Chronic Care Program Shows Early Encouraging Results

Medicare’s chronic care management program appears to be reducing the cost of caring for participants while improving their quality of life.

The program, which pays physicians for non-face-to-face services they provided to coordinate care for their Medicare patients with at least two chronic medical conditions, was introduced in 2015.  An analysis of its performance found that payments of up to $50 a month

…improved patient satisfaction and adherence to recommended therapies, improved clinician efficiency, and decreased hospitalizations and emergency department (ED) visits.

While Medicare paid roughly $52 million in chronic care management fees during the initial program period, the program produced a net savings of $36 million, mostly because patients needed less inpatient and outpatient care.

Learn more about Medicare’s chronic care management program and its initial impact on patient health and Medicare costs in the report Evaluation of the Diffusion and Impact of the Chronic Care Management Services:  Final Report, which can be found here.…

GAO: CMS Needs to Do Better Job on Demonstration Evaluations

The federal government needs to do a better job of evaluating Medicaid demonstration programs, according to the U.S. Government Accountability Office.

Demonstration programs, on which the federal government spends more than $300 billion a year, exempt states from selected federal Medicaid requirements and regulations so they can test new approaches to providing and paying for care for their Medicaid population.  As part of waiving these requirements, the Centers for Medicare & Medicaid Services requires the states to perform or commission evaluations of the effectiveness of those new approaches.

According to a new GAO study, however, those reports are not always performed in a timely manner, are sometimes too limited in scope, and their results are not sufficiently publicized so that others may learn lessons from the demonstration.  The GAO recommended that CMS establish written procedures for such matter and CMS agreed with this recommendation.

Learn more about the GAO’s review of Medicaid demonstration program evaluations in the GAO report Medicaid Demonstrations:  Evaluations Yielded Limited Results, Underscoring Need for Changes to Federal Policies and Procedures, which can be found here.…

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 that have been implemented in recent years.

The Washington Post’s “The Health 202” feature offers an in-depth look at CMS’s current approach to Medicare quality programs and reimbursement system changes.  See it here.…

Senators Push IRS on Non-Profit Compliance

Two prominent senators have written to the Internal Revenue Service seeking information about what the agency is doing to ensure that non-profit hospitals comply with the requirements for providing sufficient community benefits to justify their tax-exempt status.

 Senators Orrin Hatch (R-UT), chairman of the Senate Finance Committee, and Chuck Grassley (R-IA), a senior member of that committee, have asked the IRS to provide their committee with specific information about how the IRS evaluates non-profit hospitals’ Form 990 Schedule H; about guidance the IRS provides regarding how hospitals define their communities and their communities’ needs; about the performance and outcome of IRS reviews of individual non-profit hospitals’ compliance with legal tax-exemption requirements; and about the status of the IRS’s anticipated report to Congress on tax-exempt and public hospitals.

Go here to see the senators’ news release about their letter and the letter itself.…

Physician-Owned Hospitals Returning?

In testimony before the House Ways and Means Committee, new Health and Human Services Secretary Alex Azar indicated that he may be receptive to easing restrictions on physician-owned hospitals.

The Affordable Care Act made it difficult for doctors either to launch new hospitals of their own or to expand physician-owned hospitals already in operation, and many existing physician-owned facilities stopped serving Medicare patients.  In response to a question from a committee member, Azar expressed his interest in working to enable physician-owned hospitals to operate.

Learn more from this Fierce Healthcare article.…