Policy Updates

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 March agenda were: two Medicare payment strategies to improve price competition and value for Part B drugs: reference pricing and binding arbitration options for slowing the growth of Medicare fee-for-service spending for emergency department service. Medicare’s role in the supply of primary care physicians evaluating an episode-based payment system for post-acute care mandated report: changes in post-acute and hospice care following the implementation of the long-term care hospital dual payment rate structure MedPAC is an independent congressional [...]

iqtsupport2019-03-12T06:00:49-04:00March 12, 2019|Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC, post-acute care|

Feds Seek Input on Selling Health Insurance Across State Lines

Working to achieve an objective of reducing the cost of health insurance by encouraging the sale of health insurance policies across state lines, the Centers for Medicare & Medicaid Services has published a request for information seeking input from stakeholders and the public on how this might best be done. According to a CMS news release, the agency seeks … feedback on how states can take advantage of Section 1333 of the Patient Protection and Affordable Care Act, which provides for the establishment of a regulatory framework that allows two or more states to enter into a Health Care Choice [...]

iqtsupport2019-03-11T06:00:41-04:00March 11, 2019|Affordable Care Act, Centers for Medicare & Medicaid Services|

Surprise Medical Bills Lead Patients to Change Hospitals

Patients who receive surprise medical bills are more likely to change hospitals than those who do not, a new study has found. According to an analysis of behavior by obstetrics patients, …11 percent of mothers experienced a surprise out-of-network bill with their first delivery, and this was associated with an increase of 13 percent in the odds of switching hospitals for the second delivery, compared to mothers who did not experience a surprise bill. The study found that this switching often paid dividends for those who switched: Mothers who switched hospitals after a surprise out-of-network bill reduced their relative risk of receiving [...]

iqtsupport2019-03-08T06:00:41-05:00March 8, 2019|hospitals|

State to Experiment with Global Budgets for Rural Areas

The Commonwealth of Pennsylvania plans to launch an experiment in which participating health insurers will fund global budgets to care for residents served by selected rural hospitals. The program seeks to preserve access to care in rural parts of the state by stabilizing the financial health of struggling rural hospitals. According to a Pennsylvania Department of Health news release, The Rural Health Model is an alternative payment model, transitioning hospitals from a fee-for-service model to a global budget payment. Instead of hospitals getting paid when someone visits the hospital, they will receive a predictable amount of money. Payment for the [...]

iqtsupport2019-03-07T13:00:31-05:00March 7, 2019|Alternative payment models, hospitals, Pennsylvania|

Stark Changes Coming to Facilitate Value Care?

At a Washington, D.C. conference, Centers for Medicare & Medicaid Services Administrator Seema Verma announced that changes coming in Stark law requirements will enable Medicare to make better use of value-based purchasing in its reimbursement system. In addition to addressing cybersecurity and electronic health record system issues, changes in the anti-self-referral law will seek to facilitate better coordination of care for Medicare patients. Verma explained the underlying rationale for the anticipated changes, noting that …in a system where we’re transitioning and trying to pay for value, where the provider is ideally taking on some risk for outcomes and cost overruns, [...]

iqtsupport2019-03-07T06:00:54-05:00March 7, 2019|Centers for Medicare & Medicaid Services, Medicare, Medicare regulations, Medicare reimbursement policy|

Rural Nursing Homes Struggle With Challenges

Across rural parts of the country skilled nursing facilities are struggling, and growing numbers are faltering in the face of many problems. Among the challenges they face are: difficulty passing health and safety standards evolving health care policies that encourage people to remain in their homes instead of choosing to enter nursing homes growing proportions of patients covered by Medicaid the failure of Medicaid payments in many states to cover the cost of nursing home care These challenges are especially acute in rural areas. Today, many regions have enough skilled nursing beds, at least on paper, but they are not [...]

iqtsupport2019-03-06T06:00:27-05:00March 6, 2019|Medicaid, post-acute care|

800 Hospitals Face Medicare Penalties

800 hospitals will see their Medicare payments reduced one percent this year because they are among the 25 percent of hospitals in the U.S. with the highest rate of hospital-acquired conditions. Among the 800 hospitals are 110 that are being penalized for the fifth year in a row. Medicare’s hospital-acquired condition reduction program tracks a variety of medical problems, including infections, blood clots, sepsis, hip fractures, bedsores, and others. Every year, the 25 percent of eligible providers – the program excludes significant numbers of hospitals – are penalized even if their performance for hospital-acquired conditions is superior to the previous [...]

iqtsupport2019-03-05T06:00:59-05:00March 5, 2019|hospitals, Medicare, Medicare regulations|

Hospitals Show Mixed Results on Investments

Some hospitals are doing much better than others with their investments. According to a new report, several large health systems have recently reported major losses with their investments. On the other hand, a report late last year found that roughly half of hospitals’ net margins over the past two years has come from investment income. Learn more from the Becker’s Hospital Review article “Investment income made up almost 50% of hospitals' net margin in past 2 years.”

iqtsupport2019-03-04T06:00:01-05:00March 4, 2019|hospitals|

Grassley, Senate Finance to Resume Probe of Non-Profit Hospitals

The Senate Finance Committee will launch a review of non-profit hospitals and whether they are meeting the formal community benefit standards required to justify their tax-free status. This subject has long been of interest to committee chairman Chuck Grassley, who has returned as committee chair. He pursued the same question of the hospitals’ non-profit status and community benefit provide while leading the Senate Finance Committee from 2003 to 2007 and also as a member of the committee, although not its chair, in recent years. In a letter to the commissioner of the Internal Revenue Service, which is responsible for reviewing [...]

iqtsupport2019-03-01T06:00:44-05:00March 1, 2019|hospitals|

Nursing Home Study: More Medicaid Patients=Worse Care

Nursing homes that serve larger proportions of Medicaid patients have lower quality ratings, according to a new study from the American Health Care Association, a long-term-care provider trade group. The study also found that: For-profit nursing homes care for more Medicaid patients than non-profits. Rural nursing homes care for more Medicaid patients than urban facilities. Large facilities care for a higher proportion of Medicaid patients than smaller facilities. Learn more about the study and the theories behind some of these findings in the McKnight’s Long-Term Care News article “AHCA study: Facilities with higher Medicaid populations have poorer quality outcomes.” [...]

iqtsupport2019-02-28T13:00:01-05:00February 28, 2019|Medicaid, post-acute care|