Medicare

MedPAC to Congress: Cut Payments to Freestanding Emergency Facilities

The Medicare Payment Advisory Commission has urged Congress to reduce Medicare payments to freestanding emergency departments 30 percent. The recommendation, approved by MedPAC earlier this month and to be included in its June report to Congress, notes that such facilities have a lower cost structure because they typically lack some of the equipment, personnel, and standby capabilities of hospital ERs. In making its recommendation, MedPAC also noted that freestanding ERs typically treat patients whose conditions are not as severe as hospital ERs and tend to be located in areas that already have adequate access to hospital ERs. While MedPAC’s recommendations [...]

iqtsupport2018-04-17T13:33:12-04:00April 17, 2018|hospitals, Medicare regulations, MedPAC|

Administration Slows Movement Toward Medicare Quality Payments

The Trump administration is slowing Medicare’s movement toward making greater use of quality in its payment system. The Obama administration’s goal of having 50 percent of Medicare payments made through a quality or alternative payment model by the end of 2018 now appears to be out of sight. Instead, the Centers for Medicare & Medicaid Services has partially canceled two bundled payment programs – one for joint replacement and another for cardiac rehabilitation programs – and announced that before introducing new programs it wants to take a closer look at the successes and failures of the alternative payment model programs [...]

iqtsupport2018-02-20T10:26:50-05:00February 20, 2018|Centers for Medicare & Medicaid Services, Medicare|

CMS Unveils New Bundled Payment Program

The Centers for Medicare & Medicaid Services has announced the launch of a new bundled payment model called “Bundled Payments for Care Improvement Advanced.” Under this new program – participation in which will be voluntary – participants can, as CMS explains …earn additional payment if all expenditures for a beneficiary’s episode of care are under a spending target that factors in quality. The following are a few highlights of BPCI Advanced. It encompasses 32 types of clinical episodes (29 inpatient and three outpatient). These episodes, of 90 days, may change in the future. Participating providers can waive the Medicare requirement [...]

iqtsupport2018-01-11T06:00:30-05:00January 11, 2018|Centers for Medicare & Medicaid Services, Medicare|

GAO Urges Medicare Action on Opioids

The Centers for Medicare & Medicaid Services is not doing enough to oversee the prescribing of opioids to Medicare beneficiaries. Or so concludes the U.S. Government Accountability Office. According to the GAO, CMS provides guidance to Medicare drug plans “…but does not analyze data specifically on opioids.” Also, according to the GAO, …CMS does not identify providers who may be inappropriately prescribing large amounts of opioids separately from other drugs, and does not require plan sponsors to report actions they take when they identify such providers. As a result, CMS is lacking information that it could use to assess how [...]

iqtsupport2017-11-13T06:00:13-05:00November 13, 2017|Medicare|

Medicare ACOs Showing Promise

Medicare’s Shared Savings Program and its accountable care organizations are showing promise as a means of reducing Medicare spending and improving the quality or care. Or so concludes the U.S. Department of Health and Human Services’ Office of the Inspector General. According to a new OIG report, Over the first 3 years of the program, 428 participating Shared Savings Program ACOs served 9.7 million beneficiaries. During that time, most of these ACOs reduced Medicare spending compared to their benchmarks, achieving a net spending reduction of nearly $1 billion. At the same time, ACOs generally improved the quality of care they [...]

iqtsupport2017-09-07T06:00:13-04:00September 7, 2017|Accountable Care Organization, ACO, Medicare|

Temporarily Gone But Not Forgotten

While last week’s withdrawal of the American Health Care Act at least temporarily halted talk of immediate repeal and replacement of the Affordable Care Act, at least one aspect of that proposed legislation, often discussed in the past, is sure to arise in the future as well: replacing the current manner in which the federal government matches state Medicaid funding with Medicaid per capita limits or Medicaid block grants. In a new issue brief, the Kaiser Family Foundation examines how a switch to per capita limits or block grants might affect low-income seniors served by both Medicare and Medicaid. Among [...]

iqtsupport2017-03-29T06:00:07-04:00March 29, 2017|Medicaid, Medicare|