iqtsupport, Author at DeBrunner & Associates

MedPAC Mulls Uniform Outcome Measures to Complement Unified Post-Acute Payments

In support of its proposal that Medicare adopt a unified payment system for post-acute-care services, the Medicare Payment Advisory Commission is exploring how to develop uniform outcome measures to support such a new payment system. Under the MedPAC vision, articulated at its early April public meeting, skilled nursing facilities, home health agencies, long-term-care hospitals, and inpatient rehabilitation facilities would see their outcomes quantified based on their performance on a series of quality measures. Meanwhile, there has been little congressional interest in the unified post-acute payment proposal so far. While some aspects of such a proposal could be implemented administratively, the [...]

iqtsupport2018-04-18T06:00:59-04:00April 18, 2018|Medicare, Medicare regulations, MedPAC, post-acute care|

MedPAC to Congress: Cut Payments to Freestanding Emergency Facilities

The Medicare Payment Advisory Commission has urged Congress to reduce Medicare payments to freestanding emergency departments 30 percent. The recommendation, approved by MedPAC earlier this month and to be included in its June report to Congress, notes that such facilities have a lower cost structure because they typically lack some of the equipment, personnel, and standby capabilities of hospital ERs. In making its recommendation, MedPAC also noted that freestanding ERs typically treat patients whose conditions are not as severe as hospital ERs and tend to be located in areas that already have adequate access to hospital ERs. While MedPAC’s recommendations [...]

iqtsupport2018-04-17T13:33:12-04:00April 17, 2018|hospitals, Medicare regulations, MedPAC|

MedPAC Meets

The Medicare Payment Advisory Commission met last week in Washington, D.C. to address a number of Medicare reimbursement-related issues. Among the subjects on MedPAC’s agenda were: using payments to ensure appropriate access to and use of hospital emergency department services uniform outcome measures for post-acute care applying MedPAC’s principles for measuring quality: hospital quality incentives Medicare coverage policy and use of low-value care long-term issues confronting Medicare accountable care organizations managed care plans for dual-eligible beneficiaries While MedPAC’s policy and payment recommendations are not binding on Congress or the administration, its views are respected and influential and often become the [...]

iqtsupport2018-04-09T06:00:21-04:00April 9, 2018|Accountable Care Organization, Medicare, Medicare post-acute care, Medicare regulations, MedPAC|

Medicaid is Toughest Insurer for Providers

Medicaid is the hardest insurer for providers when it comes to billing. Or so reports a new study published in the journal Health Affairs. According to this analysis, Medicaid claims take longer to file, are more likely to be rejected, more likely to be challenged, and take longer to be paid than Medicare and private insurance claims. While the biggest problem is Medicaid fee-for-service claims, even Medicaid managed care claims pose more problems than Medicare and private insurance claims. Learn more about the challenges providers face when working with Medicaid in the Health Affairs report “The Complexity Of Billing And [...]

iqtsupport2018-04-05T06:00:27-04:00April 5, 2018|Medicaid|

Eat! You’ll Feel Better

And maybe need to spend less on health care. That is the lesson learned from a program in Massachusetts that provided home delivery of food to dually eligible Medicare/Medicaid recipients who were struggling with their meals. In a limited experiment, selected individuals received home delivery of food: some received general meal deliveries while others received food tailored to their individual medical conditions. The purpose: address a major social determinant of health in this difficult-to-serve population. The result, according to a report published in the journal Health Affairs, was that Participants in the medically tailored meal program also had fewer inpatient [...]

iqtsupport2018-04-04T06:00:52-04:00April 4, 2018|Uncategorized|

Tackling Social Determinants of Health

The growing awareness of the impact of social determinants of health comes at a time when health care providers are assuming unprecedented degrees of risk for the health of their patients, leaving many providers wondering how best to invest resources that will meet both their own needs as well as the needs of their high-cost, high-need patients. A new document from the Commonwealth Fund, “Investing in social services as a core strategy for healthcare organizations: Developing the business case,” seeks to serve as a manual for providers seeking to move into this relatively new territory. The report takes providers through [...]

iqtsupport2018-03-28T13:48:33-04:00March 28, 2018|Uncategorized|

Senate Committee Looks at 340B Program

The Senate Health, Education, Labor, and Pensions Committee (HELP) held a hearing last week on the 340B prescription drug discount program. The hearing was prompted by complaints from pharmaceutical companies about the discounts they are required to provide to eligible providers and by concern that hospitals are insufficiently accountable for how they use the savings they derive from those discounts to serve their low-income patients. In addition, the Centers for Medicare & Medicaid Services recently reduced its Medicare payments to participating hospitals. During the hearing, Senate Republicans expressed support for the program but spoke of the need for greater transparency [...]

iqtsupport2018-03-22T06:00:56-04:00March 22, 2018|340b, hospitals|

MedPAC Issues 2018 Report to Congress

The Medicare Payment Advisory Commission has issued its 2018 report and recommendations to Congress. The report includes MedPAC’s recommendations for next year’s Medicare fee-for-service payments; a review of the Medicare Advantage and Medicare Part D programs, with recommendations; and a report telehealth required by the 21st Century Cures Act. For Medicare fee-for-service rates, MedPAC proposes: the inpatient and outpatient rate increases, physician and other health professional rate increases, and outpatient dialysis increase included under current law no increase for ambulatory surgical centers, long-term-care hospitals, and hospice providers no rate increase for skilled nursing facilities a five percent reduction of payments [...]

iqtsupport2018-03-21T06:00:04-04:00March 21, 2018|Medicare, MedPAC|

MACPAC Issues Annual Report, Recommendations to Congress

The Medicaid and CHIP Payment and Access Commission has published its annual report and recommendations to Congress. MACPAC’s report addresses three primary areas: Medicaid managed care, telehealth, and Medicaid disproportionate share payments (Medicaid DSH). With 80 percent of Medicaid beneficiaries now enrolled in managed care plans, MACPAC offers three major recommendations for improving Medicaid managed care efforts: permit states to require all of their Medicaid beneficiaries to enroll in a managed care plan extend Medicaid managed care section 1915(b) waivers from two to five years permit states to obtain waivers to waive freedom of choice and selective contracting restrictions MACPAC [...]

iqtsupport2018-03-20T06:00:31-04:00March 20, 2018|Medicaid, Medicaid managed care|

CMS Reports on Quality Measures Performance

The Centers for Medicare & Medicaid Services has published a new report detailing the progress of health care providers in meeting Medicare quality standards and improving their performance under those standards. The report, required every three years, focuses on 17 key indicators of quality in the delivery of health care as defined by 247 individual quality measures. The analysis found that: 670,000 patients improved their control of their blood pressure 510,000 fewer patients have poor control of their diabetes 12,000 fewer people died following hospitalization for a heart attack there were 70,000 fewer unplanned hospital readmissions nursing home residents suffered [...]

iqtsupport2018-03-19T06:00:39-04:00March 19, 2018|Medicare, Medicare regulations|

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