Medicare

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|

Chronic Care Program Shows Early Encouraging Results

Medicare’s chronic care management program appears to be reducing the cost of caring for participants while improving their quality of life. The program, which pays physicians for non-face-to-face services they provided to coordinate care for their Medicare patients with at least two chronic medical conditions, was introduced in 2015. An analysis of its performance found that payments of up to $50 a month …improved patient satisfaction and adherence to recommended therapies, improved clinician efficiency, and decreased hospitalizations and emergency department (ED) visits. While Medicare paid roughly $52 million in chronic care management fees during the initial program period, the program [...]

iqtsupport2018-02-23T06:00:04-05:00February 23, 2018|Medicare|

Administration Slows Movement Toward Medicare Quality Payments

The Trump administration is slowing Medicare’s movement toward making greater use of quality in its payment system. The Obama administration’s goal of having 50 percent of Medicare payments made through a quality or alternative payment model by the end of 2018 now appears to be out of sight. Instead, the Centers for Medicare & Medicaid Services has partially canceled two bundled payment programs – one for joint replacement and another for cardiac rehabilitation programs – and announced that before introducing new programs it wants to take a closer look at the successes and failures of the alternative payment model programs [...]

iqtsupport2018-02-20T10:26:50-05:00February 20, 2018|Centers for Medicare & Medicaid Services, Medicare|

Lowering Prescription Drug Costs

Shifting Medicare Part B drug coverage into Medicare Part D. Reducing Medicare Part D co-pays for generic drugs. Increasing the number of pharmacy benefit managers. Establishing expedited review for new versions of brand-name drugs. Tying U.S. drug prices to prices paid for the same drugs in other countries. Using U.S. trade policies to compel other countries to pay more for American pharmaceutical products. These are among the ideas presented in a new report by the White House Council of Economic Advisers detailing steps that might be taken to reduce prescription drug prices in the U.S. To learn more about these [...]

iqtsupport2018-02-12T10:45:34-05:00February 12, 2018|Medicare|

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|

Safety-Net Hospitals Under the Gun

Safety-net hospitals across the country face a new challenge: adjusting to several cuts in the supplemental payments they receive from the federal government to help them serve the low-income residents of the communities in which they are located. First there is a $2 billion cut in Medicaid disproportionate share hospital payments (Medicaid DSH). These are payments made to hospitals that serve especially large numbers of low-income patients. These payments help safety-net hospitals with the unreimbursed expenses they incur caring for such patients. This cut, mandated by the Affordable Care Act but twice delayed by Congress, took effect on January 1. [...]

iqtsupport2018-01-19T06:00:18-05:00January 19, 2018|Affordable Care Act, hospitals, Medicaid, Medicare, Medicare cuts|

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|