Medicare

MedPAC Meets

Last week the Medicare Payment Advisory Commission held two days of public meetings in Washington, D.C. During the sessions MedPAC, a non-partisan legislative branch agency that advises Congress on Medicare payment issues, addressed the following subjects: a Medicare Advantage status report a Medicare prescription drug program (Part D) status report hospital inpatient and outpatient payments physician payments ambulatory surgical center, dialysis center, and hospice payments post-acute care facility payments the hospital readmissions reduction program telehealth accountable care organizations Go here to see the issue briefs and presentations used during the meetings.

iqtsupport2018-01-18T06:00:18-05:00January 18, 2018|Accountable Care Organization, ACO, Medicare, Medicare post-acute care, 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|

CMS Unveils New Bundled Payment Program

The Centers for Medicare & Medicaid Services has announced the launch of a new bundled payment model called “Bundled Payments for Care Improvement Advanced.” Under this new program – participation in which will be voluntary – participants can, as CMS explains …earn additional payment if all expenditures for a beneficiary’s episode of care are under a spending target that factors in quality. The following are a few highlights of BPCI Advanced. It encompasses 32 types of clinical episodes (29 inpatient and three outpatient). These episodes, of 90 days, may change in the future. Participating providers can waive the Medicare requirement [...]

iqtsupport2018-01-11T06:00:30-05:00January 11, 2018|Centers for Medicare & Medicaid Services, Medicare|

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|

Examining How Medicare Addresses Primary Care

As the country continues to struggle with a reported shortage of primary care physicians, Medicare, the country’s leading consumer of primary care services, continues to experiment with how best to pay for primary care and address the disparities in compensation between primary care doctors and specialists that has led to this shortage. In general, Medicare takes two approaches: introduce new billing codes that create incentives for primary care physicians to engage in – and get paid for – practices Medicare seeks or establish demonstration programs that facilitate the introduction of incentives for engaging in promising approaches to primary care delivery. [...]

iqtsupport2017-12-15T06:00:05-05:00December 15, 2017|Medicare|

House to Set Sights on Medicare, Medicaid Cuts in 2018

The House of Representatives will pursue entitlement spending cuts next year, House Speaker Paul Ryan recently explained on a radio program. That means Medicare, Medicaid, and possibly even Social Security. Ryan said that We're going to have to get back next year at entitlement reform, which is how you tackle the debt and the deficit... Frankly, it's the health care entitlements that are the big drivers of our debt, so we spend more time on the health care entitlements — because that's really where the problem lies, fiscally speaking. Learn more about Ryan’s remarks, the administration’s priorities, and what other members of Congress are saying [...]

iqtsupport2017-12-14T06:00:11-05:00December 14, 2017|Medicaid, Medicare, Medicare cuts|

MedPAC Meets

The Medicare Payment Advisory Commission met in Washington, D.C. last week. Among the issues on the agenda of the independent agency that advises Congress on Medicare payment issues were: payment adequacy for physicians and other health professional services An alternative to the merit-based incentive payment system (MIPS) payment adequacy for hospital inpatient and outpatient services payment adequacy for ambulatory surgical center services payment adequacy and improving the equity of payments for skilled nursing facility services payment adequacy for inpatient rehabilitation services payment adequacy for long-term-care hospital services payment adequacy for home health services payment adequacy for outpatient dialysis services payment [...]

iqtsupport2017-12-13T06:00:25-05:00December 13, 2017|hospitals, Medicare, MedPAC|

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|