Archive for Medicare regulations


Docs Not Scoring Performance Bonuses

Relatively few physicians will receive Medicare pay-for-performance bonuses under Medicare’s value-based modifier program in 2018.

The question now is whether this is because of uninspiring performance or indifference to the program.

Of the approximately 1.1 million clinicians who participate in Medicare, only two percent – 22,000 – will receive pay increases in 2018 based on their 2016 performance.  Those raises will range from 6.6 percent to 19.9 percent.

Most doctors will receive neither bonuses nor penalties.

And roughly 300,000 failed to submit the data required by the program.  In the past they would have been penalized for this failure but that penalty was eliminated for what is now the final year of the program.

Medicare now moves to a new merit-based incentive payment system – and this program, even though it is just beginning, has already been targeted for elimination by the Medicare Payment Advisory Commission.  MedPAC recommended eliminating the new program, known as MIPS, at its meeting earlier this month.

Learn more about physician performance under the value-based modifier program from this CMS fact sheet.…

E&C Calls for Action on 340B

The section 340B prescription drug program has flaws and needs change, a report by the House Energy and Commerce Committee has concluded.

The program, which requires pharmaceutical companies to provide discounts on prescription drugs to be dispensed on an outpatient basis to qualified providers that serve large numbers of low-income patients, has been controversial in recent years.  As the number of providers eligible for the program has grown, pharmaceutical companies have claimed that the program is expensive, is being abused, and is responsible for driving up prescription drug costs while providers insist that 340B is a vital tool in helping them serve low-income patients.  Congress, meanwhile, has questioned the program’s growth and sought accountability for how providers use the savings the program generates to serve their low-income patients.

The controversy moved into a new area in the fall when the Centers for Medicare & Medicaid Services adopted a regulation greatly reducing 340B payments to providers – even though the federal government does not pay for the drug discounts – and seeking to move savings elsewhere in the federal budget.  A coalition of providers sued unsuccessfully to delay implementation of the regulation.

Now, the House Energy and Commerce Committee has issued …

Reduced Hospitalizations and Improved Care for High-Risk Patients Not Driving ACO Savings

Medicare savings reported in the early years of the Medicare Shared Savings Program are not coming from reduced hospitalizations of high-risk Medicare patients or even through better coordination of care for those patients.

Instead, Medicare accountable care organization savings are coming mostly from better and more coordinated care for low-risks Medicare ACO participants.

These surprising findings are reported in the article “Medicare ACO Program Savings Not Tied To Preventable Hospitalizations Or Concentrated Among High-Risk Patients,” which can be found in the December 2017 edition of the journal Health Affairs.  Find a link to that article here.…

Hospitals, Trade Groups Differ on Supervision Requirements

According to provider representatives and trade groups, the requirement that physicians supervise the administration of outpatient therapeutic services to Medicare patients in critical access and small rural hospitals is onerous and could limit patient access to such services.

The people who run those hospitals don’t agree.

That is the conclusion reached by the Medicare Payment Advisory Commission, which looked into the matter after Congress overturned a Centers for Medicare & Medicaid Services supervision requirement in the 21st Century Cures Act because, as MedPAC observed,

CAH and rural hospital representatives…expressed concerns that, because they have difficulty recruiting physicians to practice in rural areas, the direct supervision requirement may limit beneficiary access to care in their hospitals.

But after investigating, primarily by interviewing critical access and small rural hospital officials, MedPAC concluded that

We did not hear from the CAHs that the supervision requirements cause a significant economic burden.   The CAHs have put in place processes with current staff to offer what they believe to be the appropriate supervision…

 MedPAC reported its findings in a new report to Congress.  Go here to see the MedPAC report Physician Supervision Requirements in Critical Access Hospitals and Small Rural Hospitals.…

CMS Publishes Quality Measures Under Consideration for 2018

The Centers for Medicare & Medicaid Services has published a list of quality measures it is considering implementing in Medicare quality programs in the coming year.

The list consists of 32 proposed measures, down significantly from the nearly 100 it proposed last year.  These measures are subject to comment by the National Quality Forum and stakeholders.

Go here to see a commentary from CMS explaining what it hopes to accomplish and how it is pursuing those goals and go here to see a CMS document presenting the 32 proposed quality measures.…