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MedPAC Weighs in on Proposed Medicare Payment Changes

The Medicare Payment Advisory Commission has submitted formal comments to the Centers for Medicare & Medicaid Services in response to the latter’s publication of a proposed regulation that would govern how Medicare will pay for acute-care hospital inpatient services and long-term hospital care in the coming 2020 fiscal year.

The 14-page MedPAC report addresses four aspects of the proposed Medicare payment regulation:

  • inpatient- and outpatient drug- and device related payment proposals
  • proposed changes in the hospital area wage index
  • the reporting of hospitals’ uncompensated care on the Medicare cost report’s S-10 worksheet
  • the long-term hospital prospective payment system

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.

See MedPAC’s letter to CMS here.…

Surprise! Teaching Hospitals Cost Less Than Non-Teaching Hospitals

30-day and episode-of-care costs are lower for care provided by major teaching hospitals than they are for other teaching hospitals and non-teaching hospitals.

Or so concludes a new study published by JAMA Open Network.

According to the study:

  • Major teaching hospitals’ initial hospitalization costs are higher.
  • Major teaching hospital costs are less than other hospitals after 30 days of care and over entire episodes of care.
  • Major teaching hospitals’ costs are similar to those of other teaching hospitals and non-teaching hospitals over a 90-day episode of care.
  • Major teaching hospitals’ patients incurred lower costs for post-acute care.
  • Major teaching hospitals have lower Medicare readmission rates.

Learn more about the study, how it was conducted, and what it found in the JAMA Open Network article “Comparison of Costs of Care for Medicare Patients Hospitalized in Teaching and Nonteaching Hospitals.”

Uninsured ED and Inpatient Visits Down Since ACA

Uninsured hospital admissions and emergency department visits are down since passage of the Affordable Care Act.

And Medicaid-covered admissions and ER visits are up, according to a new analysis.

The report, published on the JAMA Network Open, found that ER visits by uninsured patients fell from 16 percent to eight percent between 2006 and 2016, with most of this decline after 2014, while uninsured discharges fell from six percent to four percent.

The rate of uninsured ER visits declined, moreover, at a time when overall ER visits continued to rise.

While the Affordable Care Act is likely the cause of most of these changes, other contributing factors include the emergence of urgent care facilities, telemedicine, and free-standing ERs as well as new payment models and rules.

Learn more in the JAMA Network Open article “US Emergency Department Visits and Hospital Discharges Among Uninsured Patients Before and After Implementation of the Affordable Care Act.”

CMS Posts Proposed FY 2020 Inpatient Regulation

Medicare would change its wage index system, raise inpatient fees, increase funding for Medicare disproportionate share hospital payments (Medicare DSH), enhance payments for new technologies, and make minor modifications in its hospital readmissions reduction, value-based purchasing, and hospital-acquired condition program if a proposed regulation published this week is ultimately adopted.

The Centers for Medicare & Medicaid Services has published its proposed FY 2020 Medicare inpatient prospective payment system regulation:  its plan for paying acute-care hospitals for Medicare-covered inpatient services in FY 2020.  The 1800-page regulation calls for major changes in Medicare’s wage index system – changes CMS says would “…address the disparities between high and low wage index hospitals…”  It would do so by increasing the wage indexes of many rural hospitals, regardless of their actual wage costs, and pay for those increases by reducing the wage indexes of high-index hospitals, again regardless of their actual wage costs.

The proposed regulation also would raise inpatient payments to hospitals 3.2 percent in the coming year.  In addition, it would add $216 million to its pool of money for Medicare DSH uncompensated care payments – an increase necessitated by this year’s increase in the number of uninsured Americans – while modifying the …

Groups Seek Funding for Children’s Hospital Graduate Medical Education

Provide $400 million in funding for children’s hospital graduate medical education programs in the FY 2020 budget, 28 groups have asked congressional leaders in a recent letter.

The letter, sent to the chairs and ranking members of the Senate Appropriations Committee’s Subcommittee on Labor, Health and Human Services, and Related Agencies and the same subcommittee of the House Appropriations Committee, notes that

Sustaining pediatric training programs at children’s hospitals to meet the need of children, now and in the future, requires bolstering our national commitment.  Support for training pediatric providers through CHGME (children’s hospitals graduate medical education) lags behind the per-trainee levels provided through other federal programs.  We cannot risk falling behind in advancing children’s health.  Ongoing workforce shortages need to addressed, most acutely among pediatric specialties such as developmental pediatrics, child and adolescent psychiatry, and pediatric genetics and genomics, and CHGME is mission to meeting this need.

Read the letter and see a list of the organizations that sent it here.…