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Archive for December, 2011

Medicare Adding Obesity Screening and Counseling

Friday, December 23rd, 2011

The Centers for Medicare & Medicaid Services (CMS) has announced that Medicare is adding coverage for preventive services to reduce obesity.  This adds to Medicare’s existing portfolio of preventive services that are currently available without cost sharing under the Affordable Care Act (ACA).  It complements the Million Hearts initiative led jointly by CMS and the Centers for Disease Control and Prevention in partnership with other HHS agencies, communities, health systems, nonprofit organizations, and private sector partners across the country to prevent one million heart attacks and strokes over the next 5 years.

To read the final decision on the new national coverage determination, visit this link.

32 Health Systems to Participate in Pioneer ACO Initiative

Monday, December 19th, 2011

Thirty-two leading health care organizations will participate in a new Pioneer Accountable Care Organization (ACO) initiative made possible by the Affordable Care Act (ACA). The Pioneer ACO initiative will encourage primary care doctors, specialists, hospitals and other caregivers to provide better, more coordinated care for Medicare beneficiaries and could save up to $1.1 billion over five years.

Under this initiative, operated by the Centers for Medicare & Medicaid Services (CMS)InnovationCenter, Medicare will reward groups of health care providers that have formed ACOs based on how well they are able to both improve the health of their Medicare patients and lower their health care costs. The first performance period of the Pioneer ACO Model beganJanuary 1, 2012.

For the final list of participating Pioneer ACOs and more information about the Pioneer ACO Model, a fact sheet is posted at http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4225 or you can visit: http://innovations.cms.gov/initiatives/aco/pioneer

The Pioneer ACO Model is one of several initiatives underway at CMS designed to support the formation of ACOs. For more information, visit www.cms.gov/aco.

MedPAC Considers 2013 Hospital Payment Increase

Thursday, December 15th, 2011

On December 15, the Medicare Payment Advisory Commission (MedPAC) considered a draft recommendation to Congress that would increase fiscal year 2013 inpatient and outpatient hospital payments by 1.0%. MedPAC also considered a draft recommendation that would equalize Medicare payment rates for non-emergency evaluation and management services between hospital outpatient and physician office settings. The recommendation would reduce payment for a hospital outpatient E/M visit by nearly 75%.  Other recommendations considered were a 0.5% update for ambulatory surgical centers (ASCs) in calendar year 2013, and a requirement that they submit cost data; directing the Health and Human Services (HHS) secretary to implement a value-based purchasing program for ASCs no later than 2016; and providing a 1.0% update for outpatient dialysis rates for CY 2013. MedPAC also plans to reiterate its October recommendations for Congress to repeal the Sustainable Growth Rate (SGR) formula used to calculate the Physician Fee Schedule (PFS) and replace it with a 10-year path of legislated PFS updates. MedPAC’s draft recommendations may be revised before the commission votes on them in January.

For more information, go to www.medpac.gov

Final Rule for the Release and Use of Medicare Claims Data Released

Monday, December 5th, 2011

The Centers for Medicare & Medicaid Services (CMS) has issued a final rule for the release and use of Medicare claims data to qualified entities to measure the performance of Medicare providers under the Patient Protection and Affordable Care Act (ACA). Beginning in 2012, the ACA requires the Health and Human Services (HHS) secretary to provide standardized extracts of Medicare Parts A, B and D claims data to qualified entities on request. The rule also requires qualified entities to share measures, measurement methodologies and measure results with providers and suppliers at least 60 calendar days prior to making measurement results public.

The rule is available at http://www.ofr.gov/OFRUpload/OFRData/2011-31232_PI.pdf.