MedPAC Mulls Direct Billing for Nurse Practitioners, Physician Assistants

Medicare would permit nurse practitioners and physician assistants to bill directly for their services under a proposal being considered by the Medicare Payment Advisory Commission.

Currently such services are billed as “incident to” physician services, but according to a report in Becker’s Hospital Review,

MedPAC staff told commissioners there are problems with “incident to” billing because it “obscures policymakers’ knowledge of who is providing care for beneficiaries,” “inhibits accurate valuation of fee schedule services,” and “increases Medicare beneficiary spending.”  Staff also said that physician assistants and nurse practitioners increasingly practice outside of primary 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.

MedPAC commissioners are expected to vote on the recommendation next month.

Learn more about the billing recommendation in this article in Becker’s Hospital Review.

Number of Uninsured Children Rises

For the first time since 2008, the number of uninsured children in the U.S. increased in 2017, according to a new report from the Georgetown University Health Policy Institute.

While the total increase in the number of uninsured children is small – just 276,000 – 2017 marked the first time in nearly a decade that the number of uninsured children has risen.  For the year, 3.9 million were uninsured, up from 3.6 million in 2016.

Passage of the Affordable Care Act and extension of the Children’s Health Insurance Program (CHIP) have contributed to declines in the number of uninsured children.

In 2017, however, the number of uninsured children rose even as the overall uninsured rate in the U.S. remained the same:  8.8 percent.  States with the biggest increases in the number of uninsured children were South Dakota, Utah, and Texas.  More than 20 percent of all uninsured children in the U.S. live in Texas.

Learn more about the increase in the number of uninsured children and why these numbers have risen in the report Nation’s Progress on Children’s Health Coverage Reverses Course, which can be found here, on the web site of the Georgetown University Health Policy Institute.

The Changing of the Congressional Health Care Guard

Last week’s elections will bring to office in January a new majority party in the House and changes in the Senate as well.

Changes in leadership are coming in all of the House committees with jurisdiction over health care matters:  Energy and Commerce, Ways and Means, Appropriations, and Oversight and Government Reform.  New leadership may be coming to the Senate Finance Committee as well.

Kaiser Health News has published a look at the relevant committees, their likely new leaders, and the priorities of those new leaders.  Find that report here.

Medicaid Expansion Didn’t Hurt Access After All

The expansion of Medicaid in nearly two-thirds of the states has not affected access to care for Medicare participants in those states.

According to a new analysis by the National Bureau of Economic Research, Medicare patients had no more trouble getting timely doctors’ appointments, suffered no increase in costs, and experienced no increase in waiting times after their state expanded its Medicaid program under the Affordable Care Act.

Learn more about these findings in this Healthcare Dive report or go here for access to the National Bureau of Economic Research report “The Impact of Insurance Expansions on the Already Insured: The Affordable Care Act and Medicare.”

 

NAUH Opposes Proposed Medicare Outpatient Regulation

In a letter to the Centers for Medicare & Medicaid Services, NAUH has conveyed its opposition to aspects of CMS’s proposed Medicare outpatient prospective payment system regulation for 2019.  Once adopted, this regulation will determine how the federal government pays hospitals and some physicians for Medicare-covered outpatient services in calendar year 2019.

Aspects of the proposed regulation that NAUH opposes include:

  • reducing outpatient payments to exempted off-campus provider-based departments to site-neutral rates;
  • reversing a recent policy that permitted hospital-based outpatient facilities to be paid outpatient fee system rates rather than physician fee schedule rates for new services provided within clinical families of services; and
    reducing payments for 340B-covered prescription drugs when provided by off-campus provider-based physician.

In each of these situations, NAUH maintains that the proposed policy fails to reflect the significant differences in the roles played by hospital-based physician practices and private physician offices in the health care infrastructure of the communities in which they are located.

See the complete NAUH letter to CMS here.

MedPAC Meets

The Medicare Payment Advisory Commission met last week in Washington, D.C. to address a number of Medicare reimbursement-related issues.

