iqtsupport, Author at DeBrunner & Associates

“Oh Say Can We See?”: Ways & Means Leaders Seek CMMI Transparency

The chairman and ranking member of the House Ways and Means Committee have written to CMS administrator Seema Verma to ask her to address the lack of transparency in the Center for Medicare and Medicaid Innovation. In the bipartisan letter, committee chairman Richard Neal (D-MA) and ranking member Kevin Brady (R-TX) note that “…Congress established CMMI to test different innovative delivery system and payment models to improve quality and reduce costs for Medicare and Medicaid beneficiaries” but observe that “…significant policy changes made unilaterally by the executive branch without sufficient transparency could yield unintended negative consequences for beneficiaries and the [...]

iqtsupport2019-01-18T06:00:19-05:00January 18, 2019|Center for Medicare and Medicaid Innovation|

New ACO Incentive: Exemption From 3-Day Stay SNF Requirement

In an effort to encourage more Medicare accountable care organizations to assume financial risk for the care of their patients, the Centers for Medicare & Medicaid Services is extending its exemption from the three-day inpatient stay requirement before Medicare ACOs can discharge their patients to skilled nursing facilities to ACOs participating in selected ACO model programs that involve two-sided risk under preliminary prospective assignment with retrospective reconciliation. This move expands the waiver from the three-day SNF requirement that ACOs that assume greater financial risk already receive. Details about the new policy, including the ACO models that qualify for this exemption [...]

iqtsupport2019-01-17T06:00:00-05:00January 17, 2019|Accountable Care Organization, ACO, Alternative payment models, Medicare, Medicare reimbursement policy|

End Run Around Congress for Medicaid Block Grants?

The Trump administration reportedly is considering introducing Medicaid block grants through regulations rather than legislation, according to published reports. Those reports explain that the administration may seek to offer states an opportunity to apply to the federal government to use Medicaid block grants by obtaining section 1115 Medicaid waivers, a commonly used tool for states seeking exemptions from federal legislative or regulatory requirements. As reported by the online publication The Hill, …the Trump administration is now considering issuing guidance to states encouraging them to apply for caps on federal Medicaid spending in exchange for additional flexibility on how they run [...]

iqtsupport2019-01-16T06:00:01-05:00January 16, 2019|Centers for Medicare & Medicaid Services, Medicaid|

New Client

DeBrunner & Associates is pleased to welcome our newest client: AristaCare Health Services, a provider of post-acute rehabilitation, memory care, and long-term-care services based in Cranford, New Jersey. Welcome!

iqtsupport2019-01-15T06:00:07-05:00January 15, 2019|Uncategorized|

Readmissions Reduction Program Results Overstated?

A new study suggests that the encouraging results of Medicare’s hospital readmissions reduction program may not actually be as encouraging as people thought. According to a new study published in the journal Health Affairs, data on reduced readmissions may be more the result of changes in hospital coding practices than improved quality performance by hospitals. The report suggests that new industry standards for reporting were implemented at roughly the same time Medicare launched the value-based purchasing program and may account for most or even all of the reported improved performance by hospitals. Learn more from the Health Affairs study “Decreases [...]

iqtsupport2019-01-14T06:00:42-05:00January 14, 2019|Medicare, Medicare reimbursement policy|

Hospital Uncompensated Care Unchanged in 2017

Despite a modest increase in the uninsured rate, hospital uncompensated care in 2017 was $38.4 billion, essentially the same as it was in 2016 and down from the all-time high of $46.8 billion in 2013. This comes from an American Hospital Association survey that also found that in 2017, hospital admissions and inpatient days rose modestly hospital outpatient visits and surgeries increased emergency room visits declined the proportion of for-profit hospitals declined the number of rural hospitals fell Learn more in the Healthcare Dive article “Uncompensated care costs flat in 2017 despite uptick in uninsured.”

iqtsupport2019-01-11T06:00:13-05:00January 11, 2019|hospitals|

Medicaid MCOs Skimping on Care?

Medicaid MCOs may be skimping on care, according to a recent Kaiser Health News report. According to Kaiser, for-profit companies that sub-contract with Medicaid managed care organizations to review requests for services often deny care to Medicaid patients to save money for the MCOs that employ them and to benefit themselves financially. The Kaiser article presents examples of companies that have been identified engaging in such practices, explains how they go about their work, and outlines the dangers to Medicaid recipients posed by such practices. Learn more in the Kaiser Health News article “Coverage Denied: Medicaid Patients Suffer As Layers [...]

iqtsupport2019-01-09T14:43:28-05:00January 9, 2019|Medicaid managed care|

CMS Revamps Medicare ACO Program

The federal government seeks to pursue greater savings and an accelerated approach to value-based care through an overhaul of its programs for Medicare accountable care organizations. The Centers for Medicare & Medicaid Services’ new “Pathways to Success” program seeks to speed up the process of providers assuming risk for costs and outcomes through the following changes from the agency’s current approach. A reduction in how long participating ACOs can remain in the program without assuming some responsibility for their spending. Modifications that CMS hopes will encourage physician groups to remain independent of hospitals and health systems. Greater flexibility to innovate [...]

iqtsupport2018-12-31T06:00:14-05:00December 31, 2018|Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Medicare regulations, Medicare reimbursement policy|

Readmissions Program Failing Some Heart Patients?

The 30-day mortality rate has risen for heart failure patients since Medicare’s hospital readmission reduction program was implemented. According to a new study published in JAMA, the 30-day mortality rate for heart failure patients rose 0.49 percent between 2007-2010 and 2010-2012 and another 0.52 percent between 2010-2012 and 2012-2015. Similar results were not found for the other types of patients whose readmission rates are measured under the program: patients who were hospitalized for heart attacks, heart bypass surgery, pneumonia, chronic obstructive pulmonary disease, and hip or knee replacement. The heart failure findings, though, raise the question of whether performance under [...]

iqtsupport2018-12-28T06:00:49-05:00December 28, 2018|Medicare regulations, Medicare reimbursement policy|

CMS to Create New Office for Regulatory Reform

In 2019 the Centers for Medicare & Medicaid Services intends to create a new office to address regulatory reform. CMS administrator Seema Verma recently announced her intention to create this office, but other than saying its priority would be to reduce regulatory burden, offered no details. See a brief notice about the new office here.

iqtsupport2018-12-26T09:51:55-05:00December 26, 2018|Centers for Medicare & Medicaid Services, Medicaid regulations, Medicare regulations|

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