Noteworthy News

Archive for January, 2015


MedPAC Looks at Short Hospital Stays

The independent agency that advises Congress on Medicare payment issues is examining one of the more controversial of those payment issues:  Medicare payments for short hospital stays. At its recent public meeting in Washington, D.C., members of the Medicare Payment Advisory Commission (MedPAC) heard a presentation on Medicare short hospital stays and discussed the issue.  Among the challenges the issue poses, they noted, were the differences in Medicare reimbursement for inpatient and outpatient hospital stays and the opportunities for abuse that potentially presents; the focus of Recovery Audit Contractor (RAC auditors) on short hospital stays and the administrative burden that [&hellip

Medicare Seeks to Put Pedal to the Metal on Quality-Related Payments and Care

The federal government has unveiled its intention to pursue a significant increase in the proportion of Medicare services for which it pays based on the quality of care delivered than the quantity of care provided. The plan was announced on Monday by Health and Human Services (HHS) Secretary Sylvia Burwell at an event in Washington, D.C. According to an HHS news release, HHS has set a goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, [&hellip

MedPAC Mulls Payment Per Beneficiary for Primary Care

At a recent meeting of the Medicare Payment Advisory Commission (MedPAC), commission members discussed the inadequacy of Medicare payments to providers for primary care and considered a proposal to recommend to Congress that primary care physicians receive a “per beneficiary” payment to enhance that reimbursement. The commissioners, who advise Congress on Medicare payment matters, continue to be concerned that Medicare does not pay primary care providers adequately or fairly. See the MedPAC issue brief on this matter here and see the presentation offered at the recent MedPAC meeting here

Medicaid “Pay Bump” Worked, New Study Suggests

A federally mandated increase in Medicaid payments for primary care services appears to have achieved its goal of improving access to care for Medicaid recipients. The increase, part of the Affordable Care Act, called for raising payments for Medicaid primary care services to the same level as Medicare payments in the hope that such an increase would lead more primary care providers to serve Medicaid patients, thereby improving access to primary care services for those patients.  Historically, primary care providers have been reluctant to serve Medicaid patients, citing low pay as their reason for avoiding such patients. That Medicaid pay [&hellip

Medicare Giveth and Medicare Taketh Away

With a growing number of Medicare programs basing portions of future reimbursement on meeting specific performance metrics, hospitals are finding that they need a scorecard to keep track of their successes and failures. Medicare’s value-based purchasing program, for example, is rewarding 1700 hospitals this year for their performance under the program.  Another 1360 hospitals are being penalized under the program. But among those 1700 winners, fewer than 800 will see their bonuses because their losses under Medicare’s hospital readmissions reduction program and health care-associated infection program exceed their value-based purchasing winnings. Overall, the average bonus for large hospitals for the [&hellip

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