Archive for Medicare


Court Upholds Delay of Site-Neutral Payment Cut

Medicare cannot proceed with its plan to pay for outpatient care on a site-neutral basis while it appeals a court ruling rejecting that policy, a federal court has ruled.

A federal judge found that Medicare has not articulated an adequate reason to delay the $380 million a year in site-neutral payment cuts while the Centers for Medicare & Medicaid Services appeals the September decision rejecting the payment policy change.  The court also found that, contrary to CMS’s claim, Medicare still has an appropriate methodology for making payments that are not site-neutral and that the agency has not proved that it would suffer irreparable harm if the cuts are delayed while it considers CMS’s appeal.

The cut took effect on January 1, 2019 but the court did not address how Medicare should compensate hospitals for lost payments, instead ordering CMS and the plaintiffs in the case to submit reports on how the payment shortfalls can best be addressed.

Learn more about the Medicare site-neutral payment cut and why the federal court again ruled against that cut in the Fierce Healthcare article “Judge denies bid to preserve site-neutral payment cuts while awaiting appeal.”

Grassley Questions Aspects of Graduate Medical Education

Graduate medical education is the subject of inquiry in a recent letter from Senate Finance Committee chairman Charles Grassley to Health and Human Services Secretary Alex Azar.

In his letter to Secretary Azar, Senator Grassley asks for information about how federal GME money is spent and how much is spent, how federal money factors into the broader financing of hospital residency programs, and how the federal government ensures that GME programs engage in best practices.

The letter also questions whether the indirect benefits of operating medical education programs are factored into how much the federal government spends on medical education, how the federal government allocates residency slots based on geographic considerations and physician shortages, and how the cost of educating medical residents is calculated, and how Medicare’s share of that cost is determined.

See a news release from Senator Grassley’s office that includes the letter to Secretary Azar.

No Primary Doc Shortage for Medicare Patients – at Least Not Yet

Medicare patients currently have adequate access to primary care physicians, according to the Medicare Payment Advisory Commission.

But that could change in the near future, MedPAC warns.

Amid long-term concerns about whether there are enough primary care doctors, a new MedPAC report found that there are even fewer primary care doctors than most people believe.  MedPAC reached this conclusion after finding that approximately one out of every five doctors thought to be working as primary care physicians now labor instead as hospitalists.  As a result, growth in the number of primary care physicians has been negligible during the current decade.

Counteracting this shift are two trends:  first, Medicare patients appear to be seeing their primary care doctors less than in the past:  3.7 visits a year in 2017 versus 4.1 in 2013; and other practitioners, such as physician assistants and nurse practitioners, are seeing patients more frequently – 1.8 such encounters a year in 2017, up significantly from 1.1 in 2013.

Despite this, MedPAC is concerned that if the current trend of minimal growth in the supply of primary care physicians continues, Medicare beneficiaries may lack appropriate access to primary care in the future.

Learn more from the Healthcare Dive

Most Hospitals Hit With Medicare Readmissions Penalties

Nearly 2600 hospitals will be penalized by Medicare in FY 2020 for excessive patient readmissions under Medicare’s hospital readmissions reduction program, according to the Centers for Medicare & Medicaid Services.

In all, 83 percent of hospitals covered by the program will be penalized, forfeiting up to three percent of their Medicare payments with an average penalty of 0.71 percent of those payments.  The cumulative penalties for these hospitals will amount to $563 million in FY 2020.

In all, 1177 hospitals will be penalized more than they were last year and 1148 will be penalized less.  56 hospitals will be assessed the maximum penalty of three percent and 372 have not been penalized for the past two years.

More than 2000 hospitals, among them children’s, psychiatric, and critical access hospitals, are not covered by the program.

Learn more about how hospitals will be affected by Medicare’s hospital readmissions reduction program during the new fiscal year and what this may say about the value and effectiveness of the program in the Kaiser Health News story “New Round of Medicare Readmissions Penalties Hits 2583 Hospitals.”

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:

  • restructuring Medicare Part D
  • improving Medicare payment for low-volume and isolated outpatient dialysis facilities
  • updates to the methods used to assess the adequacy of Medicare’s payments for physicians and other health professionals
  • population-based outcome measures:  avoidable hospitalizations and emergency department visits
  • aligning benefits and cost-sharing under a unified payment system for post-acute care
  • policy options to modify the hospice aggregate cap

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.…