Medical Industry Reimbursement News
May 5th, 2016
U.S. Comptroller General Gene Dodaro has named three new members to the Health Information Technology Policy Committee, which recommends policies and standards to the National Coordinator for Health IT. James Ferguson, Vice President of HIT Strategy and Policy at Kaiser Permanente in Oakland, CA, will fill the committee position representing payers. Carolyn Petersen, Senior Editor of Mayoclinic.org for Mayo Clinic in Rochester, MN, will fill the position of patient/consumer advocate. Karen van Caulil, President and CEO of the Florida Health Care Coalition, will fill the position representing employers.
The press release can be found at http://www.gao.gov/press/appointments_hcac_2016may.htm
May 3rd, 2016
The Centers for Medicare & Medicaid Services (CMS) has published a final rule that updates health care facilities’ fire protection guidelines to improve protections for all Medicare beneficiaries in facilities from fire.
The new guidelines apply to hospitals, long term care (LTC) facilities, critical access hospitals (CAHs), inpatient hospice facilities, programs for all inclusive care for the elderly (PACE), religious non-medical healthcare institutions (RNHCI), ambulatory surgical centers (ASCs), and intermediate care facilities for individuals with intellectual disabilities (ICF-IID).
This rule adopts updated provisions of the National Fire Protection Association’s (NFPA) 2012 edition of the Life Safety Code (LSC), as well as provisions of the NFPA’s 2012 edition of the Health Care Facilities Code. CMS strives to promote health and safety for all patients, family, and staff in every provider and supplier setting. Fire safety requirements are an important part of this effort.
The final rule can be found at https://www.federalregister.gov/articles/2016/05/04/2016-10043/medicare-and-medicaid-programs-fire-safety-requirements-for-certain-health-care-facilities
April 29th, 2016
The Centers for Medicare & Medicaid Services (CMS) has announced the next set of contract suppliers for certain Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) effective July 1. Under the competitive bidding program, launched in 2011, vendors compete at least every three years for contracts to supply certain Medicare DMEPOS products in 90 geographic areas, and mail-order diabetic testing supplies at the national level. In addition, CMS is evaluating bids for a separate set of contracts to be awarded in nine different areas effective January 1.
The fact sheet can be found by going to https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-04-28.html
April 28th, 2016
Health and Human Services (HHS) Secretary Sylvia Burwell has named Andrew Bindman, M.D., director of the Agency for Healthcare Research and Quality (AHRQ). A primary care physician who has practiced, taught, and conducted research at San Francisco General Hospital, Bindman recently served as a professor of medicine, epidemiology and biostatistics, and is an affiliated faculty member for the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco.
For more information, visit http://www.ahrq.gov/cpi/centers/od/abindman-od.html
April 27th, 2016
On April 18, the Centers for Medicare & Medicaid Services (CMS) released its hospital inpatient prospective payment system (IPPS) proposed rule for fiscal year (FY) 2017. The rule would increase rates by 0.85% in FY 2017 compared to FY 2016, after accounting for inflation and other adjustments. In the rule, CMS proposes two adjustments to reverse the effects of the 0.2% cut which was instituted when implementing the two-midnight policy in FY 2014. Specifically, the agency proposes a permanent adjustment of approximately 0.2% to remove the cut prospectively for FYs 2017 and onward; as well as a temporary adjustment of 0.6% to address the retroactive impacts of this cut for FYs 2014, 2015 and 2016. In addition, those hospitals that were meaningful users of electronic health records in FY 2015 and that submit data on quality measures, less a productivity cut of 0.5% and an additional market-basket cut of 0.75%, as mandated by the Affordable Care Act (ACA).
CMS also proposes a 1.5% cut that would fulfill the requirement of the American Taxpayer Relief Act of 2012 that the agency recoup the effect of documentation and coding changes from FYs 2010 -2012. The rule also includes ACA-mandated Medicare Disproportionate Share Hospital reductions, which would reduce overall Medicare DSH payments by $134 million in FY 2017 compared to FY 2016. For the FY 2018 Hospital-Acquired Condition Reduction Program, CMS proposes a new scoring methodology in which hospitals would be scored based on how their measured performance compares to the national mean, rather than on their own of performance.
The agency also proposes changes to the Inpatient Quality Reporting (IQR) Program, the Hospital Readmissions Reduction Program, the Value-Based Purchasing Program, the Inpatient Psychiatric Facility Quality Reporting Program, and the PPS-Exempt Cancer Hospital Quality Reporting Program. In addition, the rule includes proposals to implement the Notice of Observation Treatment and Implication for Care Eligibility Act, which requires hospitals and critical access hospitals to provide notification to individuals receiving observation services as outpatients for more than 24 hours.
The proposed rule was published in the April 27 Federal Register and comments will be accepted through June 17.
