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 November agenda were:

  • congressional request on health care provider consolidation
  • increasing the supply of primary care physicians
  • redesigning the Medicare Advantage quality bonus program
  • reforming the benchmarks in the Medicare Advantage payment system
  • considerations for plans serving low-income beneficiaries in the restructuring of Medicare Part D
  • post-acute care spending under the Medicare Shared Savings Program

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.  Those recommendations, in turn, can have a major impact on the nation’s private safety-net hospitals.

Go here for links to the policy briefs and presentations that supported MedPAC’s discussion of these issues.

Azar: More Value-Based Care Coming

Medicare may add more value-based care initiatives and alternative payment models to those it already operates, Health and Human Services Secretary Alex Azar suggested at a recent event in Washington, D.C.

During his remarks, Azar spoke about population health benefits, global budgeting for Medicare patients, more primary care programs, and new models that address kidney care and opioid use and hinted at future efforts that address social determinants of health.

Learn more about Azar’s remarks about Medicare value-based purchasing and alternative payment models and other current federal health policy matters in the Healthcare Dive article “HHS chief keeps focus on alternative payment models.”

More Hospitals Gain Than Lose in FY 2020 Value-Based Purchasing Program

Medicare’s value-based purchasing program will reward more hospitals than it will penalize in FY 2020 through its value-based purchasing program.

The program, in which 2700 hospitals are scored in four domains – clinical outcomes, safety, person and community engagement, and efficiency and cost reduction – will distribute $1.9 billion in bonus payments to 1500 hospitals.

Bonus payment average 0.6 percent, with a high of 2.93 percent.  Penalties average -0.39 percent, with a high of -1.72 percent.

Overall, rural hospitals performed better in the safety, person and community engagement, and efficiency and cost reduction categories and had a higher average score nation-wide while urban hospitals produced better clinical outcomes.  Smaller hospitals performed better in safety, person and community engagement, and efficiency and cost reduction.

Hospitals can find a link to their own adjustments here.

Learn more about how Medicare’s value-based purchasing program works and how hospitals will fare in FY 2020 in this CMS fact sheet.

Court Upholds Delay of Medicare Site-Neutral Payment Cut

Medicare cannot proceed with its plan to pay for outpatient care on a site-neutral basis while it appeals a court ruling rejecting that policy, a federal court has ruled.

A federal judge found that Medicare has not articulated an adequate reason to delay the $380 million a year in site-neutral payment cuts while the Centers for Medicare & Medicaid Services appeals the September decision rejecting the payment policy change.  The court also found that, contrary to CMS’s claim, Medicare still has an appropriate methodology for making payments that are not site-neutral and that the agency has not proved that it would suffer irreparable harm if the cuts are delayed while it considers CMS’s appeal.

The cut took effect on January 1, 2019 but the court did not address how Medicare should compensate hospitals for lost payments, instead ordering CMS and the plaintiffs in the case to submit reports on how the payment shortfalls can best be addressed.

NASH has opposed implementation of the site-neutral payment policy on several occasions in recent years, doing so most recently in its letter last month to CMS (scroll down to page 5) about the agency’s proposed policy for paying for Medicare-covered outpatient services for 2020.

Learn more about the Medicare site-neutral payment cut and why the federal court again ruled against that cut in the Fierce Healthcare article “Judge denies bid to preserve site-neutral payment cuts while awaiting appeal.”

Grassley Questions Aspects of Graduate Medical Education

Graduate medical education is the subject of inquiry in a recent letter from Senate Finance Committee chairman Charles Grassley to Health and Human Services Secretary Alex Azar.

In his letter to Secretary Azar, Senator Grassley asks for information about how federal GME money is spent and how much is spent, how federal money factors into the broader financing of hospital residency programs, and how the federal government ensures that GME programs engage in best practices.

The letter also questions whether the indirect benefits of operating medical education programs are factored into how much the federal government spends on medical education, how the federal government allocates residency slots based on geographic considerations and physician shortages, and how the cost of educating medical residents is calculated, and how Medicare’s share of that cost is determined.

Many private safety-net hospitals host medical residents and have graduate medical education programs.

See a news release from Senator Grassley’s office that includes the letter to Secretary Azar.

No Primary Doc Shortage for Medicare Patients – at Least Not Yet

Medicare patients currently have adequate access to primary care physicians, according to the Medicare Payment Advisory Commission.

But that could change in the near future, MedPAC warns.

