Policy Updates

CMS to Consider Model Behavioral Health Payment and Delivery Program

The Center for Medicare and Medicaid Innovation has invited interested parties to weigh in on the possibility of creating a new Medicare model program for behavioral health care delivery and payment. According to a notice published in the Federal Register, The Innovation Center is interested in designing a potential payment or service delivery model to improve health care quality and access, while lowering the cost of care for Medicare, Medicaid, or CHIP beneficiaries with behavioral health conditions. The model may include participation by other payers, qualify as an Advanced Alternative Payment Model (APM), improve health care provider participation in telehealth [...]

iqtsupport2017-07-25T06:00:10-04:00July 25, 2017|Center for Medicare and Medicaid Innovation, CMMI, Medicare|

Congress Looks at 340B Program

Last week the House Energy and Commerce Committee took a look at the 340B prescription drug discount program, which requires pharmaceutical companies to sell discounted drugs for outpatient use to hospitals that care for especially large numbers of low-income patients. The previous week, the Centers for Medicare & Medicaid Services issued a proposed Medicare regulation calling for significant reductions in Medicare payments for such drugs. The hearing touched on the CMS proposal to reduce Medicare payments for 340B drugs, the high prices of prescription drugs, the 340B program’s growth over the years, the possibility that the program is being abused [...]

iqtsupport2017-07-24T06:00:44-04:00July 24, 2017|Medicare, Medicare regulations|

Mortality Doesn’t Go Up When Readmissions Come Down

The emphasis in recent years on reducing hospital readmissions has not resulted in an increase in post-discharge deaths among Medicare patients. Or so concludes a new study published in JAMA. Looking at outcomes associated with Medicare’s hospital readmissions reduction program, the study “Association of Changing Hospital Readmission Rates With Mortality Rates After Hospital Discharge” found that … of more than 5 million Medicare fee-for-service hospitalizations for heart failure, acute myocardial infarction, and pneumonia from 2008 to 2014, reductions in hospital 30-day readmission rates were weakly but significantly correlated with reductions in 30-day mortality rates after hospital discharge. Learn more about [...]

iqtsupport2017-07-19T15:21:29-04:00July 19, 2017|Medicare|

CMS Seeks to Track Post-ASC Hospitalizations

The Centers for Medicare & Medicaid Services has announced a new initiative to track hospital admissions among Medicare patients who have recently been served at an ambulatory surgical center. The new measure would become part of the agency’s broader quality reporting efforts. The federal government has a large stake in the performance of ambulatory surgical centers: it spends $4 billion a year on care for more than three million Medicare patients at such facilities. Learn more about the project CMS calls “Development of a Facility-Level Quality Measure of Unplanned Hospital Visits after General Surgery Procedures Performed at Ambulatory Surgical Centers” [...]

iqtsupport2017-07-14T06:00:56-04:00July 14, 2017|Medicaid regulations, Medicare|

Medicaid Enrollees: Access and Quality Are Good

Medicaid beneficiaries are generally satisfied with their access to care and the quality of care they receive. Or so reports a new study based on results of the federal Medicaid Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey for December of 2014 to July of 2015. According to the survey, nearly half of Medicaid patients rated their overall care 7.9 or greater on a scale of 10; 84 percent reported that they had been able to receive all of the care they needed over the past six months; and most were generally satisfied with the coverage. Relatively few reported [...]

iqtsupport2017-07-12T13:55:49-04:00July 12, 2017|Medicaid|

ACOs, APMs Proliferate

The number of accountable care organizations and alternative payment models is growing, as is the number of people served by such programs. According to a new study published on the Health Affairs Blog, there are more than 900 ACOs across the country – a 10 percent increase over a year ago. 32 million Americans are served by ACOs today – 2.2 million more than a year ago. Among them, 59 percent are served through commercial contracts, 29 percent by Medicare contracts, and 12 percent under Medicaid contracts. ACO growth is greatest in metropolitan areas, the states with the greatest ACO [...]

iqtsupport2017-06-30T06:00:29-04:00June 30, 2017|Accountable Care Organization, ACO|

Denied Hospital Claims Exceed A Quarter of a Trillion Dollars a Year

Insurers deny about $262 billion in hospital inpatient and outpatient claims a year, according to a new study. That amounts to about nine percent of approximately $3 trillion in claims hospitals file with insurers a year. Of that rejected $262 billion, roughly 63 percent is recoverable but that costs hospitals $118 per claim, or nearly $9 billion a year in costs associated with that recovery. Learn more about this analysis produced by Change Healthcare in this Healthcare Finance News article.

iqtsupport2017-06-29T06:00:16-04:00June 29, 2017|hospitals|

HHS Needs to Do More on Physician Training

The federal government needs to do more to ensure an adequate supply of primary care physicians and their deployment in non-urban areas outside of the northeastern U.S. Or so concludes a new study performed by the U.S. Governor Accountability Office. According to the GAO report, efforts by the U.S. Department of Health and Human Services have resulted in progress toward meeting both of these goals – but not enough progress. With the federal government spending $15 billion on graduate medical education, GAO believes, HHS can and should do more to ensure an adequate supply of primary care physicians throughout the [...]

iqtsupport2017-06-28T06:00:41-04:00June 28, 2017|Medicare|

Elderly Patients Return to Hospitals After Observation Stay

More than one in five Medicare patients who have observation stays in the hospital return to that hospital within 30 days, according to a new study published in The BMJ. Among those returning to the hospital, 8.4 percent return to the emergency room, 2.9 percent have another observation stay visit, and 11.2 percent are admitted to the hospital. Another 1.8 percent pass away within 30 days. The numbers are similar for Medicare patients who only visit the emergency room. Learn more about the study’s findings and its implications for improving post-discharge care in The BMJ article “Outcomes after observation stays [...]

iqtsupport2017-06-26T06:00:39-04:00June 26, 2017|Medicare|

MedPAC to CMS: Speed Up Move to New Post-Acute Payment System

Medicare should adopt a unified system for post-acute-care payments even earlier than its target date of 2024. Or so the Medicare Payment Advisory Commission told Congress. MedPAC’s idea? Implement such a system by 2021 and phase it in over a three-year transition period, the agency said in its annual report and recommendations to Congress Learn more about what MedPAC recommended and why it recommended it in this McKnight’s Long-Term Care News article. Find MedPAC’s annual report to Congress here.

iqtsupport2017-06-22T06:00:15-04:00June 22, 2017|Medicare post-acute care, MedPAC|