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MedPAC Offers Recommendations on FY 2020 Rates, More

Last week the Medicare Payment Advisory Commission released its annual report to Congress.  Included in this report are MedPAC’s Medicare rate recommendations for the coming year.  They are:

  • hospital inpatient rates – a two percent increase
  • hospital outpatient rates – a two percent increase
  • physician and other health professional services rates – no update
  • skilled nursing facilities – no 2020 increase
  • home health agencies – a five percent rate reduction
  • inpatient rehabilitation facilities – a five percent rate reduction
  • long-term-care hospital services – a two percent increase
  • hospice services – a two percent rate reduction

MedPAC also recommended that the Centers for Medicare & Medicaid Services replace its current array of hospital quality programs with a new, streamlined “hospital value incentive program,” or HVIP, that would replace the Hospital Inpatient Quality Program, the Hospital Readmissions Reduction Program, the Hospital-Acquired Condition Reduction Program, and the Hospital Value-Based Purchasing Program.

MedPAC’s recommendations are binding on neither the administration nor Congress but its views are highly respected and often find their way into new laws, new policies, and new programs.

Learn more about MedPAC’s annual recommendations to Congress in the full MedPAC report or the MedPAC fact sheet that accompanies the recommendations’ release.…

Surprise Balance Billing Emerges as Issue in DC

Lawmakers on both sides of the political aisle are expressing interest in addressing the problem of surprise balance billing:  when insured individuals receive unexpected medical bills from providers for services for which they believe they are insured.

Surprise balance bills have been a problem for years, with a number of proposals offered in the past to address the problem.  Now, bipartisan support for a solution appears to be growing in Congress.

In a new report, the journal Health Affairs describes the issue, outlines balance billing proposals offered in the recent past, and describes the challenges members of Congress now face while trying to balance the needs of consumers, insurers, and providers.  See the report “Federal Policy To End Surprise Billing: Building On Prior Approaches” for more.…

Hospitals Continue to Employ More Docs, Buy Physician Practices

Between 2012 and 2018, the proportion of U.S. physicians employed by hospitals and health systems rose from 25 percent to 44 percent.

And between 2016 and 2018, 14,000 physicians left private practice behind to work for hospitals and health systems while those hospitals and health systems purchased 8000 physician practices.

One reason health systems employ physicians and purchase physician practices is enhanced reimbursement:  Medicare pays more for services provided in hospital outpatient settings than in private physician offices, although Medicare has been taking steps in recent years to reduce or end this practice through the introduction of site-neutral Medicare outpatient payments.

Learn more about the continued movement toward hospital-employed physicians in the Healthcare Dive article “Hospitals now employ more than 40% of physicians, analysis finds.”

New Client

DeBrunner & Associates is pleased to welcome our newest client:  AristaCare Health Services, a provider of post-acute rehabilitation, memory care, and long-term-care services based in Cranford, New Jersey.

Welcome!…

Number of Uninsured Children Rises

For the first time since 2008, the number of uninsured children in the U.S. increased in 2017, according to a new report from the Georgetown University Health Policy Institute.

While the total increase in the number of uninsured children is small – just 276,000 – 2017 marked the first time in nearly a decade that the number of uninsured children has risen.  For the year, 3.9 million were uninsured, up from 3.6 million in 2016.

Passage of the Affordable Care Act and extension of the Children’s Health Insurance Program (CHIP) have contributed to declines in the number of uninsured children.

In 2017, however, the number of uninsured children rose even as the overall uninsured rate in the U.S. remained the same:  8.8 percent.  States with the biggest increases in the number of uninsured children were South Dakota, Utah, and Texas.  More than 20 percent of all uninsured children in the U.S. live in Texas.

Learn more about the increase in the number of uninsured children and why these numbers have risen in the report Nation’s Progress on Children’s Health Coverage Reverses Course, which can be found here, on the web site of the Georgetown University Health Policy Institute.…