iqtsupport, Author at DeBrunner & Associates

GAO Looks at Medicaid Managed Care Spending

The federal government should do more to help states ensure the accuracy and integrity of their payments to Medicaid managed care organizations and the payments those Medicaid managed care organizations make to health care providers. This is the conclusion reached in a new study of Medicaid managed care performed by the U.S. Government Accountability Office at the request of the Permanent Subcommittee on Investigations of the Senate Committee on Homeland Security and Government Affairs. The GAO study identified six payment risks among various transactions between state governments, Medicaid managed care organizations, and health care providers. The two biggest risks, the [...]

iqtsupport2018-07-31T10:00:57-04:00July 31, 2018|Medicaid managed care|

Supreme Court Nominee’s Health Care Views

How has Supreme Court nominee Brett Kavanaugh ruled in health care cases that have come before him? In a new review, the Commonwealth Fund examines Judge Kavanaugh’s past opinions on cases involving the Affordable Care Act, abortion and contraception, and Medicare entitlement. It also examines how Judge Kavanaugh approaches adjudicating the cases that come before him and his views on precedent, procedure, and executive and judicial authority. Learn more about the man who could soon join the Supreme Court in the Commonwealth Fund article “Examining Supreme Court Nominee Kavanaugh’s Health Care Opinions.”

iqtsupport2018-07-30T06:00:00-04:00July 30, 2018|Uncategorized|

New Reg Pushes Medicare Toward Site-Neutral Outpatient Payments

Medicare would make more payments for outpatient services on a site-neutral basis under a newly proposed regulation just released by the Centers for Medicare & Medicaid Services. The 2019 Medicare outpatient prospective payment system regulation, published in proposal form, calls for: paying physician fee schedule rates rather than hospital outpatient rates at excepted off-campus provider-based departments; slashing payments for office visits; extending this year’s 340B prescription drug discount payments, already cut nearly 30 percent this year, to additional providers; and raising ambulatory surgical center rates and expanding the list of procedures that can be performed in such facilities so they [...]

iqtsupport2018-07-27T06:00:18-04:00July 27, 2018|Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare regulations|

Proposal Would Equalize Medicare Physician Payments

All physicians would be paid equally for Medicare-covered office visits under a new proposal published recently by the Centers for Medicare & Medicaid Services. Under the proposed regulation, Medicare would collapse four levels of patient evaluation and management office visits, eliminate the extensive documentation required to justify the payments physicians seek, and pay one simple rate for office visits. CMS estimates that reducing the documentation requirements would save every doctor 51 hours a year. Some critics are concerned that specialists and those caring for especially ill or especially complex patients would be shortchanged by the proposed policy while others fear [...]

iqtsupport2018-07-24T06:00:47-04:00July 24, 2018|Centers for Medicare & Medicaid Services, Medicare, Medicare regulations|

Pay Raise Didn’t Lead More Docs to Participate in Medicaid

The temporary rate increase that the Affordable Care Act provided as means of encouraging more doctors to serve Medicaid patients did not work, according to two new studies published in the journal Health Affairs. According to the studies, the increase in the number of physicians who decided to begin serving Medicaid patients as a result of the fee increase was negligible. Among the reasons the studies’ authors offer for the lack of growth in the participation of doctors are the limited nature of the pay raise and the documentation required to receive it. Despite this, the authors note, access to [...]

iqtsupport2018-07-23T06:00:18-04:00July 23, 2018|Affordable Care Act, Medicaid|

CMS: Not Done With Medicaid Work Requirements

Despite the ruling of a federal court that Kentucky’s new Medicaid work requirement violates federal law, the Centers for Medicare & Medicaid Services has not ruled out approving future requests from state governments to impose work requirements on Medicaid recipients. Or so asserted CMS administrator Seema Verma at a recent health care event in Washington, D.C. The Washington Examiner reports that at that event, Verma said that We are looking at what the court said. We want to be respectful of the court’s decision while trying to push ahead with our policy and our goals. CMS currently has applications from [...]

iqtsupport2018-07-18T09:24:15-04:00July 18, 2018|Medicaid|

CMS Proposes Changes in Medicare Physician Payments

The Centers for Medicare & Medicaid Services has published a proposed regulation that it says …proposed historic changes that would increase the amount of time that doctors and other clinicians can spend with their patients by reducing the burden of paperwork that clinicians face when billing Medicare. The proposed rules would fundamentally improve the nation’s healthcare system and help restore the doctor-patient relationship by empowering clinicians to use their electronic health records (EHRs) to document clinically meaningful information instead of information that is only for billing purposes. Among the policy changes offered in the proposed 1743-page regulation governing Medicare physician [...]

iqtsupport2018-07-16T06:00:47-04:00July 16, 2018|Centers for Medicare & Medicaid Services, Medicare regulations|

New Policy Threatens Provider Payments in Missouri

Health care providers that fail to join the provider networks of Missouri Medicaid managed care plans will see their Medicaid payments cut 10 percent by the state under a new state policy. The purpose of the policy, according to the state, is to encourage hospitals and physicians to join the provider networks of three managed care plans that serve more than 700,000 residents of the state. Providers, on the other hand, say this policy will discourage them from serving Medicaid patients at all and will detract from their ability to negotiate reasonable rates with the state’s three Medicaid managed care [...]

iqtsupport2018-07-11T06:00:15-04:00July 11, 2018|Uncategorized|

Medicaid Managed Care Plans Suffer High Physician Turnover

The physician networks developed by Medicaid managed care plans suffer from a degree of turnover that threatens continuity of care for their members. While the number of Medicaid managed care plans using so-called narrow networks of providers declined by more than a third between 2010 and 2015, physician turnover is higher in those narrow network plans: three percentage points higher after one year and 20 percentage points higher after five years than the networks of plans that do not employ narrow networks. Collectively, Medicaid managed care plans experienced physician turnover of 12 percent a year from 2010 to 2015. Learn [...]

iqtsupport2018-07-10T06:00:28-04:00July 10, 2018|Medicaid, Medicaid managed care|

Comprehensive Primary Care Initiative Showing Mixed Results

The federal Comprehensive Primary Care Initiative is achieving some of its objectives but not others, according to a new Health Affairs study. The program, according to the Center for Medicare and Medicaid Innovation, seeks to use five means – risk-stratified care management, improved access to and continuity of care, planned care for chronic conditions and preventive care, patient and caregiver engagement, and coordination of care – to “achieve improved care, better health for populations, and lower costs, and can inform future Medicare and Medicaid policy.” According to the Health Affairs study, the program is achieving some of these objectives. CPC [...]

iqtsupport2018-07-09T06:00:24-04:00July 9, 2018|Center for Medicare and Medicaid Innovation|

admin

About iqtsupport