Senators Ask CMS to Back Off Medicare Outpatient Proposal

Nearly half of the members of the Senate have written to CMS asking the agency to withdraw its proposal to make more Medicare outpatient payments on a site-neutral basis.

In the letter, 48 senators note that in the 2015 Bipartisan Budget Act Congress specifically directed that CMS grandfather certain existing hospital-based off-campus outpatient facilities from CMS efforts to make more outpatient payments on a site-neutral basis.  The proposed regulation, however, would affect those very facilities.

NAUH made much the same point in its September letter to CMS expressing its opposition to this aspect of the agency’s proposed 2019 outpatient prospective payment system regulation.

Go here to see the senators’ letter to CMS.

 

New Approach to Readmissions Program Takes Effect

Medicare’s hospital readmissions reduction program is moving in a new direction beginning in FY 2019 after Congress directed the Centers of Medicare & Medicaid Services to compare hospitals’ performance on readmissions to similar hospitals instead of to all hospitals.

The policy change, driven by a belief that safety-net hospitals were harmed by the program and excessive penalties because their patients are more challenging to serve, results in all hospitals being divided into peer groups based on the proportion of low-income patients they serve.  The readmissions performance of hospitals is then compared only to other hospitals within each peer group.

As a result of this new approach, readmissions penalties against safety-net hospitals are expected to decline 25 percent in FY 2019 while the average penalty for hospitals serving the fewest low-income patients will rise.

NAUH was one of the leading proponents of this major change in how the readmissions reduction program treats hospitals.

Kaiser Health News has published a detailed story describing the policy change and its implications for hospitals, which face penalties of up to three percent of their Medicare revenue for what is considered “excessive” readmissions of Medicare patients within 30 days of their discharge from the hospital.  Included in the article is a searchable database of every hospital in the country that lists the peer group for each hospital, its FY 2018 and FY 2019 readmissions penalties by percentage of Medicare revenue, and the change in readmissions penalty expected from FY 2018 to FY 2019.  Go here to see the article “Medicare Eases Readmission Penalties Against Safety-Net Hospital.”

OIG: Medicare Advantage Plans May be Denying Access to Save Money

The Office of the Inspector General of the U.S. Department of Health and Human Services is concerned that Medicare Advantage plans may be denying their members access to services to save money and increase profits.

According to the OIG, those Medicare Advantage plans overturn 75 percent of their own denials of service upon appeal and independent reviewers are overturning still more denials.  In the OIG’s view, this high rate of service denials raises concerns that Medicare Advantage plans, which today serve more than 20 million seniors, are denying their members access to needed medical services so they can cut costs and make more money.

To address this problem, the OIG recommends that the Centers for Medicare & Medicaid Services increase its oversight of Medicare Advantage contracts, address problem plans it identifies, and do more to inform enrollees when their plans are performing in such a manner.

CMS agreed with these recommendations.

To learn more about how the OIG went about this work, what it found, and what it recommended, go here to see a summary of its report or go here to see the full report Medicare Advantage Appeal Outcomes and Audit Findings Raise Concerns About Service and Payment Denials Report, the complete OIG report.

 

New Approach to Readmissions Program to Take Effect October 1

Medicare’s hospital readmissions reduction program will move in a new direction beginning in FY 2019 after Congress directed the Centers of Medicare & Medicaid Services to compare hospitals’ performance on readmissions to similar hospitals instead of to all hospitals.

The policy change, driven by a belief that safety-net hospitals were harmed by the program and excessive penalties because their patients are more challenging to serve, results in all hospitals being divided into peer groups based on the proportion of low-income patients they serve.  The readmissions performance of hospitals is then compared only to other hospitals within each peer group.

As a result of this new approach, readmissions penalties against safety-net hospitals are expected to decline 25 percent in FY 2019 while the average penalty for hospitals serving the fewest low-income patients will rise.

NAUH was among the loudest and most persistent voices calling for reform of the program to better reflect the special challenges private safety-net hospitals face in working to prevent the readmission of their low-income Medicare payments to the hospital.

Kaiser Health News has published a detailed story describing the policy change and its implications for hospitals, which face penalties of up to three percent of their Medicare revenue for what is considered “excessive” readmissions of Medicare patients within 30 days of their discharge from the hospital.  Included in the article is a searchable database of every hospital in the country that lists the peer group for each hospital, its FY 2018 and FY 2019 readmissions penalties by percentage of Medicare revenue, and the change in readmissions penalty expected from FY 2018 to FY 2019.  Go here to see the article “Medicare Eases Readmission Penalties Against Safety-Net Hospital.”

Ways and Means Praises CMS for Red Tape Efforts, Seeks More

Leaders of the House Ways and Means Committee have written to Centers for Medicare & Medicaid Services administrator Seema Verma to praise her agency’s work in eliminating Medicare red tape – but also asking her to “…take further steps to improve patient care by alleviating administrative and regulatory burdens for Medicare providers.”

In three separate letters, committee chairman Kevin Brady (R-TX) and Health Subcommittee chairman Peter Roskam (R-IL) expressed their pleasure with CMS’s recent efforts but specified areas where they would like to see further action.

For hospitals, they wrote that they seek further red-tape cutting in the areas of Medicare conditions of participation, facility co-location, hospital quality star ratings, and meaningful measures.

