Archive for Medicare


HHS Launches New Quality Initiative

The evaluation, adoption, and streamlining of federal health care quality programs will be the objective of a new “quality summit” launched by the U.S. Department of Health and Human Services.

In response to an executive order issued by the president, HHS has established the quality summit because, according to an HHS news release,

A long-stated goal of the Trump Administration has been to shift our current government healthcare programs from paying for services and procedures to paying for better patient outcomes.  We believe the best way to effect this shift is through greater transparency and a focus on quality outcomes for patients.

The HHS news release also notes that

…important quality programs across the department have remained uncoordinated among the various agencies and inconsistent in their demands on healthcare providers.  We believe the Quality Summit will not only strengthen the protections these programs afford patients, but also improve value by reducing costs and onerous requirements that are placed on providers and ultimately stand between patients and the high quality care they deserve.

Summit participants will include government officials and approximately 15 non-government health care industry leaders, with individuals invited to nominate themselves or others for those non-government slots.

Learn more …

Readmissions Higher for Medicare Advantage Patients

Medicare Advantage patients are more likely to be readmitted to the hospital for existing medical problems than participants in traditional Medicare, a new study has found.

According to a report published in the Annals of Internal Medicine, Medicare Advantage patients suffering from acute myocardial infarction, congestive heart failure, and pneumonia were readmitted to hospitals because of those medical problems at slightly higher rates than patients served by traditional Medicare.

Learn more from the Annals of Internal Medicine study “Hospital Readmission Rates in Medicare Advantage and Traditional Medicare: A Retrospective Population-Based Analysis” and the Healthcare Dive article “MA patients’ readmission rates higher than traditional Medicare, study finds.”

MedPAC Weighs in on Proposed Medicare Payment Changes

The Medicare Payment Advisory Commission has submitted formal comments to the Centers for Medicare & Medicaid Services in response to the latter’s publication of a proposed regulation that would govern how Medicare will pay for acute-care hospital inpatient services and long-term hospital care in the coming 2020 fiscal year.

The 14-page MedPAC report addresses four aspects of the proposed Medicare payment regulation:

  • inpatient- and outpatient drug- and device related payment proposals
  • proposed changes in the hospital area wage index
  • the reporting of hospitals’ uncompensated care on the Medicare cost report’s S-10 worksheet
  • the long-term hospital prospective payment system

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.

See MedPAC’s letter to CMS here.…

Surprise! Teaching Hospitals Cost Less Than Non-Teaching Hospitals

30-day and episode-of-care costs are lower for care provided by major teaching hospitals than they are for other teaching hospitals and non-teaching hospitals.

Or so concludes a new study published by JAMA Open Network.

According to the study:

  • Major teaching hospitals’ initial hospitalization costs are higher.
  • Major teaching hospital costs are less than other hospitals after 30 days of care and over entire episodes of care.
  • Major teaching hospitals’ costs are similar to those of other teaching hospitals and non-teaching hospitals over a 90-day episode of care.
  • Major teaching hospitals’ patients incurred lower costs for post-acute care.
  • Major teaching hospitals have lower Medicare readmission rates.

Learn more about the study, how it was conducted, and what it found in the JAMA Open Network article “Comparison of Costs of Care for Medicare Patients Hospitalized in Teaching and Nonteaching Hospitals.”

CMS Outlines Improvements in RAC Audit Processes

In the face of complaints from hospitals about backlogs, time-consuming procedures, and lengthy appeals processes involving Medicare Recovery Audit Contractor audits, the Centers for Medicare & Medicaid Services recently outlined changes it has implemented in the RAC audit process to address these and other concerns.  They are (in CMS’s own words):

Better Oversight of RACs

  • We are holding RACs accountable for performance by requiring them to maintain a 95% accuracy score. RACs that fail to maintain this rate will receive a progressive reduction in the number of claims they are allowed to review.
  • We also require RACs to maintain an overturn rate of less than 10%. Failure to maintain such a rate, will also result in a progressive reduction in the number of claims the RAC can review.
  • RACs will not receive a contingency fee until after the second level of appeal is exhausted. Previously, RACs were paid immediately upon denial and recoupment of the claim. This delay in payment helps assure providers that the RAC’s decision was correct before they are paid.


Reducing Provider Burden and Appeals

  • We are making RAC audits more fair to providers. Previously, RACs could select a certain type of claim to audit. Now,