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Archive for April, 2014

FY 2015 IPPS and LTCH Proposed Rule Published

Wednesday, April 30th, 2014

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would update fiscal year (FY) 2015 Medicare payment policies and rates for inpatient stays at general acute care and long-term care hospitals (LTCHs).  This rule builds on the administration’s efforts through the Affordable Care Act (ACA) to promote improvements in hospital care that will lead to better patient outcomes while slowing the long-term health care cost growth.

CMS projects that the payment rate update to general acute care hospitals will be 1.3 percent in FY 2015. The rate update for long term care hospitals will be 0.8 percent.  The difference in the update is accounted for by different statutory and regulatory provisions that apply to each system.

The rule’s most significant changes are payment provisions intended to improve the quality of hospital care that reduce payment for readmissions and hospital acquired conditions (HACs).  The rule also includes proposed changes to the Hospital Inpatient Quality Reporting (IQR) Program. The rule also describes how hospitals can comply with the ACA’s requirements to disclose charges for their services online or in response to a request, supporting price transparency for patients and the public.

The proposed rule requests public input on an alternative payment methodology for short-stay inpatient cases that also may be treated on an outpatient basis, including how to define short stays. In addition, the proposed rule reminds stakeholders of the existing process for requesting additional exceptions to the two-midnight benchmark.

Other major proposals include:

-  Changes to the Value Based Purchasing Program (VBP) for FY 2015 in which CMS will be increasing the applicable percent reduction to the portion of Medicare payments available to fund value-based incentive payments to 1.5 percent of the base operating DRG payment amount.  CMS estimates that the total amount available for value-based incentive payments in FY 2015 will be approximately $1.4 billion, and will update this estimate in the FY 2015 IPPS/LTCH final rule.

-  The Hospital Readmissions Reduction Program maximum reduction in payments would be increased from 2 to 3 percent.  For FY 2015, CMS proposes to assess hospitals’ readmissions penalties using five readmissions measures endorsed by the National Quality Forum (NQF).  CMS estimates that Medicare hospital readmissions declined by a total of 150,000 from January 2012 through December 2013.

-  CMS is also proposing to implement the ACA’s Hospital Acquired Condition (HAC) Reduction Program.  Beginning in FY 2015, hospitals scoring in the top quartile for the rate of HACs (i.e. those with the poorest performance) will have their Medicare inpatient payments reduced by one percent.

-  The proposed rule would revise measures for the Hospital Inpatient Quality Reporting, Long-Term Care Hospital (LTCH) Quality Reporting, and PPS-Exempt Cancer Hospital Quality Reporting Programs.  For 2015 and 2016, CMS proposes to align the reporting and submission timelines for clinical quality measures for the Medicare Electronic Health Record (EHR) Incentive Program with the reporting and submission timelines of the Hospital IQR Program.

-  Core-based statistical areas (CBSA) would be revised in order to maintain a more accurate and up-to-date payment system that reflects the reality of population shifts and labor market conditions. CMS is proposing to use the most recent labor market area delineations issued by the Office of Management and Budget (OMB) using 2010 Census data.

CMS will accept comments on the proposed rule until June 30, 2014, and will respond to comments in a final rule to be issued by August 1, 2014.  The proposed rule can be found by going to http://www.gpo.gov/fdsys/pkg/FR-2014-05-15/pdf/2014-10067.pdf

White House Announces Enrollment Numbers

Thursday, April 17th, 2014

According to an announcement by the White House, about 8 million people signed up for private health insurance through a state or federally-facilitated marketplace during open enrollment. About 35% of those enrolling through a federally-facilitated marketplace were under age 35, of which 28% were adults, about the same proportion as Massachusetts experienced in its first year of health reform.

