Policy Updates

Hospitals Flee Downside Risk in Medicare Bundled Programs

More than half of the hospitals that voluntary participate in Medicare bundled payment model programs leave those programs when faced with the possibility of financial penalties based on their performance. So concludes a new report by the U.S. Government Accountability Office. Some of these models feature both “upside” and “downside” risk. Upside risk offers financial incentives to participants that keep their costs below targeted amounts; they share those savings with Medicare. Downside risk occurs when hospitals are penalized when their costs exceed agreed-upon targets. Some of the model programs begin with only upside risk and later move into both upside [...]

iqtsupport2019-01-29T06:00:06-05:00January 29, 2019|Alternative payment models, hospitals, Medicare|

No Medicaid Expansion=Greater Peril for Rural Hospitals

Rural hospitals located in states that did not expand their Medicaid programs, as authorized by the Affordable Care Act, are at much greater risk of closing than hospitals in states that did expand their Medicaid programs. According to a Stateline report, most of the 100 rural hospitals that have closed since 2010 and most of the more than 600 rural hospitals that are considered to be in danger of closing now are located in states like Texas, Mississippi, and 12 others that have not expanded their Medicaid programs. Small rural hospitals that have not closed serve large proportions of uninsured [...]

iqtsupport2019-01-28T06:00:27-05:00January 28, 2019|Affordable Care Act, hospitals, Medicaid|

MedPAC: Overhaul Medicare Quality Programs

Medicare would implement major changes in its hospital quality programs under a proposal approved by the Medicare Payment Advisory Commission. Fierce Healthcare reports that the proposal adopted by MedPAC for recommendation to Congress and the Centers for Medicare & Medicaid Services …would essentially lump together several existing programs that measure quality—the Hospital Readmissions Reduction Program, the Hospital Value-Based Purchasing Program and the Hospital-Acquired Condition Reduction Program—into the Hospital Value Incentive Program (HVIP). It would also eliminate the existing Inpatient Quality Reporting Program. Under the MedPAC proposal, Performance across five domains—readmissions, mortality, spending, patient experience and hospital-acquired conditions—would be converted to HVIP “points.” Those points would be [...]

iqtsupport2019-01-25T06:00:15-05:00January 25, 2019|Medicare, Medicare regulations, Medicare reimbursement policy|

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 December agenda were: The Medicare prescription drug program (Part D) Opioids and alternatives in hospital settings: payments, incentives, and Medicare data Hospital inpatient and outpatient services payments Redesigning Medicare’s hospital quality incentive programs Physicians and other health professional services payments Medicare payment policies for advanced practice registered nurses and physician assistants Ambulatory surgical centers and hospice payments Skilled nursing facilities, home health agency, and inpatient rehabilitation facilities payments Long-term care hospital services payments Outpatient dialysis payments Future [...]

iqtsupport2019-01-24T06:00:53-05:00January 24, 2019|Alternative payment models, hospitals, Medicare, Medicare post-acute care, MedPAC|

Proposed Public Charge Regulation Causes Confusion in Clinics, Elsewhere

A Trump administration proposal to redefine what constitutes a “public charge” is making life challenging for low-income immigrants and the clinics and other providers to which they turn for Medicaid-covered health care. The proposed regulation from the Department of Homeland Security would establish new criteria for determining whether a person is a “public charge,” based on their participation in certain public programs, and therefore in jeopardy of losing their legal immigration status. Some Medicaid patients who come to clinics ask if receiving Medicaid-covered services might jeopardize their legal immigration status; others fail to keep appointments or forego seeking care out [...]

iqtsupport2019-01-23T06:00:04-05:00January 23, 2019|Medicaid|

S&P: Stable 2019 for Non-Profit Hospitals

Non-profit hospitals should experience a relatively stable 2019, according to S&P Global Financial. The bond-rating company estimates that 81 percent of such hospitals will be stable this year, with roughly equal numbers of hospitals looking at upgrades and downgrades. This stability is being driven by strong balance sheets and diversification while challenges to hospital financial performance and stability include the possibility of a recession, rising costs for serving an aging population, changes in Medicaid eligibility and payment policies, and the continued emergence of non-traditional health care providers. S&P also concludes that hospital operating margins are recovering after years of investment [...]

iqtsupport2019-01-22T06:00:30-05:00January 22, 2019|hospitals|

Could Medicaid Buy-In Push Aside Medicare for All?

Officials in ten states are giving consideration, in one form or another, to permitting uninsured low-income residents to buy into their Medicaid programs. So while Washington considers the possibility of Medicare for all, the ten states – Nevada, New Mexico, California, Delaware, Oregon, Washington, Connecticut, Illinois, Minnesota, and Wisconsin – are tackling the many issues they must address if they intend to pursue such a ground-breaking option. Among them: Who would be eligible to participate? What benefits would be offered? Would health plans be available on Affordable Care Act health exchanges, and if so, would ACA subsidies be available to [...]

iqtsupport2019-01-21T06:00:06-05:00January 21, 2019|Medicaid|

“Oh Say Can We See?”: Ways & Means Leaders Seek CMMI Transparency

The chairman and ranking member of the House Ways and Means Committee have written to CMS administrator Seema Verma to ask her to address the lack of transparency in the Center for Medicare and Medicaid Innovation. In the bipartisan letter, committee chairman Richard Neal (D-MA) and ranking member Kevin Brady (R-TX) note that “…Congress established CMMI to test different innovative delivery system and payment models to improve quality and reduce costs for Medicare and Medicaid beneficiaries” but observe that “…significant policy changes made unilaterally by the executive branch without sufficient transparency could yield unintended negative consequences for beneficiaries and the [...]

iqtsupport2019-01-18T06:00:19-05:00January 18, 2019|Center for Medicare and Medicaid Innovation|

New ACO Incentive: Exemption From 3-Day Stay SNF Requirement

In an effort to encourage more Medicare accountable care organizations to assume financial risk for the care of their patients, the Centers for Medicare & Medicaid Services is extending its exemption from the three-day inpatient stay requirement before Medicare ACOs can discharge their patients to skilled nursing facilities to ACOs participating in selected ACO model programs that involve two-sided risk under preliminary prospective assignment with retrospective reconciliation. This move expands the waiver from the three-day SNF requirement that ACOs that assume greater financial risk already receive. Details about the new policy, including the ACO models that qualify for this exemption [...]

iqtsupport2019-01-17T06:00:00-05:00January 17, 2019|Accountable Care Organization, ACO, Alternative payment models, Medicare, Medicare reimbursement policy|

End Run Around Congress for Medicaid Block Grants?

The Trump administration reportedly is considering introducing Medicaid block grants through regulations rather than legislation, according to published reports. Those reports explain that the administration may seek to offer states an opportunity to apply to the federal government to use Medicaid block grants by obtaining section 1115 Medicaid waivers, a commonly used tool for states seeking exemptions from federal legislative or regulatory requirements. As reported by the online publication The Hill, …the Trump administration is now considering issuing guidance to states encouraging them to apply for caps on federal Medicaid spending in exchange for additional flexibility on how they run [...]

iqtsupport2019-01-16T06:00:01-05:00January 16, 2019|Centers for Medicare & Medicaid Services, Medicaid|