Amid long-term concerns about whether there are enough primary care doctors, a new MedPAC report found that there are even fewer primary care doctors than most people believe.  MedPAC reached this conclusion after finding that approximately one out of every five doctors thought to be working as primary care physicians now labor instead as hospitalists.  As a result, growth in the number of primary care physicians has been negligible during the current decade.

Counteracting this shift are two trends:  first, Medicare patients appear to be seeing their primary care doctors less than in the past:  3.7 visits a year in 2017 versus 4.1 in 2013; and other practitioners, such as physician assistants and nurse practitioners, are seeing patients more frequently – 1.8 such encounters a year in 2017, up significantly from 1.1 in 2013.

Despite this, MedPAC is concerned that if the current trend of minimal growth in the supply of primary care physicians continues, Medicare beneficiaries may lack appropriate access to primary care in the future.

This issue is especially important to private safety-net hospitals because many serve especially large numbers of low-income Medicare patients who often face challenges in gaining access to the care they need.

Learn more from the Healthcare Dive article “As docs ditch primary care to become hospitalists, MedPAC warns of shortage” or see the new MedPAC report “Updates to the methods used to assess the adequacy of Medicare payments for physician and other health professional service.”

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues.

Among issues on MedPAC’s October agenda of potential interest to private safety-net hospitals were:

  • restructuring Medicare Part D
  • updates to the methods used to assess the adequacy of Medicare’s payments for physicians and other health professionals
  • population-based outcome measures: avoidable hospitalizations and emergency department visits
  • aligning benefits and cost-sharing under a unified payment system for post-acute care

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.

Court Halts Medicare Site-Neutral Payment Changes

The Centers for Medicare & Medicaid Services did not have the authority to implement the site-neutral payment system for Medicare-covered outpatient services that it introduced last year, a federal court has concluded.

According to the court, CMS exceeded its authority because it

…was not authorized to ignore the statutory process for setting payment rates in the Outpatient Prospective Payment System and to lower payment rates only for certain services provided by certain providers.

In general, hospitals oppose the movement toward site-neutral payments and independent physician groups support it.

The court did not order CMS to reimburse affected physician practices for lost revenue.  Instead, it directed CMS to develop an appropriate remedy.

CMS is likely to appeal the ruling.

Meanwhile, CMS has proposed continuing its phase-in of the site-neutral payment policy in its proposed 2020 outpatient prospective payment system regulation that will take effect on January 1, 2020.  It is not clear how or if – the court ruling might affect CMS’s decision to move ahead with this proposal.

NASH opposed the 2019 change in a formal regulatory comment letter to CMS last year (see pages 2 and 3) on behalf of private safety-net hospitals and next week will submit another comment letter expressing the same view about year two of the proposed changes in Medicare outpatient payment policy.

Learn more about the case, the court decision, and what might happen next in the Healthcare Dive article “Hospitals score victory as judge tosses CMS site neutral rule.”

 

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues.

Among issues on MedPAC’s September agenda were:

  • context for Medicare payment policy
  • the effects of Medicare Advantage “spillover” on Medicare fee-for-service spending and coding
  • evaluation of the hospital readmissions reduction program
  • Medicare indirect medical education (IME) policy, concerns, and considerations for revising

These issues are important to most private safety-net hospitals.

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.

Can Medicare Feed its Way Out of Some Readmissions?

Feeding some Medicare patients after they are discharged from the hospital could reduce readmissions and save taxpayers millions, a new study has concluded.

According to the new Bipartisan Policy Center report Next Steps in Chronic Care:  Expanding Innovative Medicare Benefits, providing a limited number of free meals to certain Medicare patients could eliminate nearly 10,000 readmissions a year and save more than $57 million.

Participating patients would be those with more than one of a limited number of chronic medical conditions and the meals would be for one week only.  According to the report, more than 575,000 Medicare beneficiaries would be eligible to participate in such a program, with their meals costing $101 million a year, or $176 a person for one week, but the nearly 10,000 Medicare readmissions that would be prevented would reduce Medicare spending more than $158 million a year.

Such a program, if implemented, would be yet another approach to addressing the social determinants of health in many communities.

Such a program would undoubtedly benefit the low-income communities most private safety-net hospitals serve because food insecurity is one of many social determinants of health that challenge the health of the residents of those communities.

Learn more about how such an approach would work and whom it would serve in the Bipartisan Policy Center report Next Steps in Chronic Care:  Expanding Innovative Medicare Benefits.