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MedPAC Reports to Congress

MedPAC has submitted its annual report to Congress.

The congressionally mandated report, titled Report to Congress:  Medicare and the Health Care Delivery System, consists of seven chapters:

  • Realizing the promise of value-based payment in Medicare: an agenda for change.
  • Challenges in maintaining and increasing savings from accountable care organizations (ACOs).
  • Replacing the Medicare Advantage quality bonus program.
  • Mandated report: Impact of changes in the 21st Century Cures Act to risk adjustment for Medicare Advantage enrollees.
  • Realigning incentives in Medicare Part D.
  • Separately payable drugs in the hospital outpatient prospective payment system (OPPS).
  • Improving Medicare’s end-state renal disease (ESRD) prospective payment system (PPS).

While MedPAC’s recommendations are not binding on Congress or the administration, they are highly respected and often find themselves worked into new law or regulations.

Go here to see MedPAC’s news release accompanying the report and here to find the report itself.

Medicare Site-Neutral Outpatient Payment Proposal Would Have Disproportionate Impact

The Centers for Medicare & Medicaid Services’ proposal to make more Medicare outpatient payments on a site-neutral basis would significantly cut Medicare’s overall outpatient spending but most of that cut would be borne by just a few hospitals.

A report prepared for the Integrated Health Care Coalition concluded that

…CMS’ Off-Campus Site-Neutral Proposal in the FY 2019 CMS OPPS [note:  outpatient prospective payment system] NPRM [note:  notice of proposed rulemaking] will disproportionate affect about six percent of 3,333 hospitals that participate in the program.  200 hospitals will shoulder 73 percent of the proposed payment reductions….For the top 200, the average reduction will be 5.5 percent.  For the remaining hospitals, the reduction will be 0.5 percent.

Last month NAUH conveyed its strong opposition to this proposal in a formal comment letter to CMS.

Learn more about the CMS proposal and its potential implications in this story in Becker’s Hospital Review or go here to see the complete analysis.

NAUH Comments on Proposed Medicare Site-Neutral Outpatient Payment Changes

NAUH LogoThe National Association of Urban Hospitals has submitted extensive comments to the Centers for Medicare & Medicaid Services on the agency’s proposal to implement site-neutral payment policies for Medicare-covered outpatient services.

In its comments, NAUH raises objections to:

  • how the proposed rule addresses the relocation of existing hospital-based outpatient departments;
  • how it addresses the expansion of services at existing departments;
  • how it proposes addressing the sale of existing departments; and
  • how it could affect such departments’ future eligibility in the section 340B prescription drug discount program.

Last year’s Bipartisan Budget Act called for Medicare to pay providers for outpatient services on a site-neutral basis.  The proposed rule constitutes CMS’s response to that law.

To see NAUH’s entire comment letter, go here.

CMS Proposes FY 2017 Outpatient Payments

The Centers for Medicare & Medicaid Services has revealed how it proposes paying hospitals for Medicare-covered outpatient services in 2017.

Among other matters, the 764-page proposed regulation addresses:

  • proposed rate increases for outpatient and ambulatory surgery center services;
  • new site-neutral outpatient payment policies;
  • changes in the value-based purchasing program;
  • changes in hospital outpatient quality reporting requirements;
  • electronic health record policies; and
  • changes in ambulatory surgical center quality reporting requirements.

law booksNAUH members have received a detailed memo describing the proposed policies.  Representatives of other private safety-net hospitals may request a copy of that memo by clicking on the “contact us” link at the top of this screen.

Interested parties have until September 6 to submit written comments to CMS. The final rule will be published later this year and take effect on January 1, 2017. To learn more about what CMS has proposed for Medicare outpatient payments go here to see a CMS fact sheet and here to see the proposed regulation itself.