Medicare Archives - Page 5 of 9 - Safety-Net Association of Pennsylvania

Medicare Notification of Observation Care Requirement Set

Beginning on August 6, hospitals will be required to notify patients if they are under observation care and have not formally been admitted to the hospital.
The new policy, required by last year’s Notice of Observation Treatment and Implication for Care Eligibility Act, requires hospitals to provide a written notice to patients “in plain language” explaining that they have not been admitted to the hospital and how that might affect what they owe the hospital for the care they receive and their eligibility for follow-up services. Hospitals will be required to provide this information no more than 36 hours after the observation care has begun.
Hospital building More than two million Medicare patients were hospitalized under observation status in 2014.
Learn more about the new policy, what it means, and some of the challenges it may pose in this Kaiser Health News article.

PA Safety Net Admin2016-06-23T06:00:08+00:00June 23rd, 2016|Medicare|Comments Off

Examining Medicare’s Skilled Nursing Facility Three-Day Inpatient Stay Requirement

The Congressional Research Service has prepared a new report that takes a look at the requirement that Medicare patients spend three days as hospital inpatients before Medicare will pay for post-discharge skilled nursing care.
The report reviews the current requirements for Medicare coverage of skilled nursing care, describes the role of hospital outpatient observation care in clouding the question of whether individual patients have spent three days in the hospital, and examines proposals for changing the three-day requirement. It also addresses the need for greater transparency in hospital decisions to classify patients as under observation status rather as inpatients, the need to educate patients about the impact of such classification decisions, and the potential impact of changing the current policy.
Go here to see the CRS report Medicare’s Skilled Nursing Facility (SNF) Three-Day Inpatient Stay Requirement.

PA Safety Net Admin2016-06-17T06:00:14+00:00June 17th, 2016|Medicare|Comments Off

Bill Proposes Modifying Ban on Higher Medicare Outpatient Payments

A new bill introduced in the House Ways and Means Committee would limit a recent prohibition on establishing new off-campus hospital outpatient facilities that can receive hospital-based Medicare outpatient payments.
Under the Bipartisan Budget Act of 2015, new off-campus, hospital-based outpatient facilities would be paid for Medicare-covered outpatient services like regular physician offices and not like hospital outpatient departments. The Helping Hospitals Improve Patient Care Act of 2016, however, would permit new outpatient departments that were in “mid-build” at the time the 2015 law passed to be exempt from that law’s limits on outpatient payments.
According to a Ways and Means summary of the bill,

Section 201 provides for an exception to section 603 of the Bipartisan Budget Act of 2015 (BBA’15) for those hospital outpatient departments (HOPDs) that were defined as “mid-build” prior to November 2, 2015. “Mid-build” is defined as a provider that had a binding written agreement with an outside, unrelated, party for the actual construction of the HOPD. To qualify as “mid-build,” each HOPD will be required to submit a certification from the provider’s Chief Executive Officer/Chief Operating Officer that the HOPD meets the definition of mid- build prior to July 1, 2016. Further, each mid-build HOPD will be required to submit an attestation that it meets the requirements of being provider-based (42 Code of Federal Regulations 413.65) by July 1, 2016. In addition, the section also requires the Secretary to audit the accuracy of these attestations. HOPDs that meet all of above requirements will receive the full HOPD payment rate beginning January 1, 2018 instead of the lower physician fee schedule or ambulatory surgical center payments required under the BBA’ 15. Finally, those off-campus HOPDs that submitted a voluntary attestation prior to December 2, 2015 will receive the full HOPD payment rate beginning January 1, 2017.

To learn more about this and other provisions of H.R. 5273, the Helping Hospitals Improve Patient Care Act of 2016, go here to see the Ways and Means Committee’s summary of the bill and go here to see the bill itself.

PA Safety Net Admin2016-05-26T06:00:30+00:00May 26th, 2016|Medicare|Comments Off

Bill Proposes Risk-Adjusting Medicare Readmissions Program

A new bill introduced in the House Ways and Means Committee would apply risk adjustment for socio-economic factors to Medicare’s hospital readmissions reduction program.
According to a committee summary of the bill, The Helping Hospitals Improve Patient Care Act of 2016 includes a provision that would direct the Secretary of Health and Human Services to

… implement a transitional risk adjustment methodology to serve as a proxy of socio-economic status for the Hospital Readmissions Reduction Program. In addition to the transitional adjustment, the section clarifies that the Secretary is able to permanently use a more refined methodology following the analysis required by the Improving Medicare Post-Acute Care Transformation Act of 2014. The section also requires a study by the Medicare Payment Advisory Commission (MedPAC), and allows for an analysis of “V-codes” and an exploration of potential exclusions.

