Medicare Advantage

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 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 December 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 [...]

iqtsupport2019-12-10T06:00:07-05:00December 10, 2019|Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, post-acute care|

MedPAC to Meet Tomorrow

The Medicare Payment Advisory Commission meets this Thursday and Friday in Washington, D.C. MedPAC’s December agenda is dominated by Medicare payment issues: how much Medicare should pay for different types of services in calendar year 2021 and FY 2021. The services to be addressed during the December 5-6 meetings are physician and other health professional services, ambulatory surgical center services, hospital inpatient and outpatient services, skilling nursing facility services, home health services, inpatient rehabilitation facility services, long-term care hospital services, outpatient dialysis services, and hospice services. In addition, MedPAC commissioners will discuss their mandated report on expanding Medicare’s post-acute care [...]

iqtsupport2019-12-04T06:00:06-05:00December 4, 2019|Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC|

CMS Chief Criticizes Health Care Proposals

In an address to the Better Medicare Alliance 2019 Medicare Advantage Summit, Centers for Medicare & Medicaid Services Administrator Seema Verma criticized Medicare for All proposals, said Medicare “public option” proposals are no better, and called the Affordable Care Act a failure,. Verma also insisted that greater reliance on market forces would improve Medicare and Medicaid, said the 340B prescription drug program is harming the health care system, and called for a reduction of federal regulations that limit how and where people can receive care. She said reduced regulations have spurred hundreds of new plans to participate in the Medicare [...]

iqtsupport2019-07-23T10:10:59-04:00July 23, 2019|340b, Affordable Care Act, Centers for Medicare & Medicaid Services, Medicaid, Medicare, Medicare regulations|

Readmissions Higher for Medicare Advantage Patients

Medicare Advantage patients are more likely to be readmitted to the hospital for existing medical problems than participants in traditional Medicare, a new study has found. According to a report published in the Annals of Internal Medicine, Medicare Advantage patients suffering from acute myocardial infarction, congestive heart failure, and pneumonia were readmitted to hospitals because of those medical problems at slightly higher rates than patients served by traditional Medicare. Learn more from the Annals of Internal Medicine study “Hospital Readmission Rates in Medicare Advantage and Traditional Medicare: A Retrospective Population-Based Analysis” and the Healthcare Dive article “MA patients' readmission rates [...]

iqtsupport2019-07-01T06:00:15-04:00July 1, 2019|Medicare|

Are Savings Baked Into Medicare Advantage?

Medicare Advantage plans spend less for their members’ care than traditional Medicare – even when beneficiaries switch from traditional Medicare to a Medicare Advantage plan. This spending trend, moreover, applies to all types of Medicare beneficiaries, even after risk adjustment, regardless of age, gender, or dual-eligibility. It even applies to beneficiaries with chronic medical conditions, according to a recent study. Why the difference? The study’s authors suggest “favorable self-selection.” Past studies have suggested that Medicare Advantage plans’ care management components are responsible for reduced costs but this study casts that theory in doubt. Another theory is that the provider networks [...]

iqtsupport2019-05-08T13:00:45-04:00May 8, 2019|Medicare|

Medicare Advantage Permitted to Address Non-medical Needs

Starting in 2020, Medicare Advantage plans will be permitted to provide non-medical benefits to their chronically ill members. As described in the Centers for Medicare & Medicaid Services’ “final call letter’ for 2020, MA [Medicare Advantage] plans are not prohibited from offering an item or service that can be expected to improve or maintain the health or overall function of an enrollee only while the enrollee is using it. In other words, the statute does not require that the maintenance or improvement expected from an SSBCI [special supplemental benefits for the chronically ill] result in a permanent change in an [...]

iqtsupport2019-04-16T06:00:54-04:00April 16, 2019|Medicare|

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|

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|

Medicare Advantage to Address Social Determinants of Health

Beginning next year, the Centers for Medicare & Medicaid Services will authorize Medicare Advantage plans to pay for some health-related but non-medical benefits for their members – benefits that will help address social determinants of health that affect the health status of many Medicare beneficiaries. As explained by Health and Human Services Secretary Alex Azar at a recent event in Salt Lake City, These interventions can keep seniors out of the hospital, which we are increasingly realizing is not just a cost saver but actually an important way to protect their health, too. If seniors do end up going to [...]

iqtsupport2018-11-19T06:00:47-05:00November 19, 2018|Medicare|