Medicare Archives - Page 8 of 9 - Safety-Net Association of Pennsylvania

Medicare Proposes Addressing Health Disparities

The Centers for Medicare & Medicaid Services (CMS) has unveiled its first plan to reduce health disparities among Medicare beneficiaries.
The plan, produced by CMS’s Office of Minority Health and titled “The CMS Equity Plan for Improving Quality in Medicare,” will seek to improve care for

…Medicare populations that experience disproportionately high burdens of disease, lower quality of care, and barriers to accessing care. These include racial and ethnic minorities, sexual and gender minorities, people with disabilities, and those living in rural areas.

This is the very population served in disproportionate numbers by many of Pennsylvania’s private safety-net hospitals.
The program will focus on six priorities:

expanding the collection, reporting, and analysis of standardized data
evaluating disparity impacts and integrating equity solutions across Medicare programs
developing and dissemination promising approaches to reducing health disparities
increasing the ability of the health care workforce to meet the needs of vulnerable populations
improving communication and language access for individuals with limited English proficiency and persons with disabilities
increasing physical accessibility of health care facilities

To learn more about The CMS Equity Plan for Improving Quality in Medicare, see this CMS news release.

PA Safety Net Admin2015-09-15T06:00:58+00:00September 15th, 2015|Medicare, Pennsylvania safety-net hospitals|Comments Off

PA Included in New Medicare Value-Based Insurance Program Demonstration

Pennsylvania is one of seven states that will participate in a new value-based purchasing demonstration program for Medicare Advantage plans.
According to a fact sheet published by the Centers for Medicare & Medicaid Services (CMS),

Value-Based Insurance Design (VBID) generally refers to health insurers’ efforts to structure enrollee cost sharing and other health plan design elements to encourage enrollees to use high-value clinical services – those that have the greatest potential to positively impact enrollee health. VBID approaches are increasingly used in the commercial market, and evidence suggests that the inclusion of clinically-nuanced VBID elements in health insurance benefit design may be an effective tool to improve the quality of care while reducing its cost for Medicare Advantage enrollees with chronic diseases. As part of the “better care, smarter spending, healthier people” approach to improving health care delivery, CMS will test VBID in Medicare Advantage and measure whether structuring patient cost sharing and other health plan design elements does encourage enrollees to use health care services in a way that reduces costs.

According to CMS,

The MA-VBID model supports high-value clinical services, improved health outcomes, and health care cost savings or cost neutrality through the use of structured patient cost sharing and other health plan design elements that encourage enrollees to use high-value clinical services. The MA-VBID model will provide flexibility for Medicare Advantage plans accepted into the model to develop clinically-nuanced benefit designs for enrollee populations that fall within certain clinical categories.

The clinical conditions on which the program will focus are diabetes, chronic obstructive pulmonary disease, congestive heart failure, patients who have suffered strokes, hypertension, coronary artery disease, and mood disorders.
The program, to be launched in January of 2017, will run for five years in seven states: in addition to Pennsylvania, Medicare Advantage plans in Arizona, Indiana, Iowa, Massachusetts, Oregon, and Tennessee will be invited to participate.
To learn more about Medicare’s new Value-Based Insurance Design programs, see this CMS news release and fact sheet.

PA Safety Net Admin2015-09-11T06:00:03+00:00September 11th, 2015|Medicare|Comments Off

Changes Coming For Medicare Hospital-Acquired Condition Reduction Program

In response to the concerns of hospitals, Medicare is planning changes in its hospital-acquired condition reduction program.
The program, a product of the Affordable Care Act, penalizes hospitals that perform poorest on measures designed to identify medical problems their patients incur while hospitalized. Hospital performance is judged based on criteria developed by the Centers for Medicare & Medicaid Services (CMS).
In the face of criticisms about the program’s design, overlapping measures, and more, CMS now plans to share more information with hospitals about how it scores their performance and also will update some of the measures upon which those scores are based.
A recent article in the journal Health Affairs describes the hospital-acquired condition reduction program, the challenges it has faced, and CMS’s plans for it moving forward. Find that article here.

PA Safety Net Admin2015-08-12T06:00:11+00:00August 12th, 2015|Medicare|Comments Off

Is Medicare “Pay for Performance” Doing the Job?

Three Medicare initiatives – its hospital readmissions reduction program, value-based purchasing program, and hospital-acquired condition program – were designed to improve the quality of care provided to beneficiaries while eventually reducing the cost of that care.
But are they living up to their billing? That is the question considered in the Health Affairs article “Assessing Medicare’s Hospital Pay-For-Performance Programs and Whether They Are Achieving Their Goals.” Find the article here.

PA Safety Net Admin2015-08-10T06:00:27+00:00August 10th, 2015|Medicare|Comments Off

Graduate Medical Education: Boon or Bane for Hospitals’ Bottom Line?

Do hospitals make money on graduate medical education? Do they lose money subsidizing positions above and beyond the funding they receive for completing the training of the next generation of doctors? Are there other benefits hospitals reap from medical education training programs – and are those benefits worth the cost?
This is an important question for the many Pennsylvania safety-net hospitals that also are teaching hospitals.
Crain’s Detroit Business has taken a look at some of the surprisingly complex considerations that go into answering what seem like very simple questions. Go here for its report “Hospitals say they subsidize graduate medical education, but cost-benefit unknown.”

