Alternative payment models now account for more than one-third of health care payments, according to a new analysis. Leading the way is Medicare Advantage plans, which expend nearly half of their Medicare payments through APMs. Learn more about this trend in health care delivery and payments in the report “APM Measurement: Progress of Alternative Payment Models,” which was prepared by the Health Care Payment Learning & Action Network and can be found here.
138 members of the House of Representatives have written to Centers for Medicare & Medicaid Services administrator Seema Verma to protest CMS’s proposal to extend Medicare outpatient site-neutral payment policies to off-campus, provider-based outpatient departments specifically exempted from such policies by Congress under the Bipartisan Budget Act of 2015. In questioning CMS’s rationale for the proposed policy, the House members wrote that It is unclear how CMS has deemed all of the OPD [outpatient department] services at the grandfathered off-campus HOPDs [hospital outpatient departments] as cause of an unnecessary increase in volume of OPD services, and we ask you to [...]
The expansion of Medicaid in nearly two-thirds of the states has not affected access to care for Medicare participants in those states. According to a new analysis by the National Bureau of Economic Research, Medicare patients had no more trouble getting timely doctors’ appointments, suffered no increase in costs, and experienced no increase in waiting times after their state expanded its Medicaid program under the Affordable Care Act. Learn more about these findings in this Healthcare Dive report or go here for access to the National Bureau of Economic Research report “The Impact of Insurance Expansions on the Already Insured: [...]
While there has been a great deal of public discussion of late about “Medicare for all,” less attention has been paid to the concept of permitting people to buy into their state’s Medicaid program. Now, the Rockefeller Institute of Government has published a new report that presents the different approaches to the concept of Medicaid buy-in. It also seeks to address six major questions of potential Medicaid buy-in efforts: How large is the intended population of new enrollees? What kind of coverage would be offered? How would enrollment be financed? How would rates be set? Would the program use standard [...]
The U.S. Department of Health and Human Services has posted a list of the regulations it is already working on or intends to work on in the coming months. Included in the list are links to the individual subjects that lead to descriptions of the subject and HHS’s intentions as well as the latest information on the status of the anticipated regulation and its priority within the agency’s overall regulatory work. Among the listed regulations are a number that address Medicare and Medicaid. Go here to see the list.
For the most part, states’ use of alternative payment models in their Medicaid programs so far have focused on the work done by primary and acute-care providers. Now, a number of states are starting to extend their use of APMs in other areas, including: behavioral health providers safety-net providers long-term care providers For a look at what states are doing to drive value in Medicaid payments in these new areas, see the Commonwealth Fund article “The Next Generation of Paying for Value in Medicaid,” which can be found here.
If a regulation proposed by the Department of Homeland Security to redefine what constitutes a “public charge” is adopted, millions of people currently enrolled in the Medicaid and Children’s Health Insurance Program might choose to disenroll from those programs rather than risk losing their opportunity to obtain legal permanent resident status in the U.S. The proposed regulation seeks to filter out of possible residency status individuals who might become public charges, or dependent on government programs, over time. A new analysis published by the Kaiser Family Foundation concluded that Under the proposed rule, individuals with lower incomes, a health condition, [...]
The Centers for Medicare & Medicaid Services intends to pay closer attention to the work performed by accrediting organizations for different types of health care providers. With all providers and suppliers participating in Medicare subject to some kind of accreditation and inspection process, CMS intends to monitor more closely the work of those accreditors and inspectors after a 2018 Wall Street Journal investigation discovered facilities with continuing problems that continued to serve patients and keep their accreditation. With this in mind, CMS will redesign how accrediting organizations do their work, publicly post performance data on those accrediting organizations, and submit [...]
A proposal to enable Medicare to make greater use of telemedicine as a means of serving patients is receiving surprising pushback from physicians. The Centers for Medicare & Medicaid Services has proposed paying doctors $14 for what would amount to a five-minute telephone “check-in” call with patients. Some physicians note that they already have such telephone conversations patients – and do not charge for those calls. Others fear the new service will increase their patients’ health care costs because they would incur a co-pay for such conversations. The chairman of the Medicare Payment Advisory Commission (MedPAC), himself a physician, has [...]
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 October agenda were: managing prescription opioid use in Medicare Part D opioids and alternatives in hospital settings: payments, incentives, and Medicare data Medicare payment policies for advanced practice registered nurses and physicians Medicare’s role in the supply of primary care physicians Medicare payments for services provided in inpatient psychiatric facilities episode-based payments and outcome measures under a unified payment system for post-acute care Medicare policy issues related to non-urgent and emergency care MedPAC is an independent congressional [...]