For post-acute-care providers, they want CMS to address the long-term acute-care hospital 25 percent rule, to hold more inpatient rehabilitation facility open-door forums, and to address skilled nursing facility consolidated billing, documentation to satisfy home health eligibility, and hospice medical review audits.

And for physicians, they urged CMS to continue working to improve the Medicare physician fee schedule, the outpatient prospective payment system, and payments for durable medical equipment and other medical equipment and supplies.

Go here to see the Ways and Means letter addressing hospital issues, here to see the letter addressing post-acute care issues, and here to see the letter addressing physician issues.

Medicare Joint Replacement Program Produces Savings

The first reporting period for Medicare’s Comprehensive Care for Joint Replacement Model found that participating providers cut costs for episodes of care by more than $900, or 3.3 percent.

Most of the savings, the Centers for Medicare & Medicaid Services reports, were achieved by sending patients to less-expensive post-acute-care settings or by reducing patients’ length of stay in such facilities.

CMS also found that the program’s mandatory participants, located in 67 metropolitan statistical areas, achieved these savings without compromising quality of care as measured by post-discharge emergency room visits, hospital readmissions, and deaths.

Learn more about CJR’s early results in this report in Becker’s Hospital Review or go here to see the report CMS commissioned on the program’s first nine months in operation.

Congress Asks MedPAC to Look at Hospital Consolidation

The House Energy and Commerce Committee has asked the Medicare Payment Advisory Commission to examine the impact of hospital consolidation on patients and federal health care spending.

In a letter signed by Energy and Commerce Committee chairman Greg Walden (R-OR), Health Subcommittee chairman Michael Burgess (R-TX), and Oversight and Investigations Subcommittee chairman Gregg Harper (R-MS), the Energy and Commerce Committee states that

We request the Medicare Payment Advisory Commission (MedPAC) conduct research examining questions regarding the market trend of hospital consolidation and the degree to which such consolidation increases cost to the Medicare program and beneficiaries, including the costs for prescription drugs.

The eight-page letter outlines the different views the committee has heard on this subject during various hearings, questions whether certain federal policies encourage or facilitate hospital industry consolidation – and whether they should do so – and outlines some of the challenges the committee suspects may arise as a result of industry consolidation.

Go here to see the letter from the House Energy and Commerce Committee to MedPAC asking MedPAC to look into this issue and to respond with its findings within 30 days.

Medicare Announces FY 2019 Inpatient Payments

The Centers for Medicare & Medicaid Services has released its FY 2019 payment schedule for Medicare inpatient services.

Highlights of the FY 2019 inpatient prospective payment system regulation include:

  • A 1.75 percent increase in fee-for-service rates.
  • A $1.5 billion increase in Medicare disproportionate share hospital payments (Medicare DSH).
  • Major reductions of the quality measures hospitals must report for Medicare’s inpatient quality reporting and value-based purchasing programs.
  • A requirement that hospitals post their standard charges on the internet.

Learn about these and other aspects of Medicare’s FY 2019 inpatient prospective payment system regulation by seeing this Medicare fact sheet or go here to see the 2593-page (!) regulation itself.

New Reg Pushes Medicare Toward Site-Neutral Outpatient Payments

Medicare would make more payments for outpatient services on a site-neutral basis under a newly proposed regulation just released by the Centers for Medicare & Medicaid Services.

The 2019 Medicare outpatient prospective payment system regulation, published in proposal form, calls for:

  • paying physician fee schedule rates rather than hospital outpatient rates at excepted off-campus provider-based departments;
  • slashing payments for office visits;
  • extending this year’s 340B prescription drug discount payments, already cut nearly 30 percent this year, to additional providers; and
  • raising ambulatory surgical center rates and expanding the list of procedures that can be performed in such facilities so they can compete with hospitals for outpatient services.

The proposed regulation also calls for reducing quality reporting requirements and giving providers financial incentives to prescribe non-opioid pain medicine for surgery patients.

The regulation, which would affect provider payments beginning on January 1, 2019, was published in proposed form and will be finalized later in the year.  Stakeholders have until September 24 to submit comments to CMS.  For further information about what CMS has proposed, see this CMS fact sheet outlining the proposed regulation and the 761-page proposed regulation itself.

CMS Proposes Changes in Medicare Physician Payments

The Centers for Medicare & Medicaid Services has published a proposed regulation that it says

…proposed historic changes that would increase the amount of time that doctors and other clinicians can spend with their patients by reducing the burden of paperwork that clinicians face when billing Medicare. The proposed rules would fundamentally improve the nation’s healthcare system and help restore the doctor-patient relationship by empowering clinicians to use their electronic health records (EHRs) to document clinically meaningful information instead of information that is only for billing purposes.

Among the policy changes offered in the proposed 1743-page regulation governing Medicare physician payments are:

  • a 0.25 percent increase in physician fees;
  • changes in how physicians and other clinicians document and bill for their services;
  • new provisions governing Medicare payments for telehealth services, including those offered by phone;
  • reductions in the cost of new prescription drugs and reduced payments to physicians for administering drugs;
  • changes in the Medicare quality program;
  • the continuation of the current site-neutral payment policy for outpatient services; and
  • changes in the MACRA (Medicare Access and CHIP Reauthorization Act of 2015) program.

Stakeholders have until September 10 to submit formal comments about the CMS proposals.

Learn more about these and other changes presented in the proposed regulation by consulting this CMS news release, this CMS fact sheet, and the proposed regulation itself.