Policy Updates

Hospital Readmissions Tied to Local Medical Resources?

Communities with more primary care doctors and more nursing home beds experience fewer avoidable hospital readmissions, according to a new study. At the same time, communities with more nurse practitioners and more home health agencies experience a high rate of hospital readmissions. In addition to the significance this may have for the welfare of the residents of individual communities, such a finding also may have implications for Medicare’s hospital readmissions reduction program, which penalizes hospitals that have “too many” readmissions for selected medical problems. If the availability of certain community resources has a meaningful impact on readmissions it may be [...]

iqtsupport2022-07-07T13:34:05-04:00July 7, 2022|Medicare|

Transparency Comes to Health Insurer Payments

When the calendar turned to July, health insurers came under a new federal requirement that they post on web sites the price they pay to every provider with which they contract for every service they cover. The mandate, which traces its origins to the Affordable Care Act and was introduced in a 2019 executive order, was designed to enable consumers to compare what different insurers pay different providers for different services and possibly help them shop for more affordable services for themselves. Doing so, however, will be a challenge for consumers at least at first because insurers will be posting [...]

iqtsupport2022-07-06T13:42:45-04:00July 6, 2022|Affordable Care Act, hospitals|

Federal Health Policy Update for Thursday, June 30

The following is the latest health policy news from the federal government as of 2:45 p.m. on Thursday, June 30. Some of the language used below is taken directly from government documents. White House The White House has unveiled its “White House Blueprint for Addressing the Maternal Health Crisis.” Monkeypox Update The White House has announced the first phase of its national monkeypox vaccine strategy, a part of its monkeypox outbreak response. The major components of the strategy include expanded efforts to vaccinate those most at risk, expanded testing supply and availability, and greater engagement with community leaders and stakeholders. [...]

iqtsupport2022-06-30T17:01:01-04:00June 30, 2022|Centers for Medicare & Medicaid Services, COVID-19, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations for long-term care, Medicare, Medicare post-acute care, Medicare regulations, MedPAC|

Court Rejects Long-Running Medicare DSH Challenge

In a case that challenged a 2005 change in how the federal Centers for Medicare & Medicaid Services calculates Medicare disproportionate share (Medicare DSH) payments, the Supreme Court has, in a 5-4 decision, reversed a lower court ruling and upheld CMS’s policy of counting days of care for which Medicare does not pay in the Medicare fraction of the Medicare DSH percentage – a policy change widely viewed as disadvantageous to hospitals that care for larger numbers of low-income patients. This means that Medicare exhausted days and days of care provided to Medicare enrollees with another source of third-party coverage [...]

iqtsupport2022-06-29T06:00:21-04:00June 29, 2022|Medicare disproportionate share, Medicare DSH|

Federal Health Policy Update for Monday, June 27

The following is the latest health policy news from the federal government as of 2:15 p.m. on Monday, June 27. Some of the language used below is taken directly from government documents. White House The White House COVID-19 response team has briefed the press about the administration’s latest efforts in the response to COVID-19. Find a transcript of that briefing here and find the slides presented during that briefing here. Supreme Court In a case that challenged a 2005 change in how CMS calculates Medicare disproportionate share (Medicare DSH) payments, the Supreme Court has, in a 5-4 decision, reversed a [...]

iqtsupport2022-06-27T16:37:45-04:00June 27, 2022|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare reimbursement policy, Telehealth|

Hospitals to Feds: Help Us Fight Hackers

Hospitals and health systems are looking to the federal government to help them deal with cybersecurity breaches. Those breaches, which at one time might only cost a ransom of $50,000, now often cost millions of dollars in damage – and in the case of one large health system, more than $100 million. Insurance against such problems, moreover, generally pays only a fraction of the cost of the damage done. The FBI and the Department of Homeland Security, often through the latter’s Cybersecurity and Infrastructure Security Agency, offer some assistance to hospitals, as does the Department of Health and Human Services’ [...]

iqtsupport2022-06-24T06:00:47-04:00June 24, 2022|hospitals|

COVID Drugs Experiencing Arguably Inequitable Distribution

The distribution of COVID-19 drugs could be exhibit A in the argument that inadequate access to care is a major social determinant of health. At least that’s a conclusion that might be drawn based on a new CDC study. According to a new Centers for Disease Control and Prevention analysis, the rate at which COVID-19 drug therapies are being distributed “…were lowest in high vulnerability zip codes, despite these zip codes having the largest number of dispensing sites.” The study observes that “The COVID-19 pandemic has highlighted and exacerbated long-standing inequities in the social determinants of health.” Despite this, federal [...]

iqtsupport2022-06-23T06:00:43-04:00June 23, 2022|COVID-19, social determinants of health|

Federal Health Policy Update for Tuesday, June 21

The following is the latest health policy news from the federal government as of 2:45 p.m. on Tuesday, June 21. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services The Supreme Court has ruled that CMS acted inappropriately when it reduced 340B payments to hospitals. In a unanimous decision, the court found that the law creating the program gives the federal government two ways to set 340B payments for outpatient drugs for qualified providers and that the manner in which CMS cut those payments in 2018 followed neither. Learn more from [...]

iqtsupport2022-06-21T17:24:52-04:00June 21, 2022|340b, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, COVID-19, Medicaid, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|

Providers Say They Need More Time to Comply With Surprise Bill Requirement

Health care providers say they need more time to comply with the federal surprise billing law’s requirement that they supply certain patients with good-faith estimates of the potential charges they are likely to incur for medical procedures. Preparing such estimates for self-insured, uninsured, and other requesting patients is far more difficult and time-consuming than policy-makers thought it would be, provider groups insist, and they also note that there currently is no automated means of producing such estimates within the time limits imposed by the No Surprises Act, which was signed into law in late 2020. The requirement is scheduled to [...]

iqtsupport2022-06-17T06:00:48-04:00June 17, 2022|Centers for Medicare & Medicaid Services|

Supreme Court Rejects 340B Payment Cuts

The federal government had no business cutting section 340B payments to hospitals in the manner it did, the Supreme Court has ruled. In an unanimous decision, the court found that the law creating the program gives the federal government two ways to set 340B payments for outpatient drugs for qualified providers and that the manner in which the Department of Health and Human Services cut those payments in 2018 followed neither. Hospital groups estimate that the 340B payment cut amounted to about $1.6 billion annually. Learn more about the high court ruling in the Healthcare Dive article “Hospitals win SCOTUS [...]

iqtsupport2022-06-16T06:00:11-04:00June 16, 2022|340b|