Archive for Medicare regulations

 

MedPAC Mulls Uniform Outcome Measures to Complement Unified Post-Acute Payments

In support of its proposal that Medicare adopt a unified payment system for post-acute-care services, the Medicare Payment Advisory Commission is exploring how to develop uniform outcome measures to support such a new payment system.

Under the MedPAC vision, articulated at its early April public meeting, skilled nursing facilities, home health agencies, long-term-care hospitals, and inpatient rehabilitation facilities would see their outcomes quantified based on their performance on a series of quality measures.

Meanwhile, there has been little congressional interest in the unified post-acute payment proposal so far.  While some aspects of such a proposal could be implemented administratively, the comprehensive system would require legislation.

Learn more about the Medicare uniform outcomes measures proposal, the unified post-acute care payment proposal, how they interact, and the prospects for both from this article in Provider magazine.…

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 are not binding on either Congress or the administration, its views are highly respected and often find their way into future Medicare policy development efforts.

Learn more about the MedPAC recommendation on Medicare payments to freestanding ERs and the reasons behind it in this Kaiser Health News report.

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MedPAC Meets

The Medicare Payment Advisory Commission met last week in Washington, D.C. to address a number of Medicare reimbursement-related issues.

Among the subjects on MedPAC’s agenda were:

  • using payments to ensure appropriate access to and use of hospital emergency department services
  • uniform outcome measures for post-acute care
  • applying MedPAC’s principles for measuring quality: hospital quality incentives
  • Medicare coverage policy and use of low-value care
  • long-term issues confronting Medicare accountable care organizations
  • managed care plans for dual-eligible beneficiaries

While MedPAC’s policy and payment recommendations are not binding on Congress or the administration, its views are respected and influential and often become the basis for new public policy.

Go here to see the policy briefs and presentations offered to help guide MedPAC commissioners’ discussions about these and other issues.…

CMS Reports on Quality Measures Performance

The Centers for Medicare & Medicaid Services has published a new report detailing the progress of health care providers in meeting Medicare quality standards and improving their performance under those standards.

The report, required every three years, focuses on 17 key indicators of quality in the delivery of health care as defined by 247 individual quality measures.

The analysis found that:

  • 670,000 patients improved their control of their blood pressure
  • 510,000 fewer patients have poor control of their diabetes
  • 12,000 fewer people died following hospitalization for a heart attack
  • there were 70,000 fewer unplanned hospital readmissions
  • nursing home residents suffered 840,000 fewer pressure ulcers

In addition, the study reported cost savings associated with better compliance with quality standards, including:

  • $4.2 billion to $26.9 billion saved because of better compliance with medication instructions
  • $2.8 billion to $20 billion saved through fewer treatments for pressure ulcers
  • $6.5 billion to $10.4 billion saved because patients manage their diabetes more effectively

The study also looks hospital and nursing home performance variations based on race and ethnicity, income, sex, urbanicity, region, and age for many quality measures.

Learn more about Medicare’s quality measures and how hospitals and nursing homes are performing under these measures in …

Readmissions Program Working; Expansion in Order?

The Medicare hospital readmissions reduction program is working, according to the Medicare Payment Advisory Commission.

And it may even be worth expanding to additional medical conditions, MedPAC members believe.

According to MedPAC, hospital readmissions among patients with medical conditions covered by the readmissions reduction program have declined faster than readmissions among patients with medical conditions not covered by the program, suggesting that expanding the program to additional medical conditions could lead to an even greater reduction in the number of avoidable Medicare-covered readmissions.

Learn more about changes in the readmission rate since the readmissions reduction program was introduced and whether those reductions can accurately be attributed to the program this MedPage Today article.…