Medicare regulations

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|

CMS Publishes Quality Measures Under Consideration for 2018

The Centers for Medicare & Medicaid Services has published a list of quality measures it is considering implementing in Medicare quality programs in the coming year. The list consists of 32 proposed measures, down significantly from the nearly 100 it proposed last year. These measures are subject to comment by the National Quality Forum and stakeholders. Go here to see a commentary from CMS explaining what it hopes to accomplish and how it is pursuing those goals and go here to see a CMS document presenting the 32 proposed quality measures.

iqtsupport2017-12-06T06:00:01-05:00December 6, 2017|Medicare, Medicare regulations|

The Battle Over 340B

Hospitals and other health care providers say it is an essential tool in ensuring access to care, and to prescription drugs, for their low-income patients. Pharmaceutical companies say it has expanded beyond its original purpose and is being used by hospitals to pad their profits. Members of Congress are divided: some are supportive and some are skeptical. The section 340B program that requires drug companies to provide discounts to selected hospitals and other providers that serve large numbers of low-income patients has been the subject of controversy in recent years. During that time, the administration has generally sided with hospitals [...]

iqtsupport2017-11-30T06:00:01-05:00November 30, 2017|Medicare, Medicare regulations|

Telehealth on the Upswing

A number of recent developments suggest that serving patients with the assistance of telehealth services will become more commonplace in the near future. The Medicare MACRA and MIPS payment programs will include new billing codes for telehealth services, according to regulations published earlier this month. Also earlier this month, the House passed legislation, The Vets Act (H.R. 2123), that would authorize the Veterans Administration to make greater use of telehealth. And when the U.S. Department of Health and Human Services’ Office of the Inspector General recently announced plans to audit Medicaid programs for telehealth payments, it cited among its reasons [...]

iqtsupport2017-11-28T06:00:17-05:00November 28, 2017|Medicaid, Medicare, Medicare regulations|

340B Changes Would Hurt Hospital Margins

Proposed changes in the federal section 340B prescription drug discount program would hurt hospital margins. So says Moody’s Investors Service, the credit rating agency. According to Moody’s, the margins of non-profit hospitals are already under pressure because revenue increases are not keeping pace with prescription drug costs. Reductions of payments under the 340B program recently proposed by the Centers for Medicare & Medicaid Services would make a challenging situation worse, Moody’s speculates. Under the 340B program, eligible hospitals purchase prescription drugs at a discount, supply them to eligible outpatients, and use the savings they gain to provide additional services and [...]

iqtsupport2017-10-09T06:00:51-04:00October 9, 2017|Medicare, Medicare cuts, Medicare regulations|

MedPAC Comments on Proposed Physician Fee Schedule

The Medicare Payment Advisory Commission has written to the Centers for Medicare & Medicaid Services to convey its views on CMS’s proposed revisions to Medicare physician payment policies for 2018. Among the issues MedPAC addresses in its comment letter are proposed payments to physicians for nonexcepted items and services provided in nonexcepted off-campus provider-based hospital departments, the Medicare shared savings program, and the Medicare diabetes prevention program. See CMS’s comment letter here.

iqtsupport2017-09-12T06:00:52-04:00September 12, 2017|Centers for Medicare & Medicaid Services, Medicare, Medicare regulations, MedPAC|