Archive for Medicare


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.


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 December agenda were:

  • Medicare payments for physician and other health professionals services
  • payments for ambulatory surgical centers
  • payments for hospital inpatient and outpatient care
  • Medicare’s hospital quality incentive program
  • payments for skilled nursing facilities
  • payments for long-term care hospitals
  • payments for inpatient rehabilitation facilities
  • payments for outpatient dialysis services
  • payments for hospice care
  • payments for home health services
  • the Medicare Advantage program

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.…

Administration Seeks Industry Guidance on Rollback of Anti-Kickback Laws

Characterizing its objective as a “regulatory sprint to coordinated care,” the Department of Health and Human Services’ Office of the Inspector General this summer asked stakeholders for their input on how it might ease federal anti-kickback laws in ways that promote better coordination of care and cooperation between different types of caregivers while not encouraging fraud that costs consumers and taxpayers.

At the heart of this effort are laws that limit the ability of doctors and hospitals to work together.  Hospitals, for example, currently have limited tools with which to influence the behavior of doctors serving Medicare and Medicaid patients while insurers are limited in their efforts to encourage certain desired behaviors among those they insure.  Meanwhile, as this effort continues, the Justice Department continues to prosecute cases of alleged fraud that involves kickbacks.

The entire subject is exceedingly complex and the administration invited stakeholders to offer suggestions for how to loosen the laws without loosing new forms of inappropriate kickbacks.  Hundreds of interested parties submitted suggestions to the Department of Health and Human Services.

Learn more about the administration’s efforts to address anti-kickback laws in this New York Times article.


CMS to Congress: You’re the Impediment to Greater Use of Telehealth

The primary obstacle to Medicare making greater use of telehealth is current laws, the Centers for Medicare & Medicaid Services has told Congress in a new report.

The report, mandated by the 21st Century Cures Act, outlines the extent of telehealth utilization today, describes its benefits, and suggests potential new and expanded uses for telehelath, but it also notes that

Current restrictions on eligible telehealth originating sites appear to be the greatest barrier to preventing the expansion of Medicare telehealth services.  The two most significant Medicare restrictions are:  1) requiring the originating site to be located in certain types of rural areas; and 2) not allowing the beneficiary’s home to be an eligible originating site.

Congress’s mandate did not include a request for recommendations and CMS did not offer any.

Learn more about how Medicare uses telehealth today, how it could use telehealth more extensively if the opportunity presented itself, and what the barriers are to greater use of telehealth in the CMS report to Congress Information on Telehealth, which can be found here.…

Medicare Advantage to Address Social Determinants of Health

Beginning next year, the Centers for Medicare & Medicaid Services will authorize Medicare Advantage plans to pay for some health-related but non-medical benefits for their members – benefits that will help address social determinants of health that affect the health status of many Medicare beneficiaries.

As explained by Health and Human Services Secretary Alex Azar at a recent event in Salt Lake City,

These interventions can keep seniors out of the hospital, which we are increasingly realizing is not just a cost saver but actually an important way to protect their health, too.  If seniors do end up going to the hospital, making sure they can get out as soon as possible with the appropriate rehab services is crucial to good outcomes and low cost as well. If a senior can be accommodated at home rather than an inpatient rehab facility or a [skilled nursing facility], they should be.

According to Azar, HHS’s Center for Medicare and Medicaid Innovation will be looking for new ways to address social determinants of health that have an impact on Medicare beneficiaries’ health.

What if we provided more than connections and referrals?  What if we provided solutions for the whole person including addressing housing,