Interested in addressing legal obstacles that prevent providers from participating in innovative payment models, the Centers for Medicare & Medicaid Services has put out a call for stakeholders to address challenges raised by the so-called Stark law that makes it difficult for physicians to participate in such models.

In a news release accompanying CMS’s publication of its request for information, the agency notes that

Over the past year, CMS has engaged with the provider community in a discussion about regulatory burden issues. This included publishing a Request for Information (RFI) soliciting comments about areas of high regulatory burden. One of the top areas of burden identified in the over 2,600 comments received was compliance with the Stark Law and its accompanying regulations.

The news release also explains that

“We are looking for information and bold ideas on how to change the existing regulations to reduce provider burden and put patients in the driver’s seat,” said CMS Administrator Seema Verma. “Dealing with the burden of the physician self-referral law is one of our top priorities as we move towards a health care system that pays for value rather than volume.” 

In general, the Stark law prohibits physicians from referring patients to …

Aspects of a proposed reorganization of the federal government could affect the agencies that administer key health care programs.

In its 132-page Delivering Government Solutions in the 21^st Century:  Reform Plan and Reorganization Recommendations proposal, the White House calls for consolidating many social safety-net programs in a new Department of Health and Public Welfare.  This department would retain responsibility for Medicare and Medicaid but also would assume responsibility for some food aid programs, including food stamps (now the Supplemental Food Assistance Program, or SNAP).

In addition, the proposal would:

• consolidate all health research programs in the National Institutes of Health, including the Agency for Healthcare Research and Quality, the National Institute for Occupational Safety and Health, and the National Institute on Disability, Independent Living, and Rehabilitation Research;
• reduce the U.S. Public Health Service Commissioned Corps from 6500 to no more than 4000 officers; and
• remove food safety responsibilities from the Food and Drug Administration, change that agency’s name to the Federal Drug Administration, and shift food safety responsibilities to the Department of Agriculture.

Also part of this Department of Health and Public Welfare would be a new Council on Public Assistance that would ostensibly become the executive branch’s welfare …

The Centers for Medicare & Medicaid Services had introduced a new “Medicaid scorecard” that the agency says it hopes will “…increase public transparency about the programs’ administration and outcomes.”

The scorecard, now posted on the Medicaid web site, presents information and data from the federal government, and reported voluntarily by the states, in three areas:  state health system performance, state administrative accountability, and federal administrative accountability.

The scorecard currently offers information on selected health and program indicators.  Visitors can see comparative data between states and also extensive information about individual state Medicaid programs, including eligibility criteria, enrollment, quality performance, and key state documents such as state plan amendments, waivers, and managed care program overviews.  The site also presents individual state and comparative state performance based on a variety of metrics while also reporting on federal turnaround time on matters such as waiver requests and rate reviews.  CMS envisions the scorecard evolving from year to year by offering more and different information.

Go here to see a CMS fact sheet on the new Medicaid scorecard and go here to visit the scorecard’s home page.…

A recent study concluded that hospitals can expect to lose about $218 billion in federal Medicare and Medicaid payments between 2010, when the latest round of major cuts began, and 2028.

Among those cuts cited in the study, which was commissioned by the American Hospital Association and the Federation of American Hospitals, are:

• $79 billion for DRG documentation and coding adjustments
• $73 billion for Medicare sequestration
• $26 billion for Medicaid disproportionate share payments (Medicaid DSH)
• $11 billion in cuts associated with the American Taxpayer Relief Act of 2012

Other cuts came, or will be coming, through regulatory changes, the introduction of value-based payment programs, and other means.

Learn more about these cuts and their potential implications in this Healthcare Dive story.

 …

The recent growth in the number of uninsured Americans could be especially harmful to non-profit hospitals and health systems, according to S&P Global Ratings.

As reported by Healthcare Dive, S&P believes that because non-profit hospitals serve larger proportions of uninsured patients, they are more vulnerable to increases in the number of uninsured people.  Healthcare Dive also notes that

In particular, S&P warns of a credit negative for nonprofits as patients who started in a care plan with health insurance seek to continue treatment without it.  Many hospitals already are struggling as volumes and reimbursement decline and more care shifts to outpatient settings.

S&P anticipates higher levels of bad debt for hospitals in the near future.

Learn more about some of the challenges non-profit hospitals may soon face in this Healthcare Dive article.

 …