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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 January agenda were:

  • The Medicare prescription drug program (Part D):  status report and options for restructuring
  • Redesigning the Medicare Advantage quality program:  initial modeling of a value incentive program
  • Hospital inpatient and outpatient payments
  • Physician payments
  • Outpatient dialysis payments
  • Skilled nursing facility, home health, inpatient rehabilitation facility, and long-term-care hospital payments
  • Hospice and ambulatory surgery center payments
  • The 340B program
  • ACO beneficiary assignment

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.

MedPAC Meets

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

Among the issues on MedPAC’s December agenda that were of special interest to private safety-net hospitals were:

  • Assessing payment adequacy and updating payments: Physician and other health professional services
  • Assessing payment adequacy and updating payments: Ambulatory surgical center services
  • Assessing payment adequacy and updating payments: Hospital inpatient and outpatient services
  • Assessing payment adequacy and updating payments: Home health care services
  • Assessing payment adequacy and updating payments: Inpatient rehabilitation facility services
  • Assessing payment adequacy and updating payments: Long-term care hospital services

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 – policies that often have a major impact on private safety-net hospitals.

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

MedPAC to Meet Tomorrow

The Medicare Payment Advisory Commission meets this Thursday and Friday in Washington, D.C.

MedPAC’s December agenda is dominated by Medicare payment issues:  how much Medicare should pay for different types of services in calendar year 2021 and FY 2021.  The services to be addressed during the December 5-6 meetings are physician and other health professional services, ambulatory surgical center services, hospital inpatient and outpatient services, skilling nursing facility services, home health services, inpatient rehabilitation facility services, long-term care hospital services, outpatient dialysis services, and hospice services.

In addition, MedPAC commissioners will discuss their mandated report on expanding Medicare’s post-acute care transfer policy to hospice and hear a status report on the Medicare Advantage 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.

Learn more here.

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.

MedPAC Meets

Last week the Medicare Payment Advisory Commission held two days of public meetings in Washington, D.C.

During the sessions MedPAC, a non-partisan legislative branch agency that advises Congress on Medicare payment issues, addressed the following subjects:

  • a Medicare Advantage status report
  • a Medicare prescription drug program (Part D) status report
  • hospital inpatient and outpatient payments
  • physician payments
  • ambulatory surgical center, dialysis center, and hospice payments
  • post-acute care facility payments
  • the hospital readmissions reduction program
  • telehealth
  • accountable care organizations

Go here to see the issue briefs and presentations used during the meetings.

NAUH Urges CMS to Reconsider Proposed Outpatient Payment Changes

The federal government should not cut in half payments to physicians who care for their Medicare patients in off-campus, provider-based outpatient facilities.

It also should reconsider the circumstances under which hospitals can move their off-campus, provider-based hospital outpatient departments, or expand the services those departments offer, without losing their provider-based hospital outpatient department status.

These were among the comments NAUH offered to the Centers for Medicare & Medicaid Services in response to CMS’s proposed Medicare physician payment fee schedule for 2018.

See NAUH’s entire letter to CMS about the proposed outpatient physician fee regulation here.

Medicare Proposes New Way to Pay Docs

Clinicians would be paid based more on the quality of care they provide than on the quantity of services they deliver under a new Medicare quality reporting and payment proposal released last week by the Centers for Medicare & Medicaid Services.

The proposal, required by Congress last year as part of the Medicare Access and CHIP Reauthorization Act that constituted the final “Medicare doc fix” and spelled the end of the sustainable growth rate formula that constrained Medicare payments to physicians for more than a decade, would be phased in over a period of years, would end so-called meaningful use requirements for physicians, and would compensate most clinicians based on their performance on quality measures, some of them of their own choosing, in four categories – quality, advancing care information, clinical practice management, and cost – that would be part of a new Merit-Based Incentive Payment System.

iStock_000008064653XSmallClinicians who assume financial risk as part of what CMS is calling Advanced Alternative Payment Models – programs such as the Next Generation ACO model, the Comprehensive Primary Care Plus program, and tracks 2 and 3 of the Medicare Shared Savings Program – would participate in a separate quality reporting and payment program that would respond to the greater financial risks such providers shoulder with greater potential financial rewards.

Learn more about the latest Medicare proposal from the following resources:

Proposal for Improving Medicare Physician Payments

Last year, Congress considered shifting Medicare’s payments to physicians from their fee-for-service foundation to a value-based purchasing approach as part of its attempt to address the Medicare sustainable growth rate (SGR) formula problem (the “Medicare doc fix”).

urban instituteWith that problem once again facing Congress, the Urban Institute has published a new paper outlining how to make that transformation.

That paper, “Medicare Physician Payment Reform:  Securing the Connection Between Value and Payment,” can be found here.

Medicare to Add Services to Telehealth Program

Medicare would add new telehealth services to those for which it already pays providers under a newly proposed regulation.

iStock_000005787159XSmallThe new telehealth services that would be eligible for Medicare payment to physicians are annual wellness visits, psychoanalysis, psychotherapy, and prolonged evaluation and management services.

The additions are part of Medicare’s annual regulation updating how it pays providers for various outpatient services.

To learn more about the Medicare telehealth additions and the proposed regulation in general, see this fact sheet or find the regulation itself here.

CMS Provides Details on Medicare Chronic Care Payments

Following up on last year’s announced introduction of special payments to physicians who care for seniors with chronic medical conditions, the Centers for Medicare & Medicaid Services (CMS) has published a draft regulation that provides further information about how those payments would work.

cmsUnder the proposed rule, Medicare will pay physicians $41.92 for non-face-to-face management of chronic care services for selected Medicare patients.  Physicians could receive no more than one such payment per patient per month for activities that include the development and revision of care plans, communication with the involved patient’s other providers, and prescription drug management.

The proposed policy, part of Medicare’s annual regulation updating physician payment policies and rates, addresses other aspects of Medicare’s proposed changes in its approach to chronic care management as well.  To learn about these changes, see a CMS fact sheet on the new regulation here or find the entire regulation here.