The fact sheet can be found by going to http://www.whitehouse.gov/the-press-office/2014/04/17/fact-sheet-affordable-care-act-numbers

Sebelius Steps Down, President Nominates OMB Director

Thursday, April 10th, 2014

On April 10, President Obama announced that Health and Human Services Secretary (HHS) Kathleen Sebelius stepped down after five years of service. To fill the position, he nominated Office of Management and Budget (OMB) Director Sylvia Mathews Burwell. Ms. Burwell joined OMB last year and previously served as president of the Walmart Foundation and president of the Global Development Program at the Bill & Melinda Gates Foundation. She also held several positions in the Clinton administration, including deputy director of OMB and deputy chief of staff to the president.

For more information, visit http://www.whitehouse.gov/blog/2014/04/11/sylvia-mathews-burwell-nominated-be-next-secretary-health-and-human-services

HHS Releases Physician-Level Medicare Data

Wednesday, April 9th, 2014

On April 9, the Department of Health and Human Services (HHS) released a new privacy-protected data set that has information on the number and type of health care services that individual physicians and certain other health care providers furnished in 2012 under the Medicare Part B fee-for-service (FFS) program, as well as information on the amount that Medicare paid them for those services. The new data set has information for over 880,000 distinct health care providers in all 50 states, DC and Puerto Rico who collectively received $77 billion in Medicare payments in 2012. The new data are posted on the website of the Centers for Medicare & Medicaid Services (CMS).

CMS created the new data set using information from the Physician/Supplier Part B Claims File, also known as the Carrier File, which has final action FFS claims that are submitted by physicians and other non-institutional health care providers, such as non-physician practitioners, ambulatory surgical centers, clinical laboratories, and ambulance providers. The new data set does not have information for institutional health care providers, such as hospitals or nursing homes, or for suppliers of durable medical equipment.

To view the new physician data set, please go to: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Physician-and-Other-Supplier.html

Medicare Advantage Payment Policies Finalized for 2015

Monday, April 7th, 2014

The Centers for Medicare & Medicaid Services (CMS) released final capitation rates and payment policies for the 2015 Medicare Advantage (MA) and Part D prescription drug plans. CMS estimates the overall net change to plan payments between 2014 and 2015 will be 0.4%, up from an estimated -1.9% for proposals in the Advance Notice. Individual plan payments will vary by plan based on, but not limited to, the plan’s location and star rating. Among other changes, CMS modified the phase-in schedule for the new risk adjustment model that began in calendar year 2014 and removed a proposal to exclude certain diagnoses from enrollees’ risk assessments. It also delayed implementation of a new Part D risk adjustment model, refined the risk adjustment methodology to account for the impact of baby boomers, delayed changes to the star ratings system, and withdrew a proposal to require plans to provide additional coverage in the gap between generic and brand drugs. The final call letter requires plans to provide CMS with 90 days’ notice of any significant changes to their provider networks, and allows enrollees to switch plans when their MA organization initiates significant mid-year provider network terminations without cause. The final rate announcement and call letter also limit the permissible increase in total beneficiary costs to $32 per month and maintain existing limits on beneficiaries maximum out-of-pocket spending, but encourage MA organizations to allow enrollees’ dollar contributions toward these limits to be transferable when they move to any plan offered by the same organization.

For more information, visit http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-04-07.html

President Signs the Protecting Access to Medicare Act of 2014

Tuesday, April 1st, 2014

On April 1, President Obama signed into law the Protecting Access to Medicare Act of 2014. The new law prevented a scheduled payment reduction for physicians and other practitioners who treat Medicare patients from taking effect on April 1. The bill also extends the Medicare-dependent Hospital Program, low-volume adjustment, and ambulance add-on payments through March 31, 2015; extends the delay in enforcement of the Centers for Medicare & Medicaid Services’ (CMS) two-midnight policy for an additional six months, through March 31, 2015; and prohibits recovery audit contractors from auditing inpatient claims spanning less than two midnights for the six-month period. It also delays implementation of ICD-10 until October 1, 2015, delays the start of the Medicaid Disproportionate Share Hospital (DSH) cuts for one year, until 2017 and extends these cuts for an additional year through 2024.

The bill can be viewed at http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/html/PLAW-111publ148.htm