The bill would be beneficial for Pennsylvania’s private safety-net hospitals because they serve more low-income patients who are more challenging to treat than typical hospital patients and are more likely to require post-discharge readmission to address continuing medical and social issues.
For a closer look at the bill’s socio-economic risk adjustment provision and other proposals, go here to see the committee’s summary of H.R. 5273, The Helping Hospitals Improve Patient Care Act of 2016, and go here to see the bill itself.

PA Safety Net Admin2016-05-23T06:00:17+00:00May 23rd, 2016|Medicare, Pennsylvania safety-net hospitals|Comments Off

Covered by Medicare But Underinsured

Nearly a quarter of the country’s 50 million Medicare beneficiaries are underinsured and ill-equipped financially to handle the program’s cost-sharing responsibilities.
Or so concludes a new report from the Commonwealth Fund.
According to the report, Medicare’s cost-sharing requirements – premiums, co-pays, deductibles, and services not covered by the program, such as dental and vision care – far outstrip the resources of more than 11 million low-income program participants, leaving many to spend more than 20 percent of their income on health care costs.
In its new report “On Medicare But At Risk: A State-Level Analysis of Beneficiaries Who Are Underinsured or Facing High Total Cost Burdens,” the Commonwealth Fund describes the health care costs Medicare does and does not cover, defines what constitutes “underinsured” and ill-equipped to handle health care costs, delineates the out-of-pocket costs for which beneficiaries are responsible, and offers a state-by-state breakdown of where the uninsured can be found and the proportion of total income they spend on medical services.
Because they serve communities with especially large numbers of low-income residents, Pennsylvania’s safety-net hospitals care for disproportionate numbers of such underinsured Medicare patients. As a result, they face the prospect of providing significant amounts of uncollectible uncompensated care as a result of Medicare patients who cannot afford their co-pays and deductibles.
Find the Commonwealth Fund report here.

PA Safety Net Admin2016-05-16T06:00:34+00:00May 16th, 2016|Medicare, Pennsylvania safety-net hospitals|Comments Off

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.
Clinicians 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:

a CMS fact sheet
a CMS video
an FAQ from Kaiser Health News
the 962-page proposed regulation itself

PA Safety Net Admin2016-05-02T06:00:53+00:00May 2nd, 2016|Medicare|Comments Off

Hospitals Turn to Community Health Workers to Prevent Readmissions

It’s a new twist on an old concept: employ peers of low-income patients to go out into the community and work with those recently hospitalized to ensure that they are getting the care and assistance they need to recover from their illnesses and injuries.
Traditionally employed by local health departments and other government agencies, community health workers are increasingly being hired by hospitals to reach out to challenging patients and help prevent readmissions to the hospitals for which Medicare (through its hospital readmissions reduction program), and increasingly state Medicaid programs as well, penalize them.
And the early results are encouraging: some hospitals that employ community health workers have lowered their Medicare readmissions and avoided federal penalties.
Among the challenges hospitals face in employing such an approach is how to pay for community health workers. Some do so out of operating funds; others receive foundation grants; some have obtained funding from the federal government and some through enhanced Medicaid payments for this purpose; and even health insurers, lured by the prospect of reducing the cost of claims, have started helping.
For a closer look at how community health workers are helping hospitals keep their patients healthier and out of the hospital, see the Kaiser Health News report “Hospitals Eye Community Health Workers to Cultivate Patient Success.”

PA Safety Net Admin2016-04-15T06:00:04+00:00April 15th, 2016|Medicare|Comments Off

Readmissions Reduction Target Too High?

Medicare’s goal of reducing hospital readmissions 20 percent – a key aspect of its hospital readmissions reduction program – may be too ambitious, researchers have concluded after evaluating the results of a special Connecticut effort to reduce readmissions.
In that program, a new approach to reducing readmissions tested on 10,000 older patients considered at high risk of readmissions employed interventions, transition support, education, follow-up telephone calls, and assistance finding community resources and assistance. The result? It cut Medicare hospital readmissions nine percent – less than half the 20 percent goal Medicare has set.
jama internal medicine The study’s creators concluded that

Our analysis revealed a fairly consistent and sustained but small, beneficial effect of the intervention on the target population as a whole.

