Policy Updates

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|

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|