase

Payments based on alternative payment models and value-based measures continue to play a larger role in health care reimbursement. Almost 36 percent of health care payments involved APMs in 2018. In addition, fee for service accounted for 39 percent of payments. While these figures represent both represent increases over 2017, the rate at which they are growing has slowed. With APMs, one of the challenges is that providers have yet to come to terms with downside risk, which is required under some models. Medicare Advantage plans are especially advanced in adopting new approaches, with 53.6 percent of their payments tied [...]

iqtsupport2019-10-25T06:00:47-04:00October 25, 2019|Alternative payment models|

Number of Uninsured Children on the Rise

The number of children insured by Medicaid and CHIP has fallen by more than one million over the past two years after reaching an all-time low (by percentage) in 2016. Why? According to the New York Times, Some state and federal officials have portrayed the drop — 3 percent of enrolled children — as a success story, arguing that more Americans are getting coverage from employers in an improving economy. But there is growing evidence that administrative changes aimed at fighting fraud and waste — and rising fears of deportation in immigrant communities — are pushing large numbers of children [...]

iqtsupport2019-10-23T06:00:06-04:00October 23, 2019|Medicaid|

Court Upholds Delay of Site-Neutral Payment Cut

Medicare cannot proceed with its plan to pay for outpatient care on a site-neutral basis while it appeals a court ruling rejecting that policy, a federal court has ruled. A federal judge found that Medicare has not articulated an adequate reason to delay the $380 million a year in site-neutral payment cuts while the Centers for Medicare & Medicaid Services appeals the September decision rejecting the payment policy change. The court also found that, contrary to CMS’s claim, Medicare still has an appropriate methodology for making payments that are not site-neutral and that the agency has not proved that it [...]

iqtsupport2019-10-22T06:00:38-04:00October 22, 2019|Centers for Medicare & Medicaid Services, Medicare, Medicare reimbursement policy|

Grassley Questions Aspects of Graduate Medical Education

Graduate medical education is the subject of inquiry in a recent letter from Senate Finance Committee chairman Charles Grassley to Health and Human Services Secretary Alex Azar. In his letter to Secretary Azar, Senator Grassley asks for information about how federal GME money is spent and how much is spent, how federal money factors into the broader financing of hospital residency programs, and how the federal government ensures that GME programs engage in best practices. The letter also questions whether the indirect benefits of operating medical education programs are factored into how much the federal government spends on medical education, [...]

iqtsupport2019-10-21T06:00:09-04:00October 21, 2019|Medicare|

Immigrants Intimidated by New Public Charge Guidelines?

Immigrants served by community health centers appear less inclined than in the past to seek public aid to help them with their medical problems. And community health center staff believes this is the result of confusion and fear as a result of changing federal immigration policies. As stated in the Kaiser Family Foundation issue brief “Impact of Shifting Immigration Policy on Medicaid Enrollment and Utilization of Care among Health Center Patients,” Health centers reported that, in recent months, immigrant patients have declined to enroll or reenroll themselves and/or their children in Medicaid for fear of public charge. Health center respondents [...]

iqtsupport2019-10-16T06:00:49-04:00October 16, 2019|Medicaid, Medicaid regulations|

No Primary Doc Shortage for Medicare Patients – at Least Not Yet

Medicare patients currently have adequate access to primary care physicians, according to the Medicare Payment Advisory Commission. But that could change in the near future, MedPAC warns. Amid long-term concerns about whether there are enough primary care doctors, a new MedPAC report found that there are even fewer primary care doctors than most people believe. MedPAC reached this conclusion after finding that approximately one out of every five doctors thought to be working as primary care physicians now labor instead as hospitalists. As a result, growth in the number of primary care physicians has been negligible during the current decade. [...]

iqtsupport2019-10-09T06:00:54-04:00October 9, 2019|Medicare, MedPAC|

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