Medicare

Nearly Half of Hospitals Nicked for Readmissions

Medicare’s Hospital Readmissions Reduction program will penalize 2499 hospitals for excessive readmissions in the coming year. That represents 47 percent of all hospitals covered by the program. The average penalty for the nearly 2500 hospitals will be a 0.64 percent reduction of their Medicare payments. Thirty-nine hospitals will suffer the maximum penalty: a three percent cut of their Medicare payments. Learn more about the effect the Hospital Readmissions Reduction Program has had on hospitals – and on patients admitted to the hospital with specific medical conditions – in the Kaiser Health News story “Medicare Punishes 2,499 Hospitals for High Readmissions.”

iqtsupport2021-11-01T06:00:12-04:00November 1, 2021|Medicare|

Medicare Beneficiaries Happier With Their Health Insurance Than Privately Insured

People who are enrolled in Medicare are happier with their health insurance than those with private health insurance, according to a recent JAMA report. Researchers found that the privately insured had a more difficult time finding doctors, were less likely to have a personal physician, had to deal with higher medical costs, were more likely to have medical debt, were more likely not to fill prescriptions because of their cost, and were less satisfied with their care than people insured by Medicare. The findings were true whether people purchased their own health insurance or had employer-sponsored insurance. Learn more about [...]

iqtsupport2021-06-03T06:00:26-04:00June 3, 2021|Medicaid, Medicare|

Federal Health Policy Update for Thursday, April 22

The following is the latest health policy news from the federal government as of 2:30 p.m. on Thursday, April 22. Department of Health and Human Services COVID-19 HHS’s Office of the Assistant Secretary for Preparedness and Response has published a new edition of its online publication The Exchange. The issue focuses on the work of hospital allied and supportive care providers during COVID-19 and is divided into three subjects: COVID-19 and acute hospital care, home care, and hospice; the role of allied health care professionals; and engineering and environmental support during COVID-19. For each subject the issue directs readers to [...]

iqtsupport2021-04-22T17:30:26-04:00April 22, 2021|Coronavirus, COVID-19, Medicare, Medicare regulations|

Can Medicare Feed its Way Out of Some Readmissions?

Feeding some Medicare patients after they are discharged from the hospital could reduce readmissions and save taxpayers millions, a new study has concluded. According to the new Bipartisan Policy Center report Next Steps in Chronic Care: Expanding Innovative Medicare Benefits, providing a limited number of free meals to certain Medicare patients could eliminate nearly 10,000 readmissions a year and save more than $57 million. Participating patients would be those with more than one of a limited number of chronic medical conditions and the meals would be for one week only. According to the report, more than 575,000 Medicare beneficiaries would [...]

iqtsupport2019-07-31T06:00:03-04:00July 31, 2019|Medicare|

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|

Mandatory Payment Models Coming to Medicare?

Even as CMS rolls out new, voluntary Medicare alternative payment models, it is contemplating making participation in future models mandatory rather than voluntary, as is currently the case. Or so Centers for Medicare & Medicaid Services administrator Seema Verma told a gathering in Baltimore last week. At the heart of the idea, Verma told her audience, is that while CMS is pleased with participation in voluntary accountable care organization models, organizations are choosing to participate in ACO models they think would benefit them most while posing little or no downside financial risk. The agency may need to move away from [...]

iqtsupport2019-05-02T06:00:59-04:00May 2, 2019|Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Medicare, Medicare reimbursement policy|

Primary Care Accounts for Little Medicare Spending

Spending for primary care services accounts for only about two percent of Medicare fee-for-service spending, a new study has found. Even when the concept of primary care is expanded to include services provided by nurse practitioners, physician assistants, geriatricians, and gynecologists, all of whom bill for primary care services, that figure rises only to 4.88 percent. The proportion of primary care spending falls as Medicare beneficiaries age, a reflection of their greater consumption of specialist, hospital, and surgical care as they get older. Primary care spending was even lower among Medicare-eligible African-American, Native American, Medicaid-eligible seniors, and individuals with chronic [...]

iqtsupport2019-04-24T06:00:20-04:00April 24, 2019|Medicare|

A New Trend: Tying Insurance Payments to Medicare Rates?

There may be a growing movement to tie some hospital payments directly to Medicare rates. Montana started doing it two years ago, linking payments for hospital services provided to state employees to Medicare rates. Oregon will start a similar program this fall. And now, North Carolina is laying plans for a similar approach while Delaware is considering doing so. Montana is paying an average of 234 percent of Medicare hospital rates. Oregon will pay 200 percent of Medicare rates. North Carolina is talking about paying Medicare rates plus 82 percent, with extra money for rural hospitals. Such an approach could [...]

iqtsupport2019-03-25T06:00:16-04:00March 25, 2019|Uncategorized|

OIG: Medicare Errs in Paying for Some Skilled Nursing Care

Medicare is erroneously paying for skilled nursing facility care for beneficiaries who did not spend three nights in an acute-care hospital, the U.S. Department of Health and Human Services’ Office of the Inspector General has concluded. Based on a limited sampling, the OIG estimates that Medicare spent $84 million on such ineligible services from 2013 through 2015. A new report from the OIG explains that We attribute the improper payments to the absence of a coordinated notification mechanism among the hospitals, beneficiaries, and SNFs to ensure compliance with the 3-day rule. We noted that hospitals did not always provide correct [...]

iqtsupport2019-02-28T06:00:33-05:00February 28, 2019|Medicare reimbursement policy|

Government More Effective Than Private Sector at Controlling Health Care Costs

For the past dozen years, Medicare and Medicaid have done a better job of controlling rising health care costs than private insurers. Since 2016, according to a new report from the Urban Institute, private insurers’ costs per enrolled member have risen an average of 4.4 percent a year. By contrast, Medicare costs have risen an average of 2.4 percent per enrollee and Medicaid costs have risen just 1.6 percent per enrollee. The primary driver of Medicare cost increases has been prescription drug spending. For Medicaid the primary driver has been physician services and administrative costs. For private insurers, the main [...]

iqtsupport2019-02-13T06:00:47-05:00February 13, 2019|Medicaid, Medicare|