Archive for January, 2015


MedPAC Calls for Equalization of Some Post-Acute-Care Payments

The agency that advises Congress on Medicare payment policies has voted to recommend that Medicare equalize payments to skilled nursing facilities and inpatient rehabilitation facilities.

At a recent meeting in Washington, D.C., the Medicare Payment Advisory Commission (MedPAC) concluded that in areas where there is overlap in the services provided by different types of post-acute-care facilities, Medicare payments should be the same regardless of the facility where the services are provided.

Specifically, MedPAC voted to recommend that payments to skilled nursing facilities and inpatient rehabilitation facilities be the same for five orthopedic conditions and 17 other orthopedic, pulmonary, cardiac, and infection-related conditions.

MedPAC’s recommendations to Congress are advisory only and are not binding either on Congress or the Centers for Medicare & Medicaid Services, which sets Medicare payment policies.

See the MedPAC issue brief on this subject here and the presentation made to MedPAC members here.…

MedPAC Mulls Payment Per Beneficiary for Primary Care

At a recent meeting of the Medicare Payment Advisory Commission (MedPAC), commission members discussed the inadequacy of Medicare payments to providers for primary care and considered a proposal to recommend to Congress that primary care physicians receive a “per beneficiary” payment to enhance that reimbursement.

The commissioners, who advise Congress on Medicare payment matters, continue to be concerned that Medicare does not pay primary care providers adequately or fairly.

See the MedPAC issue brief on this matter here and see the presentation offered at the recent MedPAC meeting here.…

Medicare Seeks to Put Pedal to the Metal on Quality-Related Payments and Care

The federal government has unveiled its intention to pursue a significant increase in the proportion of Medicare services for which it pays based on the quality of care delivered than the quantity of care provided.

The plan was announced on Monday by Health and Human Services (HHS) Secretary Sylvia Burwell at an event in Washington, D.C.

According to an HHS news release,

HHS has set a goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50 percent of payments to these models by the end of 2018.  HHS also set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018 through programs such as the Hospital Value Based Purchasing and the Hospital Readmissions Reduction Programs.

To support this endeavor, according to the news release,

…Secretary Burwell also announced the creation of a Health Care Payment Learning and Action Network.  Through the Learning and Action Network, HHS will work with private payers, employers, consumers, providers, states and state Medicaid programs, and other

Medicare Giveth and Medicare Taketh Away

With a growing number of Medicare programs basing portions of future reimbursement on meeting specific performance metrics, hospitals are finding that they need a scorecard to keep track of their successes and failures.

Medicare’s value-based purchasing program, for example, is rewarding 1700 hospitals this year for their performance under the program.  Another 1360 hospitals are being penalized under the program.

But among those 1700 winners, fewer than 800 will see their bonuses because their losses under Medicare’s hospital readmissions reduction program and health care-associated infection program exceed their value-based purchasing winnings.

Overall, the average bonus for large hospitals for the three programs combined is nearly $213,000 while the average penalty for such hospitals is approximately $1.2 million.  For hospitals with 200 or fewer beds, the average bonus is about $32,000 and the average penalty approximately $131,000.

And that does not include the six percent of hospitals that face new penalties for failing to make enough progress in their transition to electronic health records.

For a closer look at how hospitals are faring under Medicare’s various performance-based program, as well as a state-by-state breakdown of how their hospitals are faring, see this Kaiser Health News story.…

Medicaid “Pay Bump” Worked, New Study Suggests

A federally mandated increase in Medicaid payments for primary care services appears to have achieved its goal of improving access to care for Medicaid recipients.

The increase, part of the Affordable Care Act, called for raising payments for Medicaid primary care services to the same level as Medicare payments in the hope that such an increase would lead more primary care providers to serve Medicaid patients, thereby improving access to primary care services for those patients.  Historically, primary care providers have been reluctant to serve Medicaid patients, citing low pay as their reason for avoiding such patients.

That Medicaid pay increase – often referred to as the “Medicaid pay bump” – was mandated for two years and expired at the end of 2014.  One of the reasons policy-makers resisted extending it was the lack of proof that it achieved its goal of improving access.  Now, a new study in the New England Journal of Medicine provides the first broad look at the program’s impact – and the first proof of its success.

In the study, researchers selected ten states and measured the availability and waiting times for primary care appointments for two limited periods of time.  They found that