Archive for October, 2019


Azar: More Value-Based Care Coming

Medicare may add more value-based care initiatives and alternative payment models to those it already operates, Health and Human Services Secretary Alex Azar suggested at a recent event in Washington, D.C.

During his remarks, Azar spoke about population health benefits, global budgeting for Medicare patients, more primary care programs, and new models that address kidney care and opioid use and hinted at future efforts that address social determinants of health.

Learn more about Azar’s remarks about Medicare value-based purchasing and alternative payment models and other current federal health policy matters in the Healthcare Dive article “HHS chief keeps focus on alternative payment models.”

Verma Hints at More Medicaid Changes, Deregulation

Stay tuned for more Medicaid changes, Centers for Medicare & Medicaid Services administrator Seema Verma told a Las Vegas health care gathering last week.

CMS, she told her audience, will

…soon outline new opportunities for states to flip the Medicaid paradigm and free themselves from federal micromanagement.

While Verma offered few details, one idea clearly emerged:  there will be more deregulation.  She insisted, for example, that Medicaid work requirements are not dead.  While such requirements have run into trouble in the courts in recent months, she explained that CMS is developing new implementation guidelines to address some of the challenges states have faced when introducing such requirements and made it clear that CMS would continue to approve state requests to require their Medicaid population to work or engage in volunteer activities.

Learn more about Verma’s remarks and the context in which they were offered in the Healthcare Dive article “CMS chief Verma teases more Medicaid deregulation.”

More Hospitals Gain Than Lose in FY 2020 Value-Based Purchasing Program

Medicare’s value-based purchasing program will reward more hospitals than it will penalize in FY 2020 through its value-based purchasing program.

The program, in which 2700 hospitals are scored in four domains – clinical outcomes, safety, person and community engagement, and efficiency and cost reduction – will distribute $1.9 billion in bonus payments to 1500 hospitals.

Bonus payment average 0.6 percent, with a high of 2.93 percent.  Penalties average -0.39 percent, with a high of -1.72 percent.

Overall, rural hospitals performed better in the safety, person and community engagement, and efficiency and cost reduction categories and had a higher average score nation-wide while urban hospitals produced better clinical outcomes.  Smaller hospitals performed better in safety, person and community engagement, and efficiency and cost reduction.

Hospitals can find a link to their own adjustments here.

Learn more about how Medicare’s value-based purchasing program works and how hospitals will fare in FY 2020 in this CMS fact sheet.…

Tools for Controlling Cost Growth Limited

Employers and insurers sometimes have limited means of reducing growth in health care costs, a new study has found.

While hospitals can take incremental steps to manage rising costs, those efforts will be outstripped in geographic markets that have undergone a great deal of consolidation, according to a new analysis from the Georgetown University Health Policy Institute.

In areas of such consolidation, the study found, insurers can be reluctant to negotiate hard with hospitals and health systems or to threaten to exclude those providers from their networks and businesses, rather than backing insurers or pressuring providers, are more likely to attempt to shift greater portions of rising health insurance premiums to their employees.  Enforcement of anti-trust laws in areas of hospital consolidation has been limited, and of limited effectiveness, the study also found.

Learn more about the impact of hospital consolidation of rising health care costs in the Georgetown University Health Policy Institute study “Assessing Responses to Increased Provider Consolidation.”

Hospitals Advocate Losing Chargemaster

Hospitals would no longer need to post their chargemaster prices under a new approach to Medicare payments being advocated by a new hospital lobbying group.

The small group, calling itself the Chargemaster Alternatives for Medicare Payment Alliance, wants Medicare to eliminate payment formulas based on chargemaster prices and base them instead on actual costs.  Acting in response to a new proposal that hospitals be required to post their chargemaster prices, the group argues that chargemaster prices are irrelevant for all but a few consumers.

Learn more about the group, its members, and its argument for ending use of chargemaster prices in determining Medicare rates in the Axios article “Hospitals lobbying to change Medicare’s pay formulas.”