Policy Updates

MedPAC Delivers Annual Report to Congress

The Medicare Payment Advisory Commission has issued its annual report and recommendations to Congress. The major issues addressed in the report include: implementing a unified payment system for post-acute care reforming Medicare payment for drugs under Part B redesigning the merit-based incentive payment system (MIPS) and strengthening advanced alternative payment models using premium support for Medicare the relationship between clinician services and other Medicare services payments from drug and device manufacturers to physicians and teaching hospitals in 2015 the medical device industry stand-alone emergency departments hospital and skilled nursing facility use by Medicare beneficiaries who reside in nursing facilities the [...]

iqtsupport2017-06-21T06:00:29-04:00June 21, 2017|Medicare, Medicare post-acute care, MedPAC|

States Lag in Reducing Nursing Home Utilization

States are not making adequate progress toward keeping seniors and the disabled out of nursing homes by making greater use of home and community-based services. Or so concludes a new study from AARP. According to the study, only nine states and Washington, D.C. spend more on home and community-based services and long-term services and supports than on nursing homes. Minnesota leads the nation, spending 69 percent of its long-term-care money on home and community-based services. Other leaders include Washington state (65 percent), New Mexico (64 percent), and Alaska (63 percent). Alabama pulls up the rear with only 14 percent. The [...]

iqtsupport2017-06-19T06:00:20-04:00June 19, 2017|Medicaid, Medicaid long-term services and supports|

The Prospect of a Medicaid Work Requirement

Over the past three years a dozen states have proposed establishing a work requirement for eligibility for their Medicaid programs and in its proposed FY 2018, the Trump administration has called for extending the ability to impose such a requirement to all states. But how would a Medicaid work requirement work? To whom would it apply and what kinds of work might satisfy such a requirement for the approximately 22 million Medicaid recipients (out of 76 million total recipients) to whom it might apply? A new Commonwealth Fund report looks at these and other issues. Go here to find the [...]

iqtsupport2017-05-31T16:28:01-04:00May 31, 2017|Medicaid, Medicaid regulations|

Medicare Delays New and Expanded Bundled Payment Programs

Medicare has delayed the launch of its mandatory Medicare Cardiac Rehabilitation Incentive Payment program until January 1. It also has delayed the expansion of its Comprehensive Care for Joint Replacement program through a new Surgical Hip and Femur Fracture Treatment program. Originally scheduled to begin on May 20 and then pushed back to July 1, now it, too, will not begin until January 1. Medicare’s Acute Myocardial Infarction program and Coronary Artery Bypass Graft program will still begin on July 1. For further information, see this Federal Register notice announcing the delays.

iqtsupport2017-05-26T06:00:29-04:00May 26, 2017|Medicare|

New Book Addresses Social Risk Factors in Medicare

In the new book Accounting for Social Risk Factors in Medicare Payment, the National Academies of Sciences, Engineering, and Medicine addresses the question of what social risk factors might be worth considering in Medicare value-based payment programs and how those risk factors might be reflected in value-based payments. The book, the culmination of a five-part NASEM process, focuses on five social risk factors: socio-economic position race, ethnicity, and cultural context gender social relationships residential and community context Addressing such factors in Medicare value-based payments, the book finds, can help achieve four important goals: reduce disparities in access, quality, and outcomes [...]

iqtsupport2017-05-24T11:47:42-04:00May 24, 2017|Medicare|

MedPAC Testifies Before Congress

Last week Mark Miller, executive director of the Medicare Payment Advisory Commission, testified before the House Ways and Means Committee’s Health Subcommittee. In his testimony, Miller summarized and explained some of the key points MedPAC made in its March report to Congress, including: why MedPAC believes most post-acute-care payments are too high; why Medicare needs to reduce the incentives for hospitals and doctors to deliver more services; why it recommended no FY 2018 payment increases for long-term acute-care hospitals, ambulatory surgical centers, and skilled nursing facilities and reductions of payments for home health care providers and inpatient rehabilitation facilities; why [...]

iqtsupport2017-05-22T06:00:12-04:00May 22, 2017|hospitals, Medicare, Medicare post-acute care, Medicare regulations, MedPAC|

Medicare’s Costs Can Be High for Low-Income Beneficiaries

Despite enjoying Medicare coverage, low-income seniors can still spend a significant portion of their limited income on costs Medicare does not cover. According to a new study published by the Commonwealth Fund, more than 25 percent of Medicare beneficiaries spend at least 20 percent of their income on health care – on things like premiums, cost-sharing, prescriptions, and dental and vision care, long-term care, and other services not covered by the federal program. These costs pose a problem for many because nearly half of all Medicare participants have incomes below the federal poverty level, which is slightly less than $24,000 [...]

iqtsupport2017-05-17T06:00:03-04:00May 17, 2017|Medicare|

States Get More Time to Improve Approach to Serving the Elderly, Disabled

The federal government is giving state three additional years to improve their Medicaid-funded efforts to help keep the elderly and the disabled in the community. The requirement, established in 2014 for implementation by 2019, requires states to do more to enable the elderly to remain in their homes rather than go to nursing homes and to help the disabled live and work in the community or at least have greater control of their own lives while residing in group home settings. Among the approaches states have been developing in response to the federal requirements are offering seniors programs of long-term [...]

iqtsupport2017-05-16T06:00:49-04:00May 16, 2017|Medicaid, Medicaid and housing for the disabled, Medicaid regulations|

Hospital Uncompensated Care Down

As was surely expected, reforms introduced through implementation of the Affordable Care Act have driven down uncompensated care costs for many hospitals. How much? A new study published by the Commonwealth Fund offers the following findings: uncompensated care declines in expansion states are substantial relative to profit margins; for every dollar of uncompensated care costs hospitals in expansion states had in 2013, the Affordable Care Act erased 41 cents by 2015; and Medicaid expansion reduced uncompensated care burdens for safety-net hospitals that are not made whole by Medicaid disproportionate share payments (Medicaid DSH). Learn more, including how the decline in [...]

iqtsupport2017-05-15T06:00:48-04:00May 15, 2017|Affordable Care Act, hospitals|

Tiered Networks = Lower Costs

Health plans that employ tiered provider networks reduce health care spending, a study has found. The report, published in the journal Health Affairs, found that tiered provider networks reduced spending on inpatient, outpatient, and outpatient radiology among non-elderly members of commercial health plans by five percent. Learn more about this conclusion and how researchers reached it in the Health Affairs article “Enrollment In A Health Plan With A Tiered Provider Network Decreased Medical Spending By 5 Percent,” which can be found here.

iqtsupport2017-05-11T06:00:24-04:00May 11, 2017|Uncategorized|