Archive for Medicare disproportionate share

 

MedPAC Offers DSH, 340B Recommendations

The Medicare Payment Advisory Commission has recommended that Congress direct changes in the 340B prescription drug discount program and in the manner in which Medicare makes disproportionate share hospital payments (Medicare DSH).

In its annual report to Congress, MedPAC recommended a reduction in 340B prescription drug payments to hospitals. The proposed reduction would cut 340B program spending approximately $300 million.

MedPAC then recommended that those 340B savings be redirected to the Medicare DSH uncompensated care pool.

And it also called for distributing the money in that pool based on better data on the uncompensated care hospitals provide, as reported on hospitals’ Medicare cost report S-10 worksheets, so that the Medicare DSH uncompensated care program would “…better target additional payments to hospitals that provide above average shares of uncompensated care.”

To learn more about these and other MedPAC recommendations, see the news release that accompanied the MedPAC report to Congress; a fact sheet on that report; and the report itself.…

DSH/340B Hospitals Have Lower Medicare Drug Costs

Medicare disproportionate share (Medicare DSH) hospitals that qualify for the federal 340B prescription drug discount program have lower Medicare Part B drug costs than other Medicare providers.

So concludes a new study performed for 340B Health, an association that represents more 1100 public and non-profit hospitals and health systems that participate in the 340B drug pricing program.

According to the organization 340B Health,

Medicare pays disproportionate share hospitals in the 340B drug discount program on average 13 percent less for separately payable drugs reimbursed through Medicare Part B. This is in comparison to what it pays other hospitals and physician practices in the Part B market. The study also shows that 340B DSH hospitals are treating more vulnerable patients than other providers in terms of race, age, disability, and dual eligibility.

The study also found that 340B-eligible hospitals are

  • Nearly four times as likely as non-340B providers to treat patients with end-stage renal disease
  • More than twice as likely to treat patients dually eligible for Medicare and Medicaid
  • More than twice as likely to treat patients who are disabled
  • More than twice as likely to treat Black, Hispanic, and North American Native patients

For a closer look at the study …

One State’s Battle With DSH Cuts

Hospitals across the country are concerned about the degree to which the Affordable Care Act is reducing the Medicare disproportionate share hospital (Medicare DSH) payments that help underwrite the cost of the care they provide to uninsured patients.

Those in states that have expanded their Medicaid programs are now receiving payments for at least some of those formerly uninsured patients because those individuals are now enrolled in Medicaid. In states that did not expand their Medicaid programs, however, hospitals face challenges coming from two directions: reduced Medicare DSH payments without the benefit of some of those uninsured patients enrolling in Medicaid.

The state of Louisiana has not expanded its Medicaid program, and now, policy-makers there are faced with the question of how to finance their unexpanded Medicaid program in the face of reduced – and falling – Medicare DSH revenue.

Read more about the challenges that state faces and the role of Medicare DSH cuts in those challenges in this article from the Times-Picayune.…

Proposed FY 2016 Medicare Payment Regulation Released

The Centers for Medicare & Medicaid Services (CMS) has released its proposed Medicare inpatient prospective payment system regulation for FY 2016.

Among the Medicare issues addressed in detail in the 1500-page draft regulation are:

  • inpatient payment rates
  • bundled payments
  • Medicare disproportionate share hospital payments (Medicare DSH)
  • quality reporting requirements
  • the value-based purchasing program
  • the hospital-acquired conditions program
  • the hospital readmissions reduction program
  • the two-midnight rule
  • wage index adjustments

Learn more about the proposed regulation in this CMS fact sheet and find a link to the entire proposed regulation as well.…

Medicare Payment Rule FY 2015: Inpatient Rates to Rise 1.4 Percent

Medicare inpatient rates will increase 1.4 percent in FY 2015.

But the already-shrinking Medicare disproportionate share (Medicare DSH) pool will be $900 million smaller than proposed in April.

These and other payment policies were included in the recently unveiled Medicare inpatient prospective payment system regulation for FY 2015.

The new regulation, to be published shortly in the Federal Register, also addresses changes in Medicare’s value-based purchasing program, hospital readmissions reduction program, and outlier threshold and introduces Medicare’s new hospital-acquired conditions program and changes in hospitals’ Medicare area wage indexes.

DeBrunner & Associates can provide projections detailing the anticipated impact of all of these changes on individual acute-care hospitals.  To receive this information, hit the “contact us” link in the upper right-hand portion of this screen and direct your request to Ellen Kugler, DeBrunner & Associates’ managing director.  To see the regulation itself go here and for a Reuters report on the regulation go here.…