Medicare

MedPAC Weighs in on Proposed Medicare Payment Changes

The Medicare Payment Advisory Commission has submitted formal comments to the Centers for Medicare & Medicaid Services in response to the latter’s publication of a proposed regulation that would govern how Medicare will pay for acute-care hospital inpatient services and long-term hospital care in the coming 2020 fiscal year. The 14-page MedPAC report addresses four aspects of the proposed Medicare payment regulation: inpatient- and outpatient drug- and device related payment proposals proposed changes in the hospital area wage index the reporting of hospitals’ uncompensated care on the Medicare cost report’s S-10 worksheet the long-term hospital prospective payment system MedPAC is [...]

iqtsupport2019-06-26T06:00:55-04:00June 26, 2019|Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare regulations, MedPAC, post-acute care|

Surprise! Teaching Hospitals Cost Less Than Non-Teaching Hospitals

30-day and episode-of-care costs are lower for care provided by major teaching hospitals than they are for other teaching hospitals and non-teaching hospitals. Or so concludes a new study published by JAMA Open Network. According to the study: Major teaching hospitals’ initial hospitalization costs are higher. Major teaching hospital costs are less than other hospitals after 30 days of care and over entire episodes of care. Major teaching hospitals’ costs are similar to those of other teaching hospitals and non-teaching hospitals over a 90-day episode of care. Major teaching hospitals’ patients incurred lower costs for post-acute care. Major teaching hospitals [...]

iqtsupport2019-06-13T06:00:38-04:00June 13, 2019|hospitals, Medicare|

CMS Outlines Improvements in RAC Audit Processes

In the face of complaints from hospitals about backlogs, time-consuming procedures, and lengthy appeals processes involving Medicare Recovery Audit Contractor audits, the Centers for Medicare & Medicaid Services recently outlined changes it has implemented in the RAC audit process to address these and other concerns. They are (in CMS's own words): Better Oversight of RACs We are holding RACs accountable for performance by requiring them to maintain a 95% accuracy score. RACs that fail to maintain this rate will receive a progressive reduction in the number of claims they are allowed to review. We also require RACs to maintain an [...]

iqtsupport2019-05-09T06:00:15-04:00May 9, 2019|Centers for Medicare & Medicaid Services, Medicare|

Are Savings Baked Into Medicare Advantage?

Medicare Advantage plans spend less for their members’ care than traditional Medicare – even when beneficiaries switch from traditional Medicare to a Medicare Advantage plan. This spending trend, moreover, applies to all types of Medicare beneficiaries, even after risk adjustment, regardless of age, gender, or dual-eligibility. It even applies to beneficiaries with chronic medical conditions, according to a recent study. Why the difference? The study’s authors suggest “favorable self-selection.” Past studies have suggested that Medicare Advantage plans’ care management components are responsible for reduced costs but this study casts that theory in doubt. Another theory is that the provider networks [...]

iqtsupport2019-05-08T13:00:45-04:00May 8, 2019|Medicare|

Mandatory Payment Models Coming to Medicare?

Even as CMS rolls out new, voluntary Medicare alternative payment models, it is contemplating making participation in future models mandatory rather than voluntary, as is currently the case. Or so Centers for Medicare & Medicaid Services administrator Seema Verma told a gathering in Baltimore last week. At the heart of the idea, Verma told her audience, is that while CMS is pleased with participation in voluntary accountable care organization models, organizations are choosing to participate in ACO models they think would benefit them most while posing little or no downside financial risk. The agency may need to move away from [...]

iqtsupport2019-05-02T06:00:59-04:00May 2, 2019|Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Medicare, Medicare reimbursement policy|

Adverse Selection May Explain Rising ACO Costs

Hospital ACO costs are rising because of the sicker patients they attract, a new study suggests. According to researchers at University of Wisconsin Health, patients served by traditional Medicare or by physician-led accountable care organizations often switch to hospital-led Medicare ACOs as they encounter health problems, bringing those hospital-led ACOs sicker patients than those otherwise served by such organizations. As a result, the per patient costs of hospital-led Medicare ACOs often rise more than those of the costs of traditional Medicare and physician-led ACOs. Often, these shifts are encouraged by patients’ medical specialists. Hospital-led Medicare ACOs have been criticized for [...]

iqtsupport2019-04-29T10:11:51-04:00April 29, 2019|Accountable Care Organization, ACO, Alternative payment models, Medicare|

Readmissions Program Changes Produce New Outcomes

Many hospitals are faring better under Medicare’s hospital readmissions reduction program since changes in that program were implemented earlier this fiscal year. According to a new study, safety-net, academic, and rural hospitals have enjoyed improved performance under the program since Medicare began organizing hospitals into peer groups based on the proportion of low-income patients they serve rather than simply comparing individual hospital performance to that of all other hospitals. While the current fiscal year is still under way, it appears that safety-net hospitals will enjoy a collective decline of $22 million in Medicare readmissions penalties while 44.1 percent of teaching [...]

iqtsupport2019-04-26T06:00:35-04:00April 26, 2019|Medicare, Medicare regulations, Medicare reimbursement policy|

CMS Posts Proposed FY 2020 Inpatient Regulation

Medicare would change its wage index system, raise inpatient fees, increase funding for Medicare disproportionate share hospital payments (Medicare DSH), enhance payments for new technologies, and make minor modifications in its hospital readmissions reduction, value-based purchasing, and hospital-acquired condition program if a proposed regulation published this week is ultimately adopted. The Centers for Medicare & Medicaid Services has published its proposed FY 2020 Medicare inpatient prospective payment system regulation: its plan for paying acute-care hospitals for Medicare-covered inpatient services in FY 2020. The 1800-page regulation calls for major changes in Medicare’s wage index system – changes CMS says would “…address [...]

iqtsupport2019-04-25T06:00:11-04:00April 25, 2019|Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy|

Primary Care Accounts for Little Medicare Spending

Spending for primary care services accounts for only about two percent of Medicare fee-for-service spending, a new study has found. Even when the concept of primary care is expanded to include services provided by nurse practitioners, physician assistants, geriatricians, and gynecologists, all of whom bill for primary care services, that figure rises only to 4.88 percent. The proportion of primary care spending falls as Medicare beneficiaries age, a reflection of their greater consumption of specialist, hospital, and surgical care as they get older. Primary care spending was even lower among Medicare-eligible African-American, Native American, Medicaid-eligible seniors, and individuals with chronic [...]

iqtsupport2019-04-24T06:00:20-04:00April 24, 2019|Medicare|

Medicare Advantage Permitted to Address Non-medical Needs

Starting in 2020, Medicare Advantage plans will be permitted to provide non-medical benefits to their chronically ill members. As described in the Centers for Medicare & Medicaid Services’ “final call letter’ for 2020, MA [Medicare Advantage] plans are not prohibited from offering an item or service that can be expected to improve or maintain the health or overall function of an enrollee only while the enrollee is using it. In other words, the statute does not require that the maintenance or improvement expected from an SSBCI [special supplemental benefits for the chronically ill] result in a permanent change in an [...]

iqtsupport2019-04-16T06:00:54-04:00April 16, 2019|Medicare|