The Centers for Medicare & Medicaid Services wants to adjust penalties in its Hospital Readmissions Reduction Program according to a hospital’s proportion of dual-eligible (Medicare and Medicaid) patients — a move long supported by hospital-industry stakeholders.
The proposed rule would take effect in fiscal 2019. In it, the CMS laid out several approaches for determining hospitals’ proportion of dually eligible patients and other key metrics.The change stems from the 21st Century Cures Act, enacted last December. The law required Medicare to consider patient background when calculating payment reductions to hospitals under the Hospital Readmission Reduction Program, and to adjust those penalties based on the proportion of patients dually eligible for Medicare and Medicaid.
The Medicare Payment Advisory Commission has reported that while these dual eligibles constituted 18 percent of beneficiaries they accounted for nearly a third of total Medicare fee-for-service spending in 2012.
Some call the 21st Century Cures Act an outrageous giveaway to medical-device and drug companies that cuts federal support for the less sexy but far more effective measures (than new, hugely profitable drugs and devices) for improving America’s overall health, such as immunizations and anti-smoking initiatives. And, foes say, the act will encourage sloppy and fraudulent science as it fast-tracks approval of new drugs and devices.
To read more, please hit this link.
Paul Keckley, the healthcare-sector analyst, looks at the implications of the 21st Century Cures Act for hospitals.
Among his recommendations for hospital executes for living in the Cures Act world:
- “Formulary design and medication management policies and procedures need constant review so that competing compounds can find their way readily into a hospital’s prescribing patterns. And the hospital’s interaction with retail pharmacies should enable shared knowledge about new and emerging classes and compounds that offer the same efficacy and effectiveness at a lower rate.”
- “Medical device utilization, purchasing, and measures of effectiveness and safety need closer scrutiny. Of particular note are two areas where compliance risk is quite strong: the financial relationships between physicians and hospitals and manufacturers, and the safety associated with devices.”
- “Medical directors must be proactive. Pharmacists should be included in care coordination teams across the organization.”
- ”Mental health professionals should be recruited to the clinical community.”
- The diagnostic tests inclusive of mental and physical health signs, symptoms, risk factors, and co-morbidities should be updated and hardwired into clinical decision support systems that prompt, alert and remind clinicians to make definitive diagnoses.”
To read his article, please hit this link.
A coalition of physician advocacy groups and insurers that includes the Blue Cross and Blue Shield Association and insurance industry lobbying group America’s Health Insurance Plans is asking Congress to reject a provision in the 21st Century Cures Act that lets some lets some hospital-owned outpatient facilities avoid some site-neutral payment rules.
The Alliance for Site Neutral Payment Reform called on House Energy and Commerce committees leaders to oppose exempting cancer hospitals and other outpatient departments under development before Nov. 2, 2015, from the payment policies passed as part of the Bipartisan Budget Act of 2015 and finalized by the CMS earlier this month.
Modern Healthcare reported: “The alliance said the 21st Century Cures provisions would continue to drive up costs for Medicare and patients and would encourage hospitals to swallow up independent physician practices, thereby reducing patient choice.”
The group’s letter to Congress said: “Preserving an outdated reimbursement policy that continues to drive up healthcare spending in the outpatient space is counter to Congress’s goal of modernizing the Medicare system and providing patients with healthcare choices at less cost.”
Modern Healthcare reported that “Insurers want to limit the exceptions to the site-neutral payment rates because those exempted outpatient facilities will ultimately be paid more and insurers want to keep Medicare reimbursement low. Moreover, prices tend to float up when providers consolidate, so insurers end up paying more.”
The publication noted: “Medicare pays a higher rate for services provided in a hospital’s off-site facility rather than a physician’s office. The CMS and the Alliance for Site Neutral Payment Reform said this difference has led to hospitals buying up physician offices to receive higher rates, increasing costs for both Medicare and patients.”
To read the Modern Healthcare piece, please hit this link.