Policy Updates

New Help With Addressing Low-Income Patients’ Social Services Needs?

One of the long-time barriers to states and hospitals addressing low-income patients’ social services needs and the social determinants of health has been a lack of resources for such assistance. Medicaid, in particular, has not been a financial participant in such efforts. But that may be changing. The new federal Medicaid managed care regulation, updated nearly two years ago, allows for the inclusion of some non-clinical services as covered Medicaid services and for funding for such services to be folded into Medicaid managed care plans’ capitation rates and medical loss ratios. The updated regulation also encourages greater coordination of care [...]

iqtsupport2017-12-04T06:00:13-05:00December 4, 2017|Medicaid|

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|

Is Readmissions Reduction Program Hurting Some Patients?

A new study suggests that the decline in avoidable hospital readmissions of Medicare patients driven by the federal program’s hospital readmissions reduction program may be harming cardiac patients. According to a new study published in the journal JAMA Cardiology, while the readmissions reduction program has reduced readmissions among heart failure patients from 20 percent before the program was launched to 18.4 percent, the mortality rate among the same patients rose from 7.2 percent to 8.6 percent – 5400 more deaths a year. To learn more about the study, its results, why experts believe this may be happening, and information about [...]

iqtsupport2017-11-29T06:00:23-05:00November 29, 2017|Medicare|

Telehealth on the Upswing

A number of recent developments suggest that serving patients with the assistance of telehealth services will become more commonplace in the near future. The Medicare MACRA and MIPS payment programs will include new billing codes for telehealth services, according to regulations published earlier this month. Also earlier this month, the House passed legislation, The Vets Act (H.R. 2123), that would authorize the Veterans Administration to make greater use of telehealth. And when the U.S. Department of Health and Human Services’ Office of the Inspector General recently announced plans to audit Medicaid programs for telehealth payments, it cited among its reasons [...]

iqtsupport2017-11-28T06:00:17-05:00November 28, 2017|Medicaid, Medicare, Medicare regulations|

Socio-Economic Factors’ Role in Skilled Nursing Facility Finances

Skilled nursing facilities located in communities with higher-than-typical numbers of low-income and minority patients are under greater financial stress than comparable facilities located in other communities. Nursing homes that serve higher proportions of Medicaid patients the same challenge. And both of these conditions detract from the quality of care such facilities provide. These are the findings of a new study published in the journal Health Services Research. According to the study, Medicaid-dependent nursing homes have a 3.5 percentage point lower operating ratio. Those serving primarily racial minorities have a 2.64-point lower quality rating. A 1 percent increase in the neighborhood [...]

iqtsupport2017-11-21T06:00:22-05:00November 21, 2017|post-acute care|

Bill Seeks to Block 340B Cut

Legislation introduced in Congress would block the attempt by the Centers for Medicare & Medicaid Services to slash $1.6 billion in annual payments to hospitals for prescription drugs for outpatients prescribed through the federal section 340B prescription drug discount program. Earlier this month CMS finalized its plan to reduce controversial 340B payments and shift $1.6 billion in savings into Medicare provider payments. If adopted, the bipartisan legislation co-sponsored by Representatives David McKinley (R-WV) and Mike Thompson (D-CA) would prevent the reduction of 340B payments, which are made to hospitals that care for especially large proportions of low-income patients. Go here [...]

iqtsupport2017-11-17T06:00:15-05:00November 17, 2017|Medicare|

Medicaid Retroactive Eligibility: A Dying Practice?

A growing number of states are ending or limiting retroactive eligibility for Medicaid: the practice of Medicaid reimbursing providers for the care they deliver to Medicaid-eligible patients for up to three months even if those patients had not previously enrolled in Medicaid. Arkansas, Indiana, and New Hampshire have ended the practice for some categories of Medicaid patients and Iowa joined them on November 1. In addition, Delaware, Maryland, Massachusetts, and Utah impose some limits on retroactive Medicaid eligibility for at least some Medicaid-eligible individuals. While the purpose of retroactive eligibility ostensibly is to ensure a health care safety-net for low-income [...]

iqtsupport2017-11-16T06:00:09-05:00November 16, 2017|Medicaid|

Administration Moving Away From Value Pay?

First, new Medicare programs for lump-sums payments for cardiac care and joint replacements were scaled back. Then, additional doctors were exempted from a new payment system that would have paid them more for the results they produce than for the quantity of care they provide. Next, the Department of Health and Human Services presented a document outlining a new direction for its Center for Medicare and Medicaid Innovation. And it announced that it was seeking input from doctors on payment policy. All suggest that if the Trump administration is not moving away for paying for quality rather than quantity it [...]

iqtsupport2017-11-15T06:00:55-05:00November 15, 2017|Medicare|

GAO Urges Medicare Action on Opioids

The Centers for Medicare & Medicaid Services is not doing enough to oversee the prescribing of opioids to Medicare beneficiaries. Or so concludes the U.S. Government Accountability Office. According to the GAO, CMS provides guidance to Medicare drug plans “…but does not analyze data specifically on opioids.” Also, according to the GAO, …CMS does not identify providers who may be inappropriately prescribing large amounts of opioids separately from other drugs, and does not require plan sponsors to report actions they take when they identify such providers. As a result, CMS is lacking information that it could use to assess how [...]

iqtsupport2017-11-13T06:00:13-05:00November 13, 2017|Medicare|

Hospitals Improving on Medicare Value-Based Measures

U.S. hospitals continue to improve their performance under Medicare’s value-based purchasing program. In FY 2018, 57 percent of hospitals will receive Medicare bonuses from the program, up from 55 percent in FY 2017. Bonuses are generally small but for some hospitals will be more than three percent. Roughly half of all hospitals will experience changes in their Medicare base rates. The worst performers will see their payments decline 1.65 percent. In FY 2018, hospitals that succeed in the program will share $1.9 billion in bonus payments. Funding for those payments in this budget-neutral program comes from CMS withholding two percent [...]

iqtsupport2017-11-10T06:00:07-05:00November 10, 2017|Medicaid regulations, Medicare|