Policy Updates

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues. The issues on MedPAC’s April agenda were: Expanding the use of value-based payment in Medicare Medicare Shared Savings Program performance Redesigning the Medicare Advantage quality bonus program Increasing the accuracy and completeness of Medicare Advantage encounter data Evaluating patient functional assessment data reported by post-acute-care providers Options for slowing the growth of Medicare fee-for-service spending for emergency department services Options to increase the affordability of specialty drugs and biologics in Medicare Part D Improving payment for low-volume and isolated outpatient dialysis [...]

iqtsupport2019-04-09T06:00:04-04:00April 9, 2019|Alternative payment models, hospitals, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, post-acute care|

Groups Work to Create New Codes for Social Determinants

Social determinants of health could have their own ICD-10 codes if a new initiative from the American Medical Association and United Healthcare succeeds. The two are working together to develop new ICD-10 codes that would take into consideration social determinants of health such as housing and food security, access to transportation, and ability to pay for medicine. The project launches at a time when research suggests that social determinants of health can affect nearly 80 percent of health care outcomes. Learn more in the Health Analytics IT article “AMA, UnitedHealth Partner for Social Determinants ICD-10 Project.”

iqtsupport2019-04-08T06:00:59-04:00April 8, 2019|Uncategorized|

New Web Site Shows Maximum 340B Prices

Providers can now see the maximum prices for 340B-covered drugs on a new web site established by the federal Health Resources & Services Administration. The web site, mandated by Congress after the U.S. Department of Health and Services’ Inspector General found that some providers are being overcharged, will enable 340B-eligible providers to identify the maximum price they can be charged for covered drugs. This, HRSA believes, will help providers avoid being overcharged in the future. Learn more in the Becker’s Hospital Review article “HRSA launches 340B ceiling price website” and visit the new web site itself (registration required).

iqtsupport2019-04-05T09:34:14-04:00April 5, 2019|340b|

Medicare Advantage Networks Not Narrowing

The primary care networks offered by Medicare Advantage plans are broadening and not narrowing, as some people have long feared. According to a study published in the journal Health Affairs, only 1.8 percent of Medicare Advantage plans offer narrow primary care provider networks, down from 2.7 percent in 2011. Meanwhile, the proportion of plans offering broad networks has grown from 80.1 percent in 2011 to 82.5 percent in 2015. In 2015, broad network plans enrolled 63.9 percent of Medicare Advantage participants, up from 54.1 percent in 2011. This is considered important because the proportion of Medicare beneficiaries enrolled in Medicare [...]

iqtsupport2019-04-04T13:00:55-04:00April 4, 2019|Medicare|

Moody’s: Challenging Times Ahead for Academic Medical Centers

Academic medical centers will struggle in the near future, according to Moody’s Investor Services. While academic medical centers still have a number of strengths – offering higher-end services, high demand for their inpatient services, and generally strong cash flow margins – they also face a number of challenges that make life more difficult for them in a value-based payment world. Among those challenges, most notably, are higher costs associated with teaching and research, higher-acuity patients, and payment pressure from insurers. Another challenge: the shrinking gap between academic medical center hospitals and others as more care is delivered on an outpatient [...]

iqtsupport2019-04-04T06:00:55-04:00April 4, 2019|Uncategorized|

Pressure Off 340B?

Two key House subcommittees will not hold hearings on the controversial 340B prescription drug discount program in the near future. The chairs of the House Energy and Commerce Committee’s Oversight and Investigations Subcommittee and its Health Committee have both suggested that House Democrats understand the importance and value of the 340B program and see other health care issues as greater priorities. This marks a serious departure from the last session of Congress, which saw a number of hearings on the 340B program and doubts cast about the program’s objectives and future. Learn more from the Lexology article “340B Program Gets [...]

iqtsupport2019-04-03T06:00:55-04:00April 3, 2019|340b|

Bill Would Enable Foreign-Born Docs to Work in Underserved U.S. Areas

More foreign-born, U.S.-trained doctors would be permitted to remain in the U.S. if they practice in medically underserved areas under a bill unveiled last week in Congress. Introduced with bipartisan support, the legislation would extend for two years the current “Conrad 30” program that allocates 30 slots to each state so foreign-born doctors can work in medically underserved areas under J-1 visas. The program, which already exists but will soon expire, permits such physicians to remain in the U.S. for three years after their training ends to work in underserved areas. The legislation also would establish criteria under which more [...]

iqtsupport2019-04-02T06:00:17-04:00April 2, 2019|Uncategorized|

Prospects Mixed for Non-Profit Hospitals in 2019

There’s good news and bad news for non-profit hospitals in 2019, according to Fitch Ratings, the bond-rating company. The good news: For many, major IT investments have been completed. Many have adjusted to the reality of falling inpatient volume. Many that saw reduced margins as a result of launching, purchasing, or participating in provider-sponsored plans to compete in health exchanges have scaled back those efforts. The bad: profits and margins may continue to decline – but those declines will not be as steep as they have been in recent years. Reimbursement may be weaker, too. Learn more from the Fierce [...]

iqtsupport2019-04-01T10:17:11-04:00April 1, 2019|hospitals|

ACA Repeal Would Drive Up Uninsured, Uncompensated Care

At the same time that the Trump administration announced that it has asked a federal court to repeal the entire Affordable Care Act, the Urban Institute has published a report detailing the potential impact of the health care reform law’s repeal. According to the Urban Institute report, repealing the entire Affordable Care Act would add almost 20 million Americans to the ranks of the uninsured. Medicaid and CHIP enrollment would fall by 15.4 million people and millions of others would lose the tax credits they used to purchase insurance. Some would purchase insurance with limited benefits and individual plan premiums [...]

iqtsupport2019-03-29T06:00:00-04:00March 29, 2019|Affordable Care Act, health care reform, hospitals, Medicaid|

Feds Seek More EHR in Post-Acute-Care Settings

Electronic health records may find their way into more post-acute-care settings as a result of a request for information published by the Centers for Medicare & Medicaid Services. In the RFI, CMS notes that EHR adoption has been slow in the post-acute sector and asks stakeholders what it can do to accelerate the adoption of technology designed to facilitate communication among caregivers. While EHR adoption has occurred in other areas, its use is less common in the post-acute sector, and even when used, it is used more for record-keeping than for communication among providers. EHR use and interoperability among acute-care [...]

iqtsupport2019-03-27T15:17:31-04:00March 27, 2019|Uncategorized|