Archive for Medicare regulations


CMS Revamps Medicare ACO Program

The federal government seeks to pursue greater savings and an accelerated approach to value-based care through an overhaul of its programs for Medicare accountable care organizations.

The Centers for Medicare & Medicaid Services’ new “Pathways to Success” program seeks to speed up the process of providers assuming risk for costs and outcomes through the following changes from the agency’s current approach.

  • A reduction in how long participating ACOs can remain in the program without assuming some responsibility for their spending.
  • Modifications that CMS hopes will encourage physician groups to remain independent of hospitals and health systems.
  • Greater flexibility to innovate in exchange for participating in performance-based risk.
  • Permission to offer new incentives to patients to take greater responsibility for their own health.
  • Incorporation of regional spending differences when setting individual ACOs’ target spending and to foster greater alignment with Medicare Advantage programs.

Learn more about CMS’s new Pathways to Success Program for Medicare ACOs by reading this program announcement and the regulation detailing how the ACO program will change.…

Readmissions Program Failing Some Heart Patients?

The 30-day mortality rate has risen for heart failure patients since Medicare’s hospital readmission reduction program was implemented.

According to a new study published in JAMA, the 30-day mortality rate for heart failure patients rose 0.49 percent between 2007-2010 and 2010-2012 and another 0.52 percent between 2010-2012 and 2012-2015.

Similar results were not found for the other types of patients whose readmission rates are measured under the program:  patients who were hospitalized for heart attacks, heart bypass surgery, pneumonia, chronic obstructive pulmonary disease, and hip or knee replacement.

The heart failure findings, though, raise the question of whether performance under the readmissions reduction program is a true barometer of the quality of care individual hospitals provide.

Learn more about the study, its findings, and their implications in the study “Association of the Hospital Readmissions Reduction Program With Mortality Among Medicare Beneficiaries Hospitalized for Heart Failure, Acute Myocardial Infarction, and Pneumonia,” which can be found here, on the JAMA web site.…

CMS to Create New Office for Regulatory Reform

In 2019 the Centers for Medicare & Medicaid Services intends to create a new office to address regulatory reform.

CMS administrator Seema Verma recently announced her intention to create this office, but other than saying its priority would be to reduce regulatory burden, offered no details.

See a brief notice about the new office here.…

HIPAA Overhaul Coming?

The U.S. Department of Health and Human Services has issued a request for information about stakeholders’ views on regulations implementing the Health Insurance Portability and Accountability Act, popularly known as HIPAA, leading to conjecture that the administration may be planning to revise the federal government’s application of the federal health care privacy law enacted in 1996.

According to an HHS news release,

“This RFI is another crucial step in our Regulatory Sprint to Coordinated Care, which is taking a close look at how regulations like HIPAA can be fine-tuned to incentivize care coordination and improve patient care, while ensuring that we fulfill HIPAA’s promise to protect privacy and security,” said Deputy Secretary Hargan. “In addressing the opioid crisis, we’ve heard stories about how the Privacy Rule can get in the way of patients and families getting the help they need. We’ve also heard how the Rule may impede other forms of care coordination that can drive value. I look forward to hearing from the public on potential improvements to HIPAA, while maintaining the important safeguards for patients’ health information.”

“We are looking for candid feedback about how the existing HIPAA regulations are working in the real world and how we

For Nursing Homes, Medicare Giveth and Medicare Taketh Away

Nearly 4000 skilled nursing facilities will receive bonuses from Medicare this year while nearly 11,000 will be penalized under Medicare’s Skilled Nursing Facility Value-Based Purchasing Program.

The program, created in 2014, rewards nursing homes that keep low the number of patients who must be admitted to hospitals during the year and penalizes those with the highest hospital admission rates.

Successful nursing homes will receive bonuses of as much as 1.6 percent for each Medicare patient they serve while those that had too many hospital admissions will face penalties of nearly two percent for all of their Medicare patients.

On the whole, non-profit and government-owned nursing homes fared better than for-profit facilities.  More than half of all nursing homes in Alaska, Hawaii, and Washington state will receive bonuses while 85 percent of those in Arkansas, Louisiana, and Mississippi will be penalized.

Learn more about Medicare’s Skilled Nursing Facility Value-Based Purchasing Program and its impact on nursing homes in this Kaiser Health News report.