Archive for Medicare


Study Raises Questions About Progress Toward Reducing Readmissions

A new study suggests that the reduction in hospital readmissions of recent years may not be as meaningful a reflection of improved quality of care as some observers believe.

According to a new study published in the New England Journal of Medicine, at the same time that hospitals have reduced their readmissions of Medicare patients in response to penalties imposed through Medicare’s hospital readmissions reduction program, the rate of readmission of patients who are hospitalized for observation stays after visiting the emergency room has increased 35 percent.  This increase in readmissions for observation stay patients comes at a time, moreover, when hospitals are making far greater use of observation stays to serve emergency patients than they did in the past.

Learn more about these new findings and their potential implications in the study “Excluding Observation Stays From Readmission Rates – What Quality Measures are Missing,” which can be found here, or go here for a Fierce Healthcare summary.


Medicare Model Program Improved Care But Didn’t Lower Costs

A federal program that tested a new approach to the delivery of Medicare services to high-risk patients delivered on its promise to improve the quality of care for patients but did not reduce the cost of caring for those patients.

The Centers for Medicare & Medicaid Services’ Comprehensive Primary Care Initiative improved access to care for patients in more than 500 participating medical practices and reduced their ER visits two percent but did not reduce Medicare’s cost for caring for these patients.  After several years in effect the program, which features enhanced care management for high-risk patients, improved coordination of care, and enhanced access to services, also achieved more timely post-discharge care.

A significant majority of participating doctors, while observing that the program’s reporting requirements were burdensome, also believed that the program improve the quality of care.

Learn more about this evaluation of Medicare’s Comprehensive Primary Care Initiative here, in the Health Affairs report “The Comprehensive Primary Care Initiative: Effects On Spending, Quality, Patients, And Physicians,” or go here for a summary of the report on the Healthcare Dive web site.…

HHS Unveils Spring Regulatory Agenda

The U.S. Department of Health and Human Services has published a comprehensive list of the regulatory actions it plans to take in the coming months.

Included on the list are regulations that have been proposed, that are being finalized, and that are currently under development.  They address Medicare, Medicaid, Food and Drug Administration endeavors, medical devices, the 340B prescription drug discount program, and more.

Among the policy changes contemplated through future regulations are measures to reduce regulatory burdens for hospitals, address the opioid problem, facilitate the use of non-Affordable Care Act-compliant health insurance plans, and more.

Go here to see a complete list of the areas for proposed regulatory action by HHS and for links to brief statements about the contemplated actions.…

Time to Raise the Bar on Preventable Hospital Readmissions?

A new report suggests that hospitals can have the greatest impact on reducing preventable readmissions within seven days of discharge and not through the 30-day mark at which they are currently judged by Medicare.

According to a study published in the Annals of Internal Medicine,

Early readmissions were more likely to be preventable and amenable to hospital-based interventions.  Late readmissions were less likely to be preventable and were more amenable to ambulatory and home-based interventions.

The study, conducted at 10 academic medical centers and involving more than 800 of their patients who had been readmitted to the hospital, concludes that readmissions within seven days may more accurately reflect the quality of care hospitals provide than the 30-day measure applied by Medicare’s hospital readmissions reduction program.

To learn more about the report, its findings, and their implications, go here, to the web site of the Annals of Internal Medicine, to see the study “Preventability of Early Versus Late Hospital Readmissions in a National Cohort of General Medicine Patients.”…

CMS Mulls Direct Provider Contracting for Medicare

The Centers for Medicare & Medicaid Services is seeking public input on a proposal to permit Medicare beneficiaries to enter into direct contracts with primary care and multi-specialty providers.

According to CMS,

A DPC [direct provider contracting] model would aim to enhance the beneficiary-physician relationship by providing a platform for physician group practices to provide flexible, accessible, and high quality care to beneficiaries that have actively chosen this type of care model.

The request for information, issued earlier this week, seeks public input on experience with direct provider contracting and asks interested parties to describe how Medicare might structure such a model, including addressing considerations such as provider and state participation, beneficiary participation, payments, program integrity, and beneficiary protection.

Comments are due May 25.

To learn more about the CMS request for information, a news release describing the request, and a copy of the RFI itself, go here.