The proposed rule can be found at https://federalregister.gov/a/2016-09120
April 27th, 2016
The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule implementing key provisions of the new physician payment system required by the Medicare Access and CHIP Reauthorization Act (MACRA). Section 101 of MACRA repeals the Medicare sustainable growth rate (SGR) methodology for updates to the physician fee schedule and requires CMS to establish new physician quality and value-based payment programs that start in 2019. Eligible clinicians will participate in one of two tracks – the default Merit-based Incentive Payment System (MIPS) or alternative payment models (APM). In the rule, the agency proposes implementing most of the requirements of the MIPS for 2019, including performance measures, data submission mechanisms, reporting timeframes, scoring methodology, and various administrative processes. As part of the MIPS, CMS proposes to replace EHR meaningful use requirements for physicians with a more flexible set of advancing care information measures. The rule does not propose parallel changes for hospitals. However, the agency does propose to require that all hospitals, critical access hospitals, and physicians attest to three statements that indicate they do not engage in information blocking.
CMS also proposes criteria for eligible APMs. Specifically, the agency proposes that an entity that participates in an eligible APM must bear financial risk for any excess Medicare spending over projected expenditures, or be a specified medical home. For 2019 APM incentive payments, eligible models based on financial risk would be Tracks 2 and 3 of the Medicare Shared Savings Program, the Next Generation ACO model, the Comprehensive End-stage Renal Disease Care model, and the two-sided risk model in the Oncology Care program. The newly-announced Comprehensive Primary Care Plus initiative would qualify as a medical home. CMS is accepting comments on the proposed rule through June 27.
The proposed rule can be found at https://federalregister.gov/a/2016-10032.
April 22nd, 2016
The Centers for Medicare & Medicaid Services (CMS) has issued proposed rules for inpatient rehabilitation facilities (IRF), skilled nursing facilities (SNF), and hospice providers for fiscal year (FY) 2017. For IRFs, CMS proposes a net payment increase of 1.6%, or $125 million. This includes a 2.7% market basket that would be offset by cuts of 0.5% for productivity and a mandated cut of 0.75%, as well as an increase of 0.2% for high-cost outlier cases. The SNF proposed rule would implement a net payment increase of 2.1%, or $800 million, compared to FY 2016, after accounting for a 2.6% market-basket update and a 0.5% productivity reduction. In FY 2017, hospice payments would increase by 2.0% overall, a $330 million increase compared to FY 2016, after accounting for a 2.8% market-basket update, and reductions of 0.5% for productivity and 0.3% as required by the Affordable Care Act. In addition, the hospice cap for FY 2017 would be updated by 2.0%. CMS will accept comments on the proposed rules through June 20.
The proposed rules can be found by going to https://federalregister.gov/a/2016-09397, https://federalregister.gov/a/2016-09399 , and https://federalregister.gov/a/2016-09631.
April 11th, 2016
On April 11, the Centers for Medicare & Medicaid Services (CMS) announced its largest-ever initiative to transform and improve how primary care is delivered and paid for in America. The effort, the Comprehensive Primary Care Plus (CPC+) model, will be implemented in up to 20 regions and can accommodate up to 5,000 practices, which would encompass more than 20,000 doctors and clinicians and the 25 million people they serve. The initiative is designed to provide doctors the freedom to care for their patients the way they think will deliver the best outcomes and to pay them for achieving results and improving care.
Building on the Comprehensive Primary Care initiative launched in late 2012, the five-year CPC+ model will benefit patients by helping primary care practices:
- Support patients with serious or chronic diseases to achieve their health goals
- Give patients 24-hour access to care and health information
- Deliver preventive care
- Engage patients and their families in their own care
- Work together with hospitals and other clinicians, including specialists, to provide better coordinated care
Primary care practices will participate in one of two tracks. Both tracks will require practices to perform the functions and meet the criteria listed above, but practices in Track 2 will also provide more comprehensive services for patients with complex medical and behavioral health needs, including, as appropriate, a systematic assessment of their psychosocial needs, and an inventory of resources and supports to meet those needs.
For more details, visit https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-04-11.html
April 5th, 2016
The Centers for Medicare & Medicaid Services (CMS) has announced final changes to the Medicare Advantage (MA) and Part D prescription drug programs for 2017. These changes will increase payment rates in aggregate by a net 0.85%. CMS anticipates the MA plans and Part D sponsors will see an average revenue increase of 3.05%. In addition, CMS finalized several other policy changes, including modifications to the risk-adjustment model to more closely align reimbursement with costs for dually eligible beneficiaries, and refinements to a subset of the Star Ratings program measures to account for beneficiary socioeconomic and disability status.
For further details, visit https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2017.pdf
March 25th, 2016
According to a report released by the Department of Health and Human Services (HHS), Medicare spent $473.1 billion less on personal health care expenditures between 2009 and 2014 than what would have been spent if the 2000-2008 average growth rate had continued through 2014. Using data from the Treasury Department on Medicare benefit outlays in 2015, HHS estimates that per enrollee spending growth will continue to be low at around 1%, leading to a cumulative reduction in spending of approximately $648.6 billion between 2009 and 2015. In addition, the study found that Medicare spending on inpatient care and post-acute care remained flat in 2014.
For more information, visit https://aspe.hhs.gov/pdf-report/health-care-spending-growth-and-federal-policy