iqtsupport, Author at DeBrunner & Associates

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C. The following is MACPAC’s own summary of the sessions. Hospital payment was a key focus of MACPAC’s January meeting with the Commission voting on Thursday to approve two sets of recommendations, the first addressing the structure of disproportionate share hospital (DSH) allotment reductions and the second directed to improving compliance with upper payment limit requirements. Both sets of recommendations are slated for inclusion in MACPAC’s March 2019 Report to Congress on Medicaid and CHIP. Later that morning, the Commission discussed a study on [...]

iqtsupport2019-01-31T06:00:32-05:00January 31, 2019|MACPAC, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid regulations|

Hospitals Sue Over Site-Neutral Outpatient Payment Policy

Nearly 40 hospitals have filed a joint lawsuit in opposition to the Centers for Medicare & Medicaid Services’ site-neutral payment policy for Medicare-covered outpatient services. In the suit, the hospitals charge the federal government with overstepping its authority in implementing such a change through regulation in the face of past congressional action to limit the use of site-neutral payments. Under its site-neutral payment policy, Medicare pays the same for some outpatient services regardless of where those services are provided. Under Medicare’s previous policy, Medicare paid more for services provided in hospital-run outpatient facilities. Hospitals argue that their outpatient facilities are [...]

iqtsupport2019-01-30T06:00:38-05:00January 30, 2019|Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare regulations, Medicare reimbursement policy|

Docs Still Less Likely to Treat Medicaid Patients

Medicaid patients continue to be last in line when it comes to finding doctors willing to serve them. At least that’s the conclusion drawn in a new analysis prepared by the Medicaid and CHIP Payment and Access Commission. According to a presentation delivered at a MACPAC meeting last week: Doctors are less likely to accept new Medicaid patients (70.8 percent) than they are patients insured by Medicare (85.3 percent) or private insurers (90 percent), with a much greater differential in acceptance rates among specialists and psychiatrists. Pediatricians, general surgeons, and ob/gyns have a higher acceptance rate of Medicaid patients than [...]

iqtsupport2019-01-29T13:00:57-05:00January 29, 2019|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission|

Hospitals Flee Downside Risk in Medicare Bundled Programs

More than half of the hospitals that voluntary participate in Medicare bundled payment model programs leave those programs when faced with the possibility of financial penalties based on their performance. So concludes a new report by the U.S. Government Accountability Office. Some of these models feature both “upside” and “downside” risk. Upside risk offers financial incentives to participants that keep their costs below targeted amounts; they share those savings with Medicare. Downside risk occurs when hospitals are penalized when their costs exceed agreed-upon targets. Some of the model programs begin with only upside risk and later move into both upside [...]

iqtsupport2019-01-29T06:00:06-05:00January 29, 2019|Alternative payment models, hospitals, Medicare|

No Medicaid Expansion=Greater Peril for Rural Hospitals

Rural hospitals located in states that did not expand their Medicaid programs, as authorized by the Affordable Care Act, are at much greater risk of closing than hospitals in states that did expand their Medicaid programs. According to a Stateline report, most of the 100 rural hospitals that have closed since 2010 and most of the more than 600 rural hospitals that are considered to be in danger of closing now are located in states like Texas, Mississippi, and 12 others that have not expanded their Medicaid programs. Small rural hospitals that have not closed serve large proportions of uninsured [...]

iqtsupport2019-01-28T06:00:27-05:00January 28, 2019|Affordable Care Act, hospitals, Medicaid|

MedPAC: Overhaul Medicare Quality Programs

Medicare would implement major changes in its hospital quality programs under a proposal approved by the Medicare Payment Advisory Commission. Fierce Healthcare reports that the proposal adopted by MedPAC for recommendation to Congress and the Centers for Medicare & Medicaid Services …would essentially lump together several existing programs that measure quality—the Hospital Readmissions Reduction Program, the Hospital Value-Based Purchasing Program and the Hospital-Acquired Condition Reduction Program—into the Hospital Value Incentive Program (HVIP). It would also eliminate the existing Inpatient Quality Reporting Program. Under the MedPAC proposal, Performance across five domains—readmissions, mortality, spending, patient experience and hospital-acquired conditions—would be converted to HVIP “points.” Those points would be [...]

iqtsupport2019-01-25T06:00:15-05:00January 25, 2019|Medicare, Medicare regulations, Medicare reimbursement policy|

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues. The issues on MedPAC’s December agenda were: The Medicare prescription drug program (Part D) Opioids and alternatives in hospital settings: payments, incentives, and Medicare data Hospital inpatient and outpatient services payments Redesigning Medicare’s hospital quality incentive programs Physicians and other health professional services payments Medicare payment policies for advanced practice registered nurses and physician assistants Ambulatory surgical centers and hospice payments Skilled nursing facilities, home health agency, and inpatient rehabilitation facilities payments Long-term care hospital services payments Outpatient dialysis payments Future [...]

iqtsupport2019-01-24T06:00:53-05:00January 24, 2019|Alternative payment models, hospitals, Medicare, Medicare post-acute care, MedPAC|

Proposed Public Charge Regulation Causes Confusion in Clinics, Elsewhere

A Trump administration proposal to redefine what constitutes a “public charge” is making life challenging for low-income immigrants and the clinics and other providers to which they turn for Medicaid-covered health care. The proposed regulation from the Department of Homeland Security would establish new criteria for determining whether a person is a “public charge,” based on their participation in certain public programs, and therefore in jeopardy of losing their legal immigration status. Some Medicaid patients who come to clinics ask if receiving Medicaid-covered services might jeopardize their legal immigration status; others fail to keep appointments or forego seeking care out [...]

iqtsupport2019-01-23T06:00:04-05:00January 23, 2019|Medicaid|

S&P: Stable 2019 for Non-Profit Hospitals

Non-profit hospitals should experience a relatively stable 2019, according to S&P Global Financial. The bond-rating company estimates that 81 percent of such hospitals will be stable this year, with roughly equal numbers of hospitals looking at upgrades and downgrades. This stability is being driven by strong balance sheets and diversification while challenges to hospital financial performance and stability include the possibility of a recession, rising costs for serving an aging population, changes in Medicaid eligibility and payment policies, and the continued emergence of non-traditional health care providers. S&P also concludes that hospital operating margins are recovering after years of investment [...]

iqtsupport2019-01-22T06:00:30-05:00January 22, 2019|hospitals|

Could Medicaid Buy-In Push Aside Medicare for All?

Officials in ten states are giving consideration, in one form or another, to permitting uninsured low-income residents to buy into their Medicaid programs. So while Washington considers the possibility of Medicare for all, the ten states – Nevada, New Mexico, California, Delaware, Oregon, Washington, Connecticut, Illinois, Minnesota, and Wisconsin – are tackling the many issues they must address if they intend to pursue such a ground-breaking option. Among them: Who would be eligible to participate? What benefits would be offered? Would health plans be available on Affordable Care Act health exchanges, and if so, would ACA subsidies be available to [...]

iqtsupport2019-01-21T06:00:06-05:00January 21, 2019|Medicaid|

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