Medicare regulations

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|

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|

Readmissions Program Working; Expansion in Order?

The Medicare hospital readmissions reduction program is working, according to the Medicare Payment Advisory Commission. And it may even be worth expanding to additional medical conditions, MedPAC members believe. According to MedPAC, hospital readmissions among patients with medical conditions covered by the readmissions reduction program have declined faster than readmissions among patients with medical conditions not covered by the program, suggesting that expanding the program to additional medical conditions could lead to an even greater reduction in the number of avoidable Medicare-covered readmissions. Learn more about changes in the readmission rate since the readmissions reduction program was introduced and whether [...]

iqtsupport2018-03-07T06:00:23-05:00March 7, 2018|Medicare, Medicare regulations, MedPAC|

MedPAC Meets

The Medicare Payment Advisory Commission, which advises Congress on Medicare payment issues, met last week in Washington, D.C. Among the issues on MedPAC’s agenda were: paying for sequential stays in a unified Medicare payment system for post-acute care encouraging Medicare beneficiaries to use higher-quality post-acute care providers using payment policy to ensure appropriate access to and use of hospital emergency department services the Centers for Medicare & Medicaid Services’ financial alignment demonstration for dual-eligible beneficiaries the effectiveness of the Medicare hospital readmissions reduction program population-based quality measures such as preventable admissions and home and community days Go here, to MedPAC’s [...]

iqtsupport2018-03-05T06:00:23-05:00March 5, 2018|Medicare, Medicare post-acute care, Medicare regulations, MedPAC|

Lay Outreach Workers Reduce Readmissions

A community hospital in Kentucky has found that employing lay outreach workers to assist patients recently discharged from the hospital can significantly reduce hospital readmissions. In a research project, the hospital identified high-risk patients and, upon their discharge from the hospital, assigned lay outreach workers to help those patients with matters such as providing transportation, assisting during follow-up medical appointments, and navigating the health care system. With this help, the hospital experienced a 48 percent reduction in 30-day readmissions. While the hospital needed to spend money to employ the outreach workers, the effort reduced its likelihood of being assessed penalties [...]

iqtsupport2018-02-28T06:00:39-05:00February 28, 2018|Medicare, Medicare regulations|

Docs Not Scoring Performance Bonuses

Relatively few physicians will receive Medicare pay-for-performance bonuses under Medicare’s value-based modifier program in 2018. The question now is whether this is because of uninspiring performance or indifference to the program. Of the approximately 1.1 million clinicians who participate in Medicare, only two percent – 22,000 – will receive pay increases in 2018 based on their 2016 performance. Those raises will range from 6.6 percent to 19.9 percent. Most doctors will receive neither bonuses nor penalties. And roughly 300,000 failed to submit the data required by the program. In the past they would have been penalized for this failure but [...]

iqtsupport2018-01-25T06:00:16-05:00January 25, 2018|Medicare, Medicare regulations, MedPAC|

E&C Calls for Action on 340B

The section 340B prescription drug program has flaws and needs change, a report by the House Energy and Commerce Committee has concluded. The program, which requires pharmaceutical companies to provide discounts on prescription drugs to be dispensed on an outpatient basis to qualified providers that serve large numbers of low-income patients, has been controversial in recent years. As the number of providers eligible for the program has grown, pharmaceutical companies have claimed that the program is expensive, is being abused, and is responsible for driving up prescription drug costs while providers insist that 340B is a vital tool in helping [...]

iqtsupport2018-01-12T06:00:38-05:00January 12, 2018|Centers for Medicare & Medicaid Services, Medicare, Medicare regulations|

Reduced Hospitalizations and Improved Care for High-Risk Patients Not Driving ACO Savings

Medicare savings reported in the early years of the Medicare Shared Savings Program are not coming from reduced hospitalizations of high-risk Medicare patients or even through better coordination of care for those patients. Instead, Medicare accountable care organization savings are coming mostly from better and more coordinated care for low-risks Medicare ACO participants. These surprising findings are reported in the article “Medicare ACO Program Savings Not Tied To Preventable Hospitalizations Or Concentrated Among High-Risk Patients,” which can be found in the December 2017 edition of the journal Health Affairs. Find a link to that article here.

iqtsupport2017-12-19T06:00:35-05:00December 19, 2017|Accountable Care Organization, ACO, Medicare, Medicare regulations|

Hospitals, Trade Groups Differ on Supervision Requirements

According to provider representatives and trade groups, the requirement that physicians supervise the administration of outpatient therapeutic services to Medicare patients in critical access and small rural hospitals is onerous and could limit patient access to such services. The people who run those hospitals don’t agree. That is the conclusion reached by the Medicare Payment Advisory Commission, which looked into the matter after Congress overturned a Centers for Medicare & Medicaid Services supervision requirement in the 21st Century Cures Act because, as MedPAC observed, CAH and rural hospital representatives…expressed concerns that, because they have difficulty recruiting physicians to practice in [...]

iqtsupport2017-12-12T06:00:08-05:00December 12, 2017|Medicare, Medicare regulations|