Policy Updates

Hospital Outpatient Visits Down

For the first time in 35 years, hospital outpatient volume declined in 2019. Despite the trend toward delivery of more health care in outpatient settings, hospitals saw fewer outpatients in 2019 as more people turned to urgent care settings and other clinics for outpatient services. Much of the decline was in emergency room visits, with patients also turning to urgent care facilities for non-emergency services they traditionally sought in hospital ERs. Despite the decline in volume, hospitals saw their net outpatient revenue rise 4.5 percent in 2019. Learn more about what is happening to hospital outpatient volume in the HealthCare [...]

iqtsupport2020-01-15T11:46:35-05:00January 15, 2020|hospitals|

Interview With Seema Verma

In late December, PBS broadcast an interview with Centers for Medicare & Medicaid Services administrator Seema Verma. Kaiser Health News has published a transcript of excerpts from that interview during which Verma discusses Medicaid – including enrollment, eligibility, services, and children – Medicare for all, administration attempts to reduce health care costs, protection for people with pre-existing conditions, and more. Read those excerpts in the Kaiser Health News article “One-On-One With Trump’s Medicare And Medicaid Chief: Seema Verma."

iqtsupport2020-01-07T11:50:05-05:00January 7, 2020|Centers for Medicare & Medicaid Services, Medicaid|

Pennsylvania to Introduce Medicaid PDL on January 1

Starting on January 1, Pennsylvania will employ a preferred drug list for its Medicaid program – a list that applies to both fee-for-service and managed care patients. And as many as 150,000 of the state’s 2.8 million Medicaid beneficiaries may find themselves facing changes in their prescription drugs. The purpose of the PDL is to save money – an estimated $85 million a year, according to the Pennsylvania Department of Human Services, which administers the state's Medicaid program. While physicians may submit requests to the state for exemptions for specific patients for specific purposes, those exemptions may be relatively uncommon: [...]

iqtsupport2019-12-26T11:42:42-05:00December 26, 2019|Medicaid, Pennsylvania, Pennsylvania Medicaid, Pennsylvania Medical Assistance|

Medicare Money for Nurse Practitioner and Physician Assistant Training?

Should Medicare offer graduate medical education money for nurse practitioner and physician assistant training? That was the subject of a recent inquiry by the U.S. Government Accountability Office. In a new report inspired by concern over the current physician shortage and the belief that making greater use of nurse practitioners might help relieve that shortage, the GAO examined whether expanding Medicare’s graduate medical education (GME) program to include resources for the training of nurse practitioners and physician assistants was practical or possible. As part of its research, the GAO reviewed current literature, interviewed officials of professional associations, and explored the [...]

iqtsupport2019-12-20T06:00:27-05:00December 20, 2019|Medicare|

A Look at Surprise Medical Bill Legislation

While Congress’s decision this week to put off addressing the surprise medical bill challenge until next year has disappointed many, that decision did not reflect any lack of ideas for what to do. At last count, various parts of Congress were considering four major surprise medical bill proposals: one from the Senate Health, Education, Labor and Pensions Committee, one from the House Energy and Commerce Committee, one from the House Ways and Means Committee, and a compromise proposal from the Senate HELP and House Energy and Commerce committees. Some have been around for some time while one emerged only in [...]

iqtsupport2019-12-18T06:00:37-05:00December 18, 2019|Congress|

Good News and Bad for Hospitals on Outpatient Payments

A federal court has provided relief to hospitals that saw reduced Medicare payments for some outpatient services in 2019. But that relief is only partial. In response to a suit filed by several hospital groups, a federal court ruled that the Centers for Medicare & Medicaid services had illegally reduced Medicare payments for services provided in some hospital off-campus outpatient departments beginning on January 1, 2019 and ordered the federal government to repay the hospitals for the Medicare revenue they lost. The reduced payments were part of a new Medicare site-neutral payment policy for outpatient services, and CMS has announced [...]

iqtsupport2019-12-17T09:40:07-05:00December 17, 2019|Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare reimbursement policy|

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C. The following is MACPAC’s own summary of the sessions. The Medicaid and CHIP Payment and Access Commission kicked off its December meeting with highlights from its forthcoming issue of MACStats: Medicaid and CHIP Data Book, due out December 18, 2019. MACStats brings together statistics on Medicaid and State Children’s Health Insurance Program (CHIP) enrollment and spending, federal matching rates, eligibility levels, and access to care measures, which come from multiple sources. Later the Commission discussed a proposed rule that the Centers for Medicare [...]

iqtsupport2019-12-16T13:50:19-05:00December 16, 2019|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid regulations, Medicaid upper-payment limit|

MedPAC Meeting Transcript Now Available

Last week the Medicare Payment Advisory Commission met in Washington, D.C. The Medicare payment issues on its agenda were: Assessing payment adequacy and updating payments: Physician and other health professional services Assessing payment adequacy and updating payments: Ambulatory surgical center services Assessing payment adequacy and updating payments: Hospital inpatient and outpatient services; Mandated report: Expanding the post-acute care transfer policy to hospice Assessing payment adequacy and updating payments: Skilled nursing facility services Assessing payment adequacy and updating payments: Home health care services Assessing payment adequacy and updating payments: Inpatient rehabilitation facility services Assessing payment adequacy and updating payments: Long-term care [...]

iqtsupport2019-12-13T06:00:56-05:00December 13, 2019|hospitals, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

MedPAC Considers No Pay Raise for Ambulatory Surgical Centers

Next month MedPAC will likely vote to recommend that ambulatory surgical centers receive no increase in their Medicare payments in 2021. Meeting last week in Washington, D.C., members of the Medicare Payment Advisory Commission appeared to support strongly a staff recommendation to keep Medicare ambulatory surgical center payments where they are now – enough so to expedite resolution of the issue by voting on it at MedPAC’s next meeting, in mid-January. MedPAC also will vote on a proposal to require ambulatory surgical centers to provide annual cost reports to the Centers for Medicare & Medicaid Services. CMS would use those [...]

iqtsupport2019-12-12T06:00:31-05:00December 12, 2019|Medicare reimbursement policy, MedPAC|

President, VP Attempt to Mediate HHS Feud

President Trump and Vice President Pence have stepped into a feud between Health and Human Services Secretary Alex Azar and Centers for Medicare & Medicaid Services administrator Seema Verma. Azar and Verma have apparently clashed on numerous occasions in recent months, with Verma criticizing at least one Azar proposal during an Oval Office meeting and Azar being overruled by the president on several occasions. According to Politico, President Trump “…instructed Azar to smooth things over.” Verma, meanwhile, met with Vice President Pence, with whom she worked when Pence was governor of Indiana. As head of CMS, Verma oversees the country’s [...]

iqtsupport2019-12-11T06:00:21-05:00December 11, 2019|Centers for Medicare & Medicaid Services, Medicaid, Medicare|