Archive for Medicare regulations

 

HHS Chief Derides Medicare Wage Index System

U.S. Department of Health and Human Services Secretary Alex Azar criticized the current Medicare area wage index system during a hearing of the Senate Finance Committee last week.

Reminding senators that he told them last year that they need to revise the system and warning that HHS’s ability to change it is limited without legislation, Azar referred to the system as an “absurdity” as individual senators pointed out what they view to be inequities in the system that hurt hospitals in their own states.

Medicare’s area wage index system adjusts Medicare payments to hospitals based on geographic differences in the cost of labor.

Learn more about the criticisms that Azar and Senate Finance Committee members registered about Medicare’s area wage index system in the Modern Healthcare article “Azar calls out ‘absurdity’ in Medicare wage index.”

Administration Asks if Providers Should Reveal Negotiated Rates

A proposed regulation published by the Centers for Medicare & Medicaid Services asks stakeholders if they believe hospitals, doctors, and other providers should be required to share with their patients the rates they are paid by insurers for services, medical devices, prescription drugs, and more.

Such transparency, on one hand, would give consumers a better sense of the cost of the services they receive and how their insurers reimburse providers for those costs.  Providers, suppliers, and insurers, on the other hand, might be concerned about the loss of what they have come to regard as confidential, proprietary information.

Hospitals are already required to post their standards charges online.  Since so few people pay actual charges, however, the value of such information has been questioned – and it is not clear what the value would be of knowing more about the financial arrangements between providers, suppliers, and insurers.

The request for comment on such a concept is a minor part of the proposed regulation on health care interoperability published by CMS last month.  Comments are due by May 3.

Learn more from CMS’s news release on the proposed regulation and from the proposed regulation itself.

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Stark Changes Coming to Facilitate Value Care?

At a Washington, D.C. conference, Centers for Medicare & Medicaid Services Administrator Seema Verma announced that changes coming in Stark law requirements will enable Medicare to make better use of value-based purchasing in its reimbursement system.

In addition to addressing cybersecurity and electronic health record system issues, changes in the anti-self-referral law will seek to facilitate better coordination of care for Medicare patients.  Verma explained the underlying rationale for the anticipated changes, noting that

…in a system where we’re transitioning and trying to pay for value, where the provider is ideally taking on some risk for outcomes and cost overruns, we don’t have nearly as much of a need to interfere with who’s getting paid for what service.

Learn more from the Fierce Healthcare article “Verma promises hospital industry ‘significant’ Stark Law changes later this year.”

800 Hospitals Face Medicare Penalties

800 hospitals will see their Medicare payments reduced one percent this year because they are among the 25 percent of hospitals in the U.S. with the highest rate of hospital-acquired conditions.

Among the 800 hospitals are 110 that are being penalized for the fifth year in a row.

Medicare’s hospital-acquired condition reduction program tracks a variety of medical problems, including infections, blood clots, sepsis, hip fractures, bedsores, and others.  Every year, the 25 percent of eligible providers – the program excludes significant numbers of hospitals – are penalized even if their performance for hospital-acquired conditions is superior to the previous year.

Critics of the program say it creates unachievable goals and  penalizes hospitals that are doing an excellent job of reducing hospital-acquired conditions and that there is virtually no statistical difference in performance between some hospitals that are and some hospitals that are not penalized.  Program proponents maintain that all hospitals can and should do an even better job than they already are of reducing their patients’ hospital-acquired conditions.

Learn more about Medicare’s hospital-acquired conditions reduction program, the penalties some hospitals face in the coming year, and the arguments for and against the program in the Kaiser Health News article …

Hospitals Sue Over Site-Neutral Outpatient Payment Policy

Nearly 40 hospitals have filed a joint lawsuit in opposition to the Centers for Medicare & Medicaid Services’ site-neutral payment policy for Medicare-covered outpatient services.

In the suit, the hospitals charge the federal government with overstepping its authority in implementing such a change through regulation in the face of past congressional action to limit the use of site-neutral payments.

Under its site-neutral payment policy, Medicare pays the same for some outpatient services regardless of where those services are provided.  Under Medicare’s previous policy, Medicare paid more for services provided in hospital-run outpatient facilities.

Hospitals argue that their outpatient facilities are more resource-intensive than ordinary doctors’ offices and that larger payments are justified.  CMS maintains that its site-neutral payment policies will save Medicare beneficiaries $150 million through reduced co-payments and increase competition among providers.

Learn more about the lawsuit, the issue, and the arguments for and against site-neutral Medicare outpatients payments in the Fierce Healthcare article “38 hospitals sue HHS over site-neutral payment policy.”…