Learn more about the study in this Fierce Healthcare report and find the study itself here, on the web site of JAMA Internal Medicine.

PA Safety Net Admin2016-04-14T06:00:34+00:00April 14th, 2016|Medicare|Comments Off

Academy Offers Practices to Improve Care for Disadvantaged Patients

The National Academies of Science, Engineering, and Medicine has published a new report that acknowledges the challenges faced by hospitals that care for socio-economically challenged patients and offers suggestions for how to serve those patients more effectively.
The report, Systems Practices for the Care of Socially At-Risk Populations, is the second in a projected series of five reports on the subject.
The study notes that

Emerging evidence suggests that providers disproportionately serving patients with social risk factors for poor health outcomes may be more likely to fare poorly on quality rankings and to receive financial penalties, and less likely to receive financial rewards.

Because the study did not include any original empirical research and is based instead on literature reviews and case studies, the Academy declined to suggest best practices for serving this challenging population but did offer six recommendations for improving care to socio-economically disadvantaged communities:

Commitment to health equity. Value and promote health equity and hold yourself accountable.
Data and measurement. Understand your population’s health, risk factors, and patterns of care.
Comprehensive needs assessment. Identify, anticipate, and respond to clinical and social needs.
Collaborative partnerships. Collaborate within and across provider teams and service sectors to deliver care.
Care continuity. Plan care and transitions in care to prepare for patients’ changing clinical and social needs.
Engaging patients in their care. Design individualized care to promote the health of individuals in the community setting.

The study also acknowledged the importance of adequate provider (primarily Medicare) payments in serving such a challenging population:

Both the availability of resources and alignment of financial incentives are prerequisites for the adoption and sustainability of these practices…Resources can provide the incentives to reduce disparities by targeting interventions at socially at-risk populations and incorporating equitable care and outcomes into accountability processes. Interventions that improve health and quality of care or reduce utilization and cost are only sustainable if the provider’s profits are higher with the intervention than without. Most of the efforts presented by the committee involve fixed costs and potentially shared benefits across multiple payers, so their economic feasibility depends on Medicare’s payment system and that of other payers. Environments in which a greater share of a provider’s revenue derives from payments related to health outcomes will make it more sustainable for them to invest in programs that improve quality and reduce cost.

The communities described in the report are the very types of communities Pennsylvania’s safety-net hospitals serve.
To learn more about what the Academy learned and what it has recommended, go here to see its news release accompanying publication of the report and go here to see the report itself.

PA Safety Net Admin2016-04-12T06:00:50+00:00April 12th, 2016|Medicare, Pennsylvania safety-net hospitals, Uncategorized|Comments Off

New Approaches to Readmissions Reduction Program?

While Medicare’s readmissions reduction program has produced a decline in the number of Medicare readmissions within 30 days of discharge, critics – among them many safety-net hospitals – argue that the program is unfair to hospitals that serve especially large numbers of low-income patients whose distinct needs pose a greater risk of requiring readmission to address.
In a new report, the journal Health Affairs notes that such arguments have given rise to a number of proposals for possible changes in the readmissions reduction program. Among them, the Medicare Payment Advisory Commission

…has proposed a revision to the method for calculating readmissions. Rather than including patient SES [note: socio-economic status] in the risk-adjustment step, which MedPAC argues would take years to develop empirically and could mask true quality disparities, MedPAC suggests grouping hospitals into peer groups based on their share of low-income Medicare patients and then set readmissions targets for each peer group. Put another way, hospitals with similar shares of low-income patients would be compared with each other instead of all hospitals.

Other suggestions for modifying the readmissions reduction program include shortening the window on readmissions, which might better reflect the quality of care a hospital provides rather than the nature of the patients it serves; changing the quality measures on which hospitals are judged, choosing new measures that might be less sensitive to socio-economic factors; and providing additional financial or other support to hospitals that serve especially large numbers of low-income patients.
To learn more about the kinds of challenges Medicare’s hospital readmissions reduction program pose and what might be done to address them without discarding the program entirely, go here for the Health Affairs article “The Challenges Of Rewarding Value Over Volume Without Penalizing Safety-Net Hospitals.”

PA Safety Net Admin2016-04-07T06:00:04+00:00April 7th, 2016|Affordable Care Act, Medicare|Comments Off

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