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Serving High-Risk Patients Leads to VPB Penalties

Practices that served more socially high-risk patients had lower quality and lower costs, and practices that served more medically high-risk patients had lower quality and higher costs. These patterns were associated with fewer bonuses and more penalties for high-risk practices. So concludes a new study that looked at the results of the first year of the Medicare Physician Value-Based Payment Modifier Program. The study looked at 899 physician practices serving more than five million Medicare beneficiaries, and it points to the continuing challenge of how best to serve patients who pose greater socio-economic risks than the average patient. Pennsylvania safety-net hospitals serve far more high-risk patients than the typical hospital. Learn more these findings and how they were reached in … Read More

Posted in Medicare, Pennsylvania safety-net hospitals

Ways and Means Seeks to Cut Medicare Red Tape

The House Ways and Means Committee’s Health Subcommittee has launched a new initiative to attempt to improve the delivery of Medicare services and eliminate statutory and regulatory obstacles to more effective care delivery. The subcommittee describes its “Medicare Red Tape Relief Project” as …a new initiative to deliver relief from the regulations and mandates that impede innovation, drive up costs, and ultimately stand in the way of delivering better care for Medicare beneficiaries. In support of this initiative, the committee has announced a three-part approach in which it will seek feedback from stakeholders, host roundtables with stakeholders across the country, and pursue congressional action to address the problems identified through this process. As part of the first step, the Health … Read More

Posted in Medicare

Congress Looks at 340B Program

Last week the House Energy and Commerce Committee took a look at the 340B prescription drug discount program, which requires pharmaceutical companies to sell discounted drugs for outpatient use to hospitals that care for especially large numbers of low-income patients. The previous week, the Centers for Medicare & Medicaid Services issued a proposed Medicare regulation calling for significant reductions in Medicare payments for such drugs. The hearing touched on the CMS proposal to reduce Medicare payments for 340B drugs, the high prices of prescription drugs, the 340B program’s growth over the years, the possibility that the program is being abused by hospitals and clinics, and more. The 340B program is an essential tool in the efforts of Pennsylvania safety-net hospitals … Read More

Posted in Medicare, Pennsylvania safety-net hospitals, Uncategorized

Temporarily Gone But Not Forgotten

While last week’s withdrawal of the American Health Care Act at least temporarily halted talk of immediate repeal and replacement of the Affordable Care Act, at least one aspect of that proposed legislation, often discussed in the past, is sure to arise in the future as well:  replacing the current manner in which the federal government matches state Medicaid funding with Medicaid per capita limits or Medicaid block grants. In a new issue brief, the Kaiser Family Foundation examines how a switch to per capita limits or block grants might affect low-income seniors served by both Medicare and Medicaid.  Among the issues the brief addresses are: why such a switch would matter to low-income seniors at all how it might … Read More

Posted in Federal Medicaid issues, Medicare, Pennsylvania safety-net hospitals

CMS Shares Evaluation of Medicare-Medicaid Financial Alignment Efforts

In 2011 the Centers for Medicare & Medicaid Services launched a “Medicare-Medicaid Financial Alignment Initiative” that seeks “…to provide Medicare-Medicaid enrollees with a better care experience and to better align the financial incentives of the Medicare and Medicaid programs.” How is that initiative working so far?  CMS recently released three reports that evaluate different aspects of the program.  Those reports are: “Early Findings on Care Coordination in Capitated Medicare-Medicaid Plans under the Financial Alignment Initiative” “Beneficiary Experience: Early Findings from Focus Groups with Enrollees Participating in the Financial Alignment Initiative” “Issue Brief: Special Populations Enrolled in Demonstrations under the Financial Alignment Initiative” Pennsylvania’s private safety-net hospitals serve especially large numbers of dually eligible Medicare and Medicaid beneficiaries, so such programs … Read More

Posted in Federal Medicaid issues, Medicare, Uncategorized

Serving High-Need, High-Cost Medicare Patients

With Medicare beneficiaries who have four or more chronic conditions accounting for 90 percent of Medicare hospital readmissions and 74 percent of Medicare costs (both 2010 figures), policy-makers are constantly looking for better ways to serve such individuals. Academic research suggests that these beneficiaries need a variety of non-medical social interventions and supports, most of which are not covered by Medicare. With this in mind, the Bipartisan Policy Center has prepared a review of current regulatory, payment, and other barriers that prevent providers and insurers from meeting some of the non-medical needs of high-need, high-cost patients that result in such high health care costs and hospital readmissions rates. Many of these high-need, high-cost patients live in low-income communities served by … Read More

Posted in Medicare, Pennsylvania safety-net hospitals

MedPAC: Small Pay Raise for Hospital Inpatient, Outpatient Services

The independent agency that advises Congress on Medicare payment matters has recommended modest increases in Medicare payments for hospital inpatient and outpatient services in FY 2018. The Medicare Payment Advisory Commission voted in support of a market basket increase of approximately 1.85 percent for Medicare outpatient and inpatient services in FY 2018. MedPAC also voted to recommend a 0.5 percent increase in payments to physicians but no increase for ambulatory surgery centers. MedPAC will formally submit its recommendations to Congress in March. Learn more about these and other MedPAC recommendations for changes in Medicare provider reimbursement in this article on the Provider web site.

Posted in Medicare

ACOs Serving High Proportions of Racial and Ethnic Minorities Lag in Quality Performance

Accountable care organizations that serve large numbers of minority patients score lower on Medicare quality measures than other ACOs, a new study has found. According to the study, ACOs serving larger numbers of minority patients perform worse than other ACOs on 25 of 44 Medicare performance measures – and that performance does not improve over time. The study also pointed out that the minority patients served by ACOs are generally poorer and sicker than other ACO participants. These are the very patients typically served in especially large numbers by Pennsylvania’s safety-net hospitals. Learn more about these and other findings in the report “ACOs Serving High Proportions of Racial and Ethnic Minorities Lag in Quality Performance,” which can be found here.

Posted in Medicare

Academies Completes Work on Social Risk Factors in Health Care

Completing its assignment from the U.S. Department of Health and Human Services, the Health and Medicine Division of the National Academies of Science, Engineering, and Medicine has published its fifth and final report on social risk factors that affect health outcomes for Medicare beneficiaries and how to account for those risk factors in Medicare payments. Among other things, the report notes that Although VBP [value-based purchasing] programs have catalyzed health care providers and plans to address social risk factors in health care delivery through their focus on improving health care outcomes and controlling costs, the role of social risk factors in producing health care outcomes is generally not reflected in payment under current VBP design. This misalignment has led to … Read More

Posted in Medicare, Pennsylvania safety-net hospitals, Uncategorized

New Medicare Payments to Help With High-Need Patients

New Medicare payment practices that took effect on January 1 will improve payments to physicians who care for high-need patients in the hope that those enhanced payments will improve the care such seniors receive. Among those improved payments are: payments to physicians for the time they spend working with specialists, families, pharmacists, caregivers, and others to coordinate services for seriously ill patients improved payments for time spent coordinating seniors’ transitions between different care settings and home and connecting those patients with additional resources separate payments to perform cognitive impairment assessments payments for time physicians spend reviewing patient records and talking on the phone to patients and their caregivers ayments for work physicians perform with their high-need patients’ behavioral health caregivers … Read More

Posted in Medicare
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