Among the subjects on MedPAC’s agenda were:

  • a unified payment system for post-acute care
  • long-term-care hospitals
  • physician payments
  • next steps in redesigning Medicare’s hospital quality and value programs

While MedPAC’s policy and payment recommendations are not binding on Congress or the administration, its views are respected and influential and often become the basis for new public policy.

Go here to see the policy briefs and presentations offered to help guide MedPAC commissioners’ discussions about these and other issues.

Low-Acuity Use of Emergency Departments Declines

People are using hospital emergency departments less frequently for low-acuity medical problems, turning instead to retail clinics and urgent care.

According to a new study of a limited patient population published in JAMA Internal Medicine,

Visits to the ED for the treatment of low-acuity conditions decreased by 36% (from 89 visits per 1000 members in 2008 to 57 visits per 1000 members in 2015), whereas use of non-ED venues increased by 140% (from 54 visits per 1000 members in 2008 to 131 visits per 1000 members in 2015). There was an increase in visits to all non-ED venues: urgent care centers (119% increase, from 47 visits per 1000 members in 2008 to 103 visits per 1000 members in 2015), retail clinics (214% increase, from 7 visits per 1000 members in 2008 to 22 visits per 1000 members in 2015), and telemedicine (from 0 visits in 2008 to 6 visits per 1000 members in 2015). Utilization and spending per person per year for low-acuity conditions had net increases of 31% (from 143 visits per 1000 members in 2008 to 188 visits per 1000 members in 2015) and 14% ($70 per member in 2008 to $80 per member in 2015), respectively. The increase in spending was primarily driven by a 79% increase in price per ED visit for treatment of low-acuity conditions (from $914 per visit in 2008 to $1637 per visit in 2015).

Despite the emergency these ED alternatives, ED utilization continues to rise.

Learn more from the report “Trends in Visits to Acute Care Venues for Treatment of Low-Acuity Conditions in the United States From 2008 to 2015,” which can be found here, on the JAMA Internal Medicine web site.

Ways and Means Releases Red Tape Report

The House Ways and Means Committee has released a report detailing its efforts to date to reduce red tape in the delivery of health care and to present steps it might take in the future to continue with that process.

In the first stage of its red tape project, Ways and Means solicited stakeholder input and heard from nearly 300 stakeholder groups.  Next, it hosted roundtable discussions with various groups to review the issues they raised.  Now, following publication of its report, the committee plans to work in consultation with the administration to advance legislation to address some of the challenges that have been brought to its attention.

Among the most frequently mentioned challenges brought to Ways and Means’ attention were:

  • The need for improved flexibility to provide telehealth services
  • Challenges associated with the Stark law
  • Documentation and reporting burdens

Learn more about the committee’s work and the issues brought to its attention in its report “Medicare Red Tape Relief,” which can be found here.

 

CMS: Not Done With Medicaid Work Requirements

Despite the ruling of a federal court that Kentucky’s new Medicaid work requirement violates federal law, the Centers for Medicare & Medicaid Services has not ruled out approving future requests from state governments to impose work requirements on Medicaid recipients.

Or so asserted CMS administrator Seema Verma at a recent health care event in Washington, D.C.

The Washington Examiner reports that at that event, Verma said that

We are looking at what the court said.  We want to be respectful of the court’s decision while trying to push ahead with our policy and our goals.

CMS currently has applications from eight states to establish new Medicaid work requirements.

Learn more about the legal obstacles Medicaid work requirements have encountered and how CMS views those obstacles in this Washington Examiner article.

 

New Policy Threatens Provider Medicaid Payments

Health care providers that fail to join the provider networks of Missouri Medicaid managed care plans will see their Medicaid payments cut 10 percent by the state under a new state policy.

The purpose of the policy, according to the state, is to encourage hospitals and physicians to join the provider networks of three managed care plans that serve more than 700,000 residents of the state.  Providers, on the other hand, say this policy will discourage them from serving Medicaid patients at all and will detract from their ability to negotiate reasonable rates with the state’s three Medicaid managed care plans.

Learn more about this new Missouri policy and its potential implications for providers, Medicaid beneficiaries, the insurers, and the state in this article in the St. Louis Post-Dispatch.