Archive for August, 2015


Changes Coming For Medicare Hospital-Acquired Condition Reduction Program

In response to the concerns of hospitals, Medicare is planning changes in its hospital-acquired condition reduction program.

The program, a product of the Affordable Care Act, penalizes hospitals that perform poorest on measures designed to identify medical problems their patients incur while hospitalized. Hospital performance is judged based on criteria developed by the Centers for Medicare & Medicaid Services (CMS).

In the face of criticisms about the program’s design, overlapping measures, and more, CMS now plans to share more information with hospitals about how it scores their performance and also will update some of the measures upon which those scores are based.

A recent article in the journal Health Affairs describes the hospital-acquired condition reduction program, the challenges it has faced, and CMS’s plans for it moving forward. Find that article here.…

Is Medicare “Pay for Performance” Doing the Job?

Three Medicare initiatives – its hospital readmissions reduction program, value-based purchasing program, and hospital-acquired condition program – were designed to improve the quality of care provided to beneficiaries while eventually reducing the cost of that care.

But are they living up to their billing? That is the question considered in the Health Affairs article “Assessing Medicare’s Hospital Pay-For-Performance Programs and Whether They Are Achieving Their Goals.” Find the article here.…

CMS Proposes New Medicaid Substance Abuse Initiatives

The Centers for Medicare & Medicaid Services (CMS) has announced a new initiative designed to improve how states identify and serve Medicaid beneficiaries with substances use disorders (SUD).

According to a recent notice sent by CMS to state Medicaid directors, the agency is proposing

… an opportunity to allow states embarking on broad and deep system transformations in the area of SUD to pursue 1115 demonstrations to improve the care and outcomes for individuals with SUD. This new initiative would be available to states that are developing comprehensive strategies to ensure a full continuum of services, focusing greater attention to integration efforts with primary care and mental health treatment, and working to deliver services that are considered promising practices or have fidelity to evidence-based models consistent with industry standards. In addition, we seek to support states that are interested in developing new payment mechanisms and performance quality initiatives…

The aim of this initiative is to enable states that are pursuing significant delivery system transformation efforts in the area of SUD to better identify individuals with an SUD in the Medicaid population, increase access to care for these individuals, increase provider capacity, to deliver effective treatments for SUD, and use quality

CMS: No New Home Health Agencies, Ambulance Services in Some Cities

The federal government is extending its current moratorium on new home health agencies serving Medicare beneficiaries in and around selected cities across the country.

The affected areas include the Chicago, Dallas, Detroit, Fort Lauderdale, Houston, and Miami metropolitan areas.

The purpose of the moratorium is to reduce the potential for fraud, waste, and abuse.

A similar moratorium on the introduction of new ambulance service providers has been extended in the Houston and Philadelphia areas.

In both cases, a moratorium against the introduction of these services was already in place. The new moratorium extends those bans another six months.

For further information on CMS’s decision, and the reasons underlying it, see this Federal Register notice.…