Policy Updates

MedPAC Debates Post-Acute Payments

As the Centers for Medicare & Medicaid Services continues to develop a unified payment system for all post-acute-care providers, Congress’s advisors on Medicare payment policy appear ready to weigh in on an important aspect of such a system: Whether payments should be based on entire episodes of care or individual stays in post-acute-care facilities. And at least for now, the Medicare Payment Advisory Commission is leaning toward recommending that post-acute-care payments be based on individual stays. At their March public meeting, MedPAC commissioners expressed concern that post-acute-care payments based on entire episodes of care might create financial incentives for providers [...]

iqtsupport2019-03-13T14:55:27-04:00March 13, 2019|Medicare post-acute care, MedPAC|

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. MACPAC looked ahead to its June 2019 report to Congress on the initial day of the March 2019 Commission meeting. In the morning, sessions focused on potential recommendations to create a grace period for states to determine coverage policies for outpatient prescription drugs and removing or raising the rebate cap; a uniform definition of therapeutic foster care; and treatment of third-party payment when determining hospitals’ Medicaid shortfall for disproportionate share hospital payments. In the [...]

iqtsupport2019-03-13T06:00:16-04:00March 13, 2019|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission|

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 March agenda were: two Medicare payment strategies to improve price competition and value for Part B drugs: reference pricing and binding arbitration options for slowing the growth of Medicare fee-for-service spending for emergency department service. Medicare’s role in the supply of primary care physicians evaluating an episode-based payment system for post-acute care mandated report: changes in post-acute and hospice care following the implementation of the long-term care hospital dual payment rate structure MedPAC is an independent congressional [...]

iqtsupport2019-03-12T06:00:49-04:00March 12, 2019|Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC, post-acute care|

Feds Seek Input on Selling Health Insurance Across State Lines

Working to achieve an objective of reducing the cost of health insurance by encouraging the sale of health insurance policies across state lines, the Centers for Medicare & Medicaid Services has published a request for information seeking input from stakeholders and the public on how this might best be done. According to a CMS news release, the agency seeks … feedback on how states can take advantage of Section 1333 of the Patient Protection and Affordable Care Act, which provides for the establishment of a regulatory framework that allows two or more states to enter into a Health Care Choice [...]

iqtsupport2019-03-11T06:00:41-04:00March 11, 2019|Affordable Care Act, Centers for Medicare & Medicaid Services|

Surprise Medical Bills Lead Patients to Change Hospitals

Patients who receive surprise medical bills are more likely to change hospitals than those who do not, a new study has found. According to an analysis of behavior by obstetrics patients, …11 percent of mothers experienced a surprise out-of-network bill with their first delivery, and this was associated with an increase of 13 percent in the odds of switching hospitals for the second delivery, compared to mothers who did not experience a surprise bill. The study found that this switching often paid dividends for those who switched: Mothers who switched hospitals after a surprise out-of-network bill reduced their relative risk of receiving [...]

iqtsupport2019-03-08T06:00:41-05:00March 8, 2019|hospitals|

State to Experiment with Global Budgets for Rural Areas

The Commonwealth of Pennsylvania plans to launch an experiment in which participating health insurers will fund global budgets to care for residents served by selected rural hospitals. The program seeks to preserve access to care in rural parts of the state by stabilizing the financial health of struggling rural hospitals. According to a Pennsylvania Department of Health news release, The Rural Health Model is an alternative payment model, transitioning hospitals from a fee-for-service model to a global budget payment. Instead of hospitals getting paid when someone visits the hospital, they will receive a predictable amount of money. Payment for the [...]

iqtsupport2019-03-07T13:00:31-05:00March 7, 2019|Alternative payment models, hospitals, Pennsylvania|

Stark Changes Coming to Facilitate Value Care?

At a Washington, D.C. conference, Centers for Medicare & Medicaid Services Administrator Seema Verma announced that changes coming in Stark law requirements will enable Medicare to make better use of value-based purchasing in its reimbursement system. In addition to addressing cybersecurity and electronic health record system issues, changes in the anti-self-referral law will seek to facilitate better coordination of care for Medicare patients. Verma explained the underlying rationale for the anticipated changes, noting that …in a system where we’re transitioning and trying to pay for value, where the provider is ideally taking on some risk for outcomes and cost overruns, [...]

iqtsupport2019-03-07T06:00:54-05:00March 7, 2019|Centers for Medicare & Medicaid Services, Medicare, Medicare regulations, Medicare reimbursement policy|

Rural Nursing Homes Struggle With Challenges

Across rural parts of the country skilled nursing facilities are struggling, and growing numbers are faltering in the face of many problems. Among the challenges they face are: difficulty passing health and safety standards evolving health care policies that encourage people to remain in their homes instead of choosing to enter nursing homes growing proportions of patients covered by Medicaid the failure of Medicaid payments in many states to cover the cost of nursing home care These challenges are especially acute in rural areas. Today, many regions have enough skilled nursing beds, at least on paper, but they are not [...]

iqtsupport2019-03-06T06:00:27-05:00March 6, 2019|Medicaid, post-acute care|

800 Hospitals Face Medicare Penalties

800 hospitals will see their Medicare payments reduced one percent this year because they are among the 25 percent of hospitals in the U.S. with the highest rate of hospital-acquired conditions. Among the 800 hospitals are 110 that are being penalized for the fifth year in a row. Medicare’s hospital-acquired condition reduction program tracks a variety of medical problems, including infections, blood clots, sepsis, hip fractures, bedsores, and others. Every year, the 25 percent of eligible providers – the program excludes significant numbers of hospitals – are penalized even if their performance for hospital-acquired conditions is superior to the previous [...]

iqtsupport2019-03-05T06:00:59-05:00March 5, 2019|hospitals, Medicare, Medicare regulations|

Hospitals Show Mixed Results on Investments

Some hospitals are doing much better than others with their investments. According to a new report, several large health systems have recently reported major losses with their investments. On the other hand, a report late last year found that roughly half of hospitals’ net margins over the past two years has come from investment income. Learn more from the Becker’s Hospital Review article “Investment income made up almost 50% of hospitals' net margin in past 2 years.”

iqtsupport2019-03-04T06:00:01-05:00March 4, 2019|hospitals|