medicare Archives - Safety-Net Association of Pennsylvania

Profile of Nominee to Head CMS

President-elect Donald Trump has nominated Seema Verma, a health care consultant, to serve as administrator of the Centers for Medicare & Medicaid Services. That agency runs the Medicare and Medicaid programs.
In this capacity she would have enormous influence on the development of new Medicare and Medicaid initiatives, including many proposals for change from the incoming administration and Congress – all matters of vital concern to Pennsylvania safety-net hospitals.
Go here to see a Kaiser Health News profile of Ms. Verma and learn more about her past work, especially on Medicaid issues.

PA Safety Net Admin2016-12-06T06:00:58+00:00December 6th, 2016|Medicare, Pennsylvania Medicaid|Comments Off

CMS Proposes 2017 Medicare Outpatient Payment Policies

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

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.

PA Safety Net Admin2016-07-08T06:00:26+00:00July 8th, 2016|Medicare|Comments Off

CMS Proposes Changes in Terms of Medicare, Medicaid Provider Participation

The Centers for Medicare & Medicaid Services has proposed changes in the terms under which hospitals may participate in Medicare and Medicaid.
Among those changes, hospitals must:

establish an infection prevention and control program with qualified leaders
establish an antibiotic stewardship program with qualified leaders
establish policies prohibiting discrimination based on race, color, religion, national origin, general, sexual orientation, age, and disability
incorporate readmission and hospital-acquired conditions information into their Quality Assessment and Performance Improvement program
improve their medical record-keeping and provide for patient access to those records

Learn more what CMS has proposed and why it has proposed it in this CMS news release and this CMS fact sheet. CMS is accepting comments about the proposed changes until August 15. Find a link to the proposed rule itself here.

PA Safety Net Admin2016-06-28T06:00:07+00:00June 28th, 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

Study Considers How Best to Prevent Readmissions

A five-year study performed by researchers from the Yale School of Public Health has found that while many hospitals have successfully reduced the rate of readmission for their Medicare patients, few specific strategies have emerged as best practices for tackling this challenge.
In fact, only one strategy appears to be universally effective: discharging patients with their follow-up appointments already made.
Beyond that, researchers found that hospitals lowered their readmission rates by employing a number of tools and that most successful hospitals employed at least three such tools – although which tools they employed differed and more tools did not produce better results.
Hospitals have been working to lower their readmissions in response to Medicare’s hospital readmissions reduction program, which imposes financial penalties for hospitals that readmit “too many” of their Medicare patients.
The study’s conclusion:

Hospital readmission rates result from the confluence of diverse patient, provider, and organizational factors. Despite a wide range of hospitals and five years of study, we found little evidence that specific strategies conferred improvements across hospitals, aside from booking follow-up appointments before discharge. Rather, adopting at least three strategies, tailoring implementation efforts to local circumstances, and persistence over time seemed to be keys to success.

Find the Yale study “National Campaigns to Reduce Readmissions: What Have We Learned?” here, on the web site of the Commonwealth Fund, which underwrote the research.

PA Safety Net Admin2015-10-05T06:00:55+00:00October 5th, 2015|Medicare|Comments Off

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

Feds Provide More Info on Short Stay Settlement Offer

The Centers for Medicare & Medicaid Services (CMS) has posted more information about its offer to settle hospital appeals of Medicare denials of payments for short hospital stays.
The offer, made last week, seeks to help CMS with an 18-month backlog of hundreds of thousands of appeals from acute-care and critical access hospitals. Hospitals willing to drop their appeals are eligible to receive 68 cents on the dollar for the value of the cases in dispute. The offer is available only for cases in which Medicare’s auditors rejected hospital claims for inpatient reimbursement for short hospital stays and then categorized the cases in question as outpatient care. Hospitals that wish to take advantage of the CMS offer must drop their claims for all such cases; they cannot selectively choose to drop some appeals and continue to pursue others.
Now, CMS has outlined how the process of filing for settlement of the cases will work, including the information hospitals must provide and the format in which they must provide it, the forms they must use, and descriptions of the processes it will employ to address discrepancies and reconcile claims.
CMS also has posted an FAQ, a recording of a teleconference on the subject, and the email address for questions.
Learn more about CMS’s offer and this process and find the materials cited above and additional documents available for download in this announcement on the CMS web site.

PA Safety Net Admin2014-09-12T06:00:11+00:00September 12th, 2014|Uncategorized|Comments Off

Bill in Congress Would Benefit PA Safety-Net Hospitals

New legislation introduced in Congress would add a risk adjustment component to Medicare’s hospital readmissions reduction program.
Such a measure would benefit Pennsylvania’s safety-net hospitals.
H.R. 4188, the Establishing Beneficiary Equity in the Hospital Readmission Program Act, proposes modifying Medicare’s hospital readmissions reduction program. Under the bill, hospitals’ performance in preventing Medicare readmissions would be risk-adjusted for patients who are dually eligible for Medicare and Medicaid; for patients who are considered non-compliant; for patients whose readmission has been classified as based on psychosis or substance abuse; and for patients who have specific medical conditions.
Hospitals found to have too many Medicare readmissions suffer financial penalties under Medicare’s hospital readmissions reduction program. Recent studies suggest that in its current form, the program unfairly targets safety-net hospitals for financial penalties.
Learn more about the bill from this news release from its sponsor, Rep. James Renacci (R-Ohio), or find the bill itself here.

PA Safety Net Admin2014-03-17T06:00:07+00:00March 17th, 2014|Uncategorized|Comments Off

Increase Use of Value-Based Purchasing, HHS Told

A study performed for the U.S. Department of Health and Human Services calls for greater use of value-based purchasing in federal health care reimbursement policy.
The study, performed by the RAND Corporation, recommends developing a national value-based purchasing strategy; developing a more deliberate approach to evaluating the effectiveness of value-based purchasing efforts; and developing performance measures that support value-based purchasing approaches.
Such an approach could be a major challenge for Pennsylvania’s safety-net hospitals, according to a Harvard School of Public Health analysis that found that in the first year of Medicare’s value-based purchasing program, hospitals that served the largest numbers of low-income patients suffered the largest financial penalties from that program.
Read more about the RAND study in this Fierce Healthcare story and find the RAND study itself here. Read another Fierce Healthcare article about the impact of value-based purchasing on safety-net hospitals here.

PA Safety Net Admin2014-03-11T06:00:25+00:00March 11th, 2014|Uncategorized|Comments Off

New Approaches to Serving Dual Eligibles Set to Launch

Provisions in the Affordable Care Act that encourage states to take new approaches to serving their dually eligible residents – low-income seniors eligible for both Medicare and Medicaid – will soon translate into new state programs.
Massachusetts has already launched such an initiative, a new California program will begin in May, and 17 additional states are scheduled to begin new efforts later this year and next.
New federal policies encourage state Medicaid programs to work with Medicare in service to their dually eligible population, with the states and Medicare sharing in the savings they produce. Currently, dually eligible patients constitute 15 percent of the Medicaid population but account for 40 percent of Medicaid’s costs and 20 percent of the Medicare population but 30 percent of Medicare’s costs.
Eighteen percent of Pennsylvania’s Medicaid population is dually eligible. The state is not among those with new dual eligibles programs preparing to launch.
How are states tackling this challenge? Learn more in this Stateline report.

PA Safety Net Admin2014-02-18T06:00:56+00:00February 18th, 2014|Pennsylvania Medicaid policy|Comments Off

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