PA Safety Net Admin2015-07-23T06:00:32+00:00July 23rd, 2015|Medicare|Comments Off

GAO Reports on 340B Program

The U.S. Government Accountability Office (GAO) recently completed a review of the federal 340B Drug Pricing Program.
The program, which requires pharmaceutical companies to provide drug discounts to qualified hospitals that serve especially large proportions of low-income patients, has come under fire recently because approximately 40 percent of U.S. hospitals now participate in the program and there have been questions about how hospitals use the program and its drug discounts.
The GAO found that Medicare Part B spending on drugs was much higher at participating 340B hospitals than it was at non-participating hospitals, suggesting that participating hospitals prescribe more drugs and more expensive drugs. It found that

The Centers for Medicare & Medicaid Services (CMS), which administers the Medicare program, uses a statutorily defined formula to pay hospitals for drugs at set rates regardless of hospitals’ costs for acquiring the drugs. Therefore, there is a financial incentive at hospitals participating in the 340B program to prescribe more drugs or more expensive drugs to Medicare beneficiaries.

In the review, GAO recommended that

Congress should consider eliminating the incentive to prescribe more drugs or more expensive drugs than necessary to treat Medicare Part B beneficiaries at 340B hospitals.

Go here to find the GAO report Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals.
A number of groups have criticized GAO’s findings. Learn about their perspective in articles in Healthcare Finance News, Modern Healthcare, and Becker’s Hospital Review.

PA Safety Net Admin2015-07-13T06:00:49+00:00July 13th, 2015|Medicare|Comments Off

Medicare Proposes Changes in Two-Midnight Rule

The Centers for Medicare & Medicaid Services (CMS) has unveiled a proposal for long-awaited changed in its controversial Medicare “two-midnight rule.”
The changes, part of the agency’s proposed 2016 Medicare outpatient prospective payment system regulation released last week, include:

changes in the standards by which inpatient admissions qualify for Medicare Part A payments
a shift in responsibility for enforcement of the regulation, with Quality Information Organizations (QIOs) taking over from Recovery Audit Contractors (RAC auditors).
changes in how long hospitals have to rebill for Medicare Part B services
time limits on auditor requests for additional information about claims
new limits on when recovery auditors must complete complex reviews and how long they must wait before sending claims to Medicare administrative contractors (MACs) for adjustment so providers have a reasonable opportunity to comment on preliminary findings.

CMS has published a fact sheet on the proposed changes in the two-midnight rule; find that fact sheet here. The two-midnight rule changes are part of a broader proposed regulation governing Medicare outpatient payments to providers in 2016. Find that proposed regulation here.

PA Safety Net Admin2015-07-07T06:00:30+00:00July 7th, 2015|Medicare|Comments Off

Patient Satisfaction Survey Results Misleading?

A new report from a non-partisan bioethics institute suggests that the patient satisfaction surveys that Medicare uses as part of its value-based purchasing program may not be providing the kind of information on which Medicare payments should be based.
According to the Hastings Center report “Patient-Satisfaction Surveys on a Scale of 0 to 10: Improving Health Care, or Leading It Astray?” the surveys appear to blend patient satisfaction with their experience while hospitalized with the quality of care they received during that hospitalization and that “Good ratings depend more on manipulable patient perceptions than on good medicine.”
Currently, patient satisfaction is a major component of Medicare’s value-based purchasing program and hospitals can be rewarded or penalized based on their patients’ satisfaction as measured in surveys. The report notes that “The current institutional focus on patient satisfaction and on surveys designed to assess this could eventually compromise the quality of health care while simultaneously raising its cost.”
Find the complete study here, on the web site of the Hastings Institute.

PA Safety Net Admin2015-06-12T06:00:16+00:00June 12th, 2015|Medicare|Comments Off

30-Day Readmission Standard Flawed, Study Suggests

A new study raises the possibility that Medicare’s policy of penalizing hospitals that readmit patients within 30 days of their discharge may be flawed.
According to a new report in the Annals of Internal Medicine, risk factors for readmission often change within those 30 days.
In addition, patients with chronic medical problems are more likely to need readmission. Even the time of day of discharge appears to affect patients’ likelihood of readmission, with those discharged between 8 a.m. and 1:00 p.m. less likely to be readmitted.
The study also found that social determinants and insurance status also increase the likelihood of readmission within 30 days of discharge.
Together, these and other findings appear to raise questions about the fairness of Medicare’s hospital readmissions reduction program.
These findings also mirror a growing body of research that suggests that the program is inherently unfair to safety-net hospitals that serve large numbers of low-income patients who have had limited and sporadic access to medical care during their lives.
To learn more, see this Fierce Healthcare report. Find the study “Differences Between Early and Late Readmissions Among Patients: A Cohort Study” here, on the web site of the Annals of Internal Medicine.

PA Safety Net Admin2015-06-08T06:00:26+00:00June 8th, 2015|Medicare|Comments Off

Senate Takes Testimony on Medicare Observation Status

The Senate Special Committee on Aging recently heard testimony about the challenges posed by the “observation status” designation conferred on some Medicare patients in hospitals.
Among the concerns raised at the hearing were the financial vulnerability of some seniors hospitalized only under observation and not as inpatients; the possibility that some hospitals may be using observation status to avoid Medicare penalties for readmitting recently discharged payments; the punitive actions of Medicare recovery audit contractors (RAC auditors); and more. Intertwined with this is Medicare’s two-midnight rule and the challenges the program has faced attempting to implement this rule.
Testifying before the committee were representatives of the Medicare Payment Advisory Commission (MedPAC), the Centers for Medicare & Medicaid Services (CMS), the American Hospital Association, and others.
For a closer look at the hearing, a link to a video of the hearing, and copies of some of the testimony, see this Fierce Healthcare article.

PA Safety Net Admin2015-06-01T06:00:59+00:00June 1st, 2015|Medicare|Comments Off

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