Archive for November, 2016


MedPAC Meets

The Medicare Payment Advisory Commission met in Washington, D.C. last week to discuss a number of issues on which it is contemplating advising Congress.

Those issues were:

  • the role of Medicare policy in provider consolidation
  • stand-alone ERs
  • payments from drug and device manufacturers to physicians and teaching hospitals
  • determining benchmarks and beneficiary premiums under a premium support system for Medicare
  • Medicare outlier payments and hospital charging practices
  • Medicare Advantage: calculating benchmarks and coding intensity
  • population-based outcome measures: healthy days at home and potentially preventable admissions and ER visits

Go here to see the issue briefs and presentations associated with MedPAC commissioners’ discussions about these issues.…

States Exploring Deviations from ACA Standards

A number of states are considering pursuing waivers from selected requirements of the Affordable Care Act in the name of health care innovation.

Section 1332 of the 2010 health care reform law permits states, with federal approval, to implement different approaches to providing their residents with quality, affordable health care that fall outside the restrictions of Affordable Care Act requirements so long as those different approaches provide comparable coverage and do not increase federal costs.

These state innovation waivers, also commonly referred to as section 1332 waivers, are available to take effect as of January 1, 2017 and a number of states – Alaska, California, Hawaii, Minnesota, and Oklahoma – either have applied for waivers or appear to be on a path for doing so.

Learn more about efforts in those states in this Health Affairs Blog article and learn more about section 1332 waivers from this description on the web site of the Centers for Medicare & Medicaid Services.


Medicare Establishes 2017 Outpatient Payments

The Centers for Medicare & Medicaid Services has revealed how it will pay hospitals and doctors for outpatient care in 2017.

A new regulation calls for increasing outpatient payment rates 1.7 percent and ambulatory surgery center rates 1.9 percent.

In addition, the regulation adds new quality measures to existing outpatient quality reporting programs, removes pain management questions from patient satisfaction surveys, and introduces new standards designed to pay for medical care based on the kind of care being delivered rather than the setting in which that care is delivered.

Learn more about the 2017 outpatient prospective payment system in this CMS news release and fact sheet or here, by viewing the entire 1376-page regulation.…

More Evidence Supports Shortcomings of Medicare Readmissions Penalties

A new study supports the belief that Medicare’s hospital readmissions reduction program is unfair to hospitals that serve especially large numbers of low-income patients.

A study published in the journal Surgery found that hospitals that serve larger numbers of minority patients have higher 30-day and 90-day readmissions rates for patients who undergo colorectal surgery than other hospitals.

According to the study, 65 percent of the increased risk of readmission can be attributed to “patient factors,” as opposed to hospital factors, with study data suggesting that such factors include income, race, and insurance status.

For a closer look at the study and its finding, see this Fierce Healthcare report.