Medicare

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues. The issues on MedPAC’s September agenda were: context for Medicare payment policy the effects of Medicare Advantage “spillover” on Medicare fee-for-service spending and coding evaluation of the hospital readmissions reduction program examining the effects of competitive bidding for diabetes testing supplies and improving payment policies for DMEPOS products excluded from competitive bidding a value incentive program for post-acute-care providers Medicare indirect medical education (IME) policy, concerns, and considerations for revising MedPAC is an independent congressional agency that advises Congress on issues [...]

iqtsupport2019-09-12T09:50:13-04:00September 12, 2019|Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC|

Can Medicare Feed its Way Out of Some Readmissions?

Feeding some Medicare patients after they are discharged from the hospital could reduce readmissions and save taxpayers millions, a new study has concluded. According to the new Bipartisan Policy Center report Next Steps in Chronic Care: Expanding Innovative Medicare Benefits, providing a limited number of free meals to certain Medicare patients could eliminate nearly 10,000 readmissions a year and save more than $57 million. Participating patients would be those with more than one of a limited number of chronic medical conditions and the meals would be for one week only. According to the report, more than 575,000 Medicare beneficiaries would [...]

iqtsupport2019-07-31T06:00:03-04:00July 31, 2019|Medicare|

CMS Chief Criticizes Health Care Proposals

In an address to the Better Medicare Alliance 2019 Medicare Advantage Summit, Centers for Medicare & Medicaid Services Administrator Seema Verma criticized Medicare for All proposals, said Medicare “public option” proposals are no better, and called the Affordable Care Act a failure,. Verma also insisted that greater reliance on market forces would improve Medicare and Medicaid, said the 340B prescription drug program is harming the health care system, and called for a reduction of federal regulations that limit how and where people can receive care. She said reduced regulations have spurred hundreds of new plans to participate in the Medicare [...]

iqtsupport2019-07-23T10:10:59-04:00July 23, 2019|340b, Affordable Care Act, Centers for Medicare & Medicaid Services, Medicaid, Medicare, Medicare regulations|

HHS Launches New Quality Initiative

The evaluation, adoption, and streamlining of federal health care quality programs will be the objective of a new “quality summit” launched by the U.S. Department of Health and Human Services. In response to an executive order issued by the president, HHS has established the quality summit because, according to an HHS news release, A long-stated goal of the Trump Administration has been to shift our current government healthcare programs from paying for services and procedures to paying for better patient outcomes. We believe the best way to effect this shift is through greater transparency and a focus on quality outcomes [...]

iqtsupport2019-07-11T06:00:33-04:00July 11, 2019|Medicare|

Readmissions Higher for Medicare Advantage Patients

Medicare Advantage patients are more likely to be readmitted to the hospital for existing medical problems than participants in traditional Medicare, a new study has found. According to a report published in the Annals of Internal Medicine, Medicare Advantage patients suffering from acute myocardial infarction, congestive heart failure, and pneumonia were readmitted to hospitals because of those medical problems at slightly higher rates than patients served by traditional Medicare. Learn more from the Annals of Internal Medicine study “Hospital Readmission Rates in Medicare Advantage and Traditional Medicare: A Retrospective Population-Based Analysis” and the Healthcare Dive article “MA patients' readmission rates [...]

iqtsupport2019-07-01T06:00:15-04:00July 1, 2019|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|