Policy Updates

Improvements Inspired by Readmissions Reduction Program Level Off

After major improvements during the early years of Medicare’s hospital readmissions reduction program, the program is no longer showing significant new gains. While Medicare readmissions have fallen from 21.5 percent to 17.8 percent since 2007, there has been very little improvement since 2012, suggesting that most of the benefits from the program have already been achieved. And in FY 2018, Medicare will penalize almost the same number of hospitals it penalized in FY 2017: approximately 80 percent of the hospitals subject to the program. In FY 2018, the average penalty will be 0.73 percent of affected hospitals’ Medicare payments. Forty-eight [...]

iqtsupport2017-08-08T06:00:18-04:00August 8, 2017|Medicare regulations|

Serving High-Risk Patients Leads to VPB Penalties

Practices that served more socially high-risk patients had lower quality and lower costs, and practices that served more medically high-risk patients had lower quality and higher costs. These patterns were associated with fewer bonuses and more penalties for high-risk practices. So concludes a new study that looked at the results of the first year of the Medicare Physician Value-Based Payment Modifier Program. The study looked at 899 physician practices serving more than five million Medicare beneficiaries, and it points to the continuing challenge of how best to serve patients who pose greater socio-economic risks than the average patient. Learn more [...]

iqtsupport2017-08-03T09:05:51-04:00August 3, 2017|Medicare|

ACA Reduced Disparities in Access to Care

The Affordable Care Act has reduced socioeconomic disparities in access to health care in the U.S. According to a new study published in the journal Health Affairs, Health care access for people in lower socioeconomic strata improved in both states that did expand eligibility for Medicaid under the ACA and states that did not. However, gains were larger in expansion states. The absolute gap in insurance coverage between people in households with annual incomes below $25,000 and those in households with incomes above $75,000 fell from 31 percent to 17 percent (a relative reduction of 46 percent) in expansion states and from 36 percent [...]

iqtsupport2017-08-01T06:00:32-04:00August 1, 2017|Affordable Care Act|

CMS Takes First Steps Toward Medicaid DSH Cuts

Federal funds allocated to states to make Medicaid disproportionate share hospital payments (Medicaid DSH) payments would be reduced beginning in FY 2018 under a new rule proposed by the Centers for Medicare & Medicaid Services. The Medicaid DSH cuts, mandated by the Affordable Care Act but delayed several times at the behest of Congress, would come in the form of reduced Medicaid DSH allocations to individual states, with the size of those allocation cuts based on the nature of individual states’ Medicaid programs and changes in the number of uninsured patients in individual states. The cuts were established in the [...]

iqtsupport2017-07-31T06:00:34-04:00July 31, 2017|Centers for Medicare & Medicaid Services, hospitals, Medicaid|

Behavioral Health Services in Medicaid Expansion States

The U.S. Government Accountability Office has performed a limited study of the utilization of Medicaid behavioral health services in Medicaid expansion states. The study, based on data from New York, Washington, Iowa, and West Virginia, found that the two most heavily utilized behavioral health services were diagnostic and psychotherapy services and that more than two-thirds of behavioral health patients were prescribed anti-depressants. More people sought help for mental health challenges that for substance abuse problems. Medicaid officials in the selected states concluded that enrollment in Medicaid enhanced access to behavioral health care. Learn more about the study’s findings in the [...]

iqtsupport2017-07-28T06:00:52-04:00July 28, 2017|Affordable Care Act, Medicaid|

Ways and Means Seeks to Cut Medicare Red Tape

The House Ways and Means Committee’s Health Subcommittee has launched a new initiative to attempt to improve the delivery of Medicare services and eliminate statutory and regulatory obstacles to more effective care delivery. The subcommittee describes its “Medicare Red Tape Relief Project” as …a new initiative to deliver relief from the regulations and mandates that impede innovation, drive up costs, and ultimately stand in the way of delivering better care for Medicare beneficiaries. In support of this initiative, the committee has announced a three-part approach in which it will seek feedback from stakeholders, host roundtables with stakeholders across the country, [...]

iqtsupport2017-07-27T13:00:59-04:00July 27, 2017|Medicare, Medicare regulations|

Study Finds Communication Woes That Pose Risks for the Elderly

Inadequate communication between doctors and home health providers unnecessarily puts elderly patients at risk, a new study has found. At the heart of this problem are lack of access to physician information for home health workers, challenges home providers face when seeking to order new services, lack of accountability among physicians, and poor transitions between hospitalists and patients’ primary care doctors. Learn more about these challenges and ways to address them in the study “’Connecting the Dots’: A Qualitative Study of Home Health Nurse Perspectives on Coordinating Care for Recently Discharged Patients,” which can be found here, in the Journal [...]

iqtsupport2017-07-27T06:00:59-04:00July 27, 2017|Medicare|

GAO Looks at Use of Telehealth in Medicare, Medicaid

The U.S. Government Accountability Office has examined the use of telehealth services in the Medicare and Medicaid programs. In a study that looked at current Medicare practices, sampled Medicaid practices in six states, and consulted selected provider, payment, and patient associations, the GAO evaluated the extent to which telehealth is used in Medicare and Medicaid today, factors that affect the use of telehealth in Medicare, and the degree to which new payment and delivery models might affect future telehealth utilization in Medicare. The report does not offer recommendations. The GAO released its findings in a new report titled Telehealth: Use [...]

iqtsupport2017-07-26T06:00:39-04:00July 26, 2017|Medicaid, Medicare|

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|