Archive for Medicare reimbursement policy

 

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 September agenda were:

  • context for Medicare payment policy
  • the effects of Medicare Advantage “spillover” on Medicare fee-for-service spending and coding
  • evaluation of the hospital readmissions reduction program
  • examining the effects of competitive bidding for diabetes testing supplies and improving payment policies for DMEPOS products excluded from competitive bidding
  • a value incentive program for post-acute-care providers
  • Medicare indirect medical education (IME) policy, concerns, and considerations for revising

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.…

MedPAC Issues Annual Report to Congress

The Medicare Payment Advisory Commission has sent its mandatory annual report to Congress.

Included in the report are sections on:

  • Beneficiary enrollment in Medicare: eligibility notification, enrollment process, and Part B late enrollment penalties.
  • Restructuring Medicare Part D for the era of specialty drugs.
  • Medicare payment strategies to improve price competition and value for Part B drugs.
  • MedPAC’s mandated report to Congress on clinician payments.
  • Issues in Medicare beneficiaries’ access to primary care.
  • Assessment of the Medicare Shared Savings Program’s effect on Medicare spending.
  • Ensuring the accuracy and completeness of Medicare Advantage encounter data.
  • Redesigning the Medicare Advantage quality bonus program.
  • Payment issues in post-acute care.
  • MedPAC’s mandated report to Congress on changes in post-acute and hospice care after implementation of the long-term care hospital dual payment rate structure.
  • Options for slowing the growth of Medicare fee-for-service spending for emergency department services.
  • Promoting integration in dual-eligible special needs plans.

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.

Learn more from …

Mandatory Payment Models Coming to Medicare?

Even as CMS rolls out new, voluntary Medicare alternative payment models, it is contemplating making participation in future models mandatory rather than voluntary, as is currently the case.

Or so Centers for Medicare & Medicaid Services administrator Seema Verma told a gathering in Baltimore last week.

At the heart of the idea, Verma told her audience, is that while CMS is pleased with participation in voluntary accountable care organization models, organizations are choosing to participate in ACO models they think would benefit them most while posing little or no downside financial risk.  The agency may need to move away from that approach to advance its efforts to transform more of Medicare into a value-based payment program.

Learn more in the Fierce Healthcare article “Verma: Trump administration mulling mandatory payment models.”

Readmissions Program Changes Produce New Outcomes

Many hospitals are faring better under Medicare’s hospital readmissions reduction program since changes in that program were implemented earlier this fiscal year.

According to a new study, safety-net, academic, and rural hospitals have enjoyed improved performance under the program since Medicare began organizing hospitals into peer groups based on the proportion of low-income patients they serve rather than simply comparing individual hospital performance to that of all other hospitals.

While the current fiscal year is still under way, it appears that safety-net hospitals will enjoy a collective decline of $22 million in Medicare readmissions penalties while 44.1 percent of teaching hospitals and 43.7 percent of rural hospitals will face smaller penalties than last year.

Learn more about the readmissions reduction program and how changes in that program have significantly altered its outcomes in the JAMA Internal Medicine study “Association of Stratification by Dual Enrollment Status With Financial Penalties in the Hospital Readmissions Reduction Program.”

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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 …