Archive for Medicare


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.…

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.…

Lowering Prescription Drug Costs

Shifting Medicare Part B drug coverage into Medicare Part D.

Reducing Medicare Part D co-pays for generic drugs.

Increasing the number of pharmacy benefit managers.

Establishing expedited review for new versions of brand-name drugs.

Tying U.S. drug prices to prices paid for the same drugs in other countries.

Using U.S. trade policies to compel other countries to pay more for American pharmaceutical products.

These are among the ideas presented in a new report by the White House Council of Economic Advisers detailing steps that might be taken to reduce prescription drug prices in the U.S.

To learn more about these and other ideas, go here to see the White House Council of Economic Advisers report Reforming Biopharmaceutical Pricing at Home and Abroad.…

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.…

Safety-Net Hospitals Under the Gun

Safety-net hospitals across the country face a new challenge:  adjusting to several cuts in the supplemental payments they receive from the federal government to help them serve the low-income residents of the communities in which they are located.

First there is a $2 billion cut in Medicaid disproportionate share hospital payments (Medicaid DSH).  These are payments made to hospitals that serve especially large numbers of low-income patients.  These payments help safety-net hospitals with the unreimbursed expenses they incur caring for such patients.  This cut, mandated by the Affordable Care Act but twice delayed by Congress, took effect on January 1.  In many states the value of Medicaid DSH cuts will exceed the reductions in uninsured care that hospitals have experienced since the Affordable Care Act made health insurance more widely available.

Second there is a 28 percent cut in Medicare payments for prescription drugs dispensed through the section 340B prescription drug discount program.  This cut, too, took effect on January 1.

Finally, federal funding has lapsed for the Children’s Health Insurance Program (CHIP) and for community health centers.

Safety-net hospitals are considering a number of moves to offset these losses.  Among them:  reducing or eliminating services, laying off staff, discontinuing …