Archive for Medicare reimbursement policy

 

MedPAC Meets

Earlier this week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues.

Among the issues on MedPAC’s November agenda were:

  • expansion of telehealth in Medicare
  • report on Medicare beneficiaries’ access to care in rural areas
  • effects of pharmaceutical rebates on Part D’s risk adjustment
  • improving competition among Medicare Part D’s benchmark plans
  • separately payable drugs in the hospital outpatient prospective payment system
  • Medicare Advantage payment and access for enrollees with end-stage renal disease

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.

Go here for links to the policy briefs and presentations that supported MedPAC’s discussion of these issues.…

Most Hospitals Fined by Medicare Over Readmissions

More than 80 percent of all hospitals subject to Medicare’s hospital readmissions reduction program, and half of all of hospitals in the country, will be penalized in FY 2021 under that program because they have what Medicare considers to be too many avoidable readmissions.

In all, 2556 of the 3080 hospitals subject to the program will be penalized.  More than 600 will see their inpatient payments cut one percent as a result and the average cut will be 0.69 percent.

The penalties are based on hospital performance with patients experiencing congestive heart failure, heart attacks, chronic obstructive pulmonary disease, coronary artery bypass graft surgery, pneumonia, and knee and hip replacement.  Such patients are considered readmitted if they return to the hospital within 30 days of their discharge for these conditions unless their return to the hospital was planned as part of their treatment.

Learn more about hospital performance under Medicare’s hospital readmissions reduction program and find links to tools to look up individual hospitals and download nation-wide hospital 2021 readmissions data in the Kaiser Health News article “Medicare Fines Half of Hospitals for Readmitting Too Many Patients.”

Feds Penalizing Wrong Hospitals for Readmissions, Study Finds

Medicare’s hospital readmissions reduction program often penalizes the wrong hospitals for excessive readmissions.

Or so concludes a new study published in the journal JAMA Cardiology.

According to the study,

…the percentage of hospitals that were incorrectly penalized was 10.1% for acute myocardial infarction, 10.9% for heart failure, and 12.3 percent for pneumonia.

The study also found that the readmissions reduction program is failing to penalize some hospitals that do deserve penalties based on the program’s standards, writing that

…in fiscal year 2019, the percentage of hospitals that should have been penalized by the program, but were not, was 20.9% for acute myocardial infarction, 13.5% for heart failure, and 13.2 percent for pneumonia.

Learn more about the study’s findings and why Medicare’s hospital readmissions reduction program is missing its mark in the JAMA Cardiology report “Misclassification of Hospital Performance Under the Hospital Readmissions Reduction Program.”

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MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues.

The issues on MedPAC’s October agenda were:

  • the skilled nursing facility value-based payment system
  • future research directions in hospice payments
  • Medicare Advantage benchmark policy
  • indirect medical education:  current Medicare policy, concerns, and principles for revising
  • the evolution of Medicare’s advanced alternative payment models
  • vertical integration and Medicare payment policy

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.

Go here for links to the policy briefs and presentations that supported MedPAC’s discussion of these issues and here for a transcript of the proceedings.…

Private Insurer Payments Far Exceed Medicare Payments, Study Finds

“…employers and private insurers … paid 247 percent of what Medicare would have paid for the same services at the same facilities,” according to a new study by the Rand Corporation, which also notes that “This difference increased from 224 percent of Medicare in 2016 and 230 percent in 2017.”

The study also found that:

  • From 2016 to 2018, the overall relative price for hospitals (including inpatient and outpatient care) increased from 224 to 247 percent, a compounded annual rate of increase of 5.1 percent.
  • Some states (Arkansas, Michigan, Rhode Island) had relative prices under 200 percent of Medicare; others (Florida, West Virginia, South Carolina) had relative prices that approached 350 percent of Medicare.
  • High-value hospitals — those offering low prices and high safety — do exist. In at least some parts of the country, employers have options for high-value facilities that offer high quality at lower prices. However, there is no clear link between hospital price and quality or safety.

 

Learn more from the Rand Corporation study “Nationwide Evaluation of Health Care Prices Paid by Private Health Plans.”…