Archive for Medicare


Medicare Advantage Permitted to Address Non-medical Needs

Starting in 2020, Medicare Advantage plans will be permitted to provide non-medical benefits to their chronically ill members.

As described in the Centers for Medicare & Medicaid Services’ “final call letter’ for 2020,

MA [Medicare Advantage] plans are not prohibited from offering an item or service that can be expected to improve or maintain the health or overall function of an enrollee only while the enrollee is using it.  In other words, the statute does not require that the maintenance or improvement expected from an SSBCI [special supplemental benefits for the chronically ill] result in a permanent change in an enrollee’s condition.  Items and services may include, but are not limited to:  meals furnished to the enrollee beyond a limited basis, transportation for non-medical needs, pest control, air quality equipment and services, and benefits to address social needs, so long as such items and services have a reasonable expectation of improving or maintaining the health or overall function of an individual as it relates to their chronic condition or illness.

The CMS final call letter offers permission to Medicare Advantage plans to offer such services; it does not require them to do so.

Learn more from the Commonwealth Fund report …

Feds Looking to Bundle Medicare Post-Acute Payments?

Bring us your ideas for bundling Medicare post-acute-care payments, the head of the Center for Medicare and Medicaid Innovation recently told a gathering of hospital officials in Washington, D.C.

As reported by Fierce Healthcare, CMMI director Adam Boehler told hospital officials that

Now is the time to bring us ideas.  We’re really in listening mode…I think there’s been a lot of intrigue and interest we’ve heard from people.  So we’re gathering stakeholder input there on that and it’s a great time to give us thoughts on where we can lower costs.

Learn more from the Fierce Healthcare article “CMMI’s Adam Boehler: ‘Now is the time’ to bring post-acute care bundle ideas.”

SNF Discharge May Affect Hospital Readmission Rates

Heart failure patients discharged from skilled nursing facilities after two days or less may be as much as four times more likely to be readmitted to a hospital than those who stay longer, according to a new analysis.

The study also found that the hospital readmission rate falls by half for patients who remain in a skilled nursing facility for one to two weeks.

The analysis evaluated Medicare data for heart failure patients at least 65 years old and did not adjust for their severity of illness.

These findings suggest that the current emphasis on limiting patients’ time in post-acute-care settings may not contribute to their return to good health and increases their chances of being readmitted to a hospital.  Even under ideal circumstances, 25 percent of heart failure patients admitted to skilled nursing facilities are readmitted to a hospital within 30 days of discharge.

Learn more from the Healthcare Finance News article “Shorter stays in a skilled nursing facility tied to higher risk for readmission” and the Journal of Post-Acute and Long-Term Care Medicine study “Risk of Readmission After Discharge From Skilled Nursing Facilities Following Heart Failure Hospitalization: A Retrospective Cohort Study.”

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 April agenda were:

  • Expanding the use of value-based payment in Medicare
  • Medicare Shared Savings Program performance
  • Redesigning the Medicare Advantage quality bonus program
  • Increasing the accuracy and completeness of Medicare Advantage encounter data
  • Evaluating patient functional assessment data reported by post-acute-care providers
  • Options for slowing the growth of Medicare fee-for-service spending for emergency department services
  • Options to increase the affordability of specialty drugs and biologics in Medicare Part D
  • Improving payment for low-volume and isolated outpatient dialysis facilities

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.


Medicare Advantage Networks Not Narrowing

The primary care networks offered by Medicare Advantage plans are broadening and not narrowing, as some people have long feared.

According to a study published in the journal Health Affairs, only 1.8 percent of Medicare Advantage plans offer narrow primary care provider networks, down from 2.7 percent in 2011.  Meanwhile, the proportion of plans offering broad networks has grown from 80.1 percent in 2011 to 82.5 percent in 2015.  In 2015, broad network plans enrolled 63.9 percent of Medicare Advantage participants, up from 54.1 percent in 2011.

This is considered important because the proportion of Medicare beneficiaries enrolled in Medicare Advantage plans has risen from 22 percent in 2008 to 33 percent in 2017 (about 20 million people).

The study also found that HMOs are more likely to have narrow networks than point-of-service (POS) or preferred provider organization (PPO) and that narrow network plans are more likely to be found in markets with less Medicare Advantage penetration.

Learn more in the Health Affairs study “Primary Care Physician Networks in Medicare Advantage,” which is summarized in an article from the Commonwealth Fund, which supported the research, titled “Most Medicare Advantage Plans Offer Broad Primary Care Provider Networks.”