Hospitals and post-acute care providers, Medicare drug providers, and older adults could see substantial changes in payments and benefits if President Obama’s 2015 fiscal year budget proposal is passed as presented.
The president’s $3.9 trillion plan includes more than $400 billion in cuts over the next decade in Medicare and Medicaid spending, as well as changes in provider reimbursement to place greater emphasis on quality. As Politico reported, additional savings would come from higher premiums of wealthier beneficiaries, changes in Medicare Part D payments to drug companies, and reimbursement cuts to post-acute providers like skilled nursing facilities and home health care agencies.
AARP criticized the proposal for “simply cost shifting.”
“We know that brand name prescription drugs are one of the key drivers of escalating health care costs, so we appreciate the President’s inclusion of proposals to find savings in lower drug costs, said AARP Executive Vice President Nancy A. LeaMond in a statement. “But instead of shifting additional costs onto Medicare beneficiaries, we must look for savings throughout the entire health care system, as the rising cost of health care threatens people of all ages.” Continue reading
Members of the Senate Finance Committee are urging the federal Centers for Medicare & Medicaid Services (CMS) to reconsider a proposal to revise the Medicare Part D prescription drug program for seniors.
In a letter sent on Friday to Marilyn Tavenner, administrator of the federal Centers for Medicare & Medicaid Services (CMS), 20 of the 24 members of the committee wrote to say the proposal would disrupt the care for millions of Part D beneficiaries.
According to an article by Lisa Gillespie of Inside Health Policy (free trial subscription available), only Sens. Sherrod Brown (D-Ohio), Maria Cantwell (D-Wash.), Ben Cardin (D-Md.), and Chuck Schumer (D-N.Y.) did not sign the letter. Continue reading
The recently released 2014 work plan sets up how the Inspector General’s office of U.S. Department of Health and Human Services will scrutinize claims CMS pays to hospitals, nursing homes, and home care agencies, as well as for prescription drugs, medical equipment and other care services. Continue reading
An agreement has finally been reached in both houses of Congress that replaces the Medicare physician sustainable growth rate formula, or SGR, with plan that provides stable funding updates based pay-for-performance and increases reimbursements by 0.5 percent annually for the next five years. The SGR, part of the 1997 Balanced Budget amendment, essentially ensured that the yearly increase in the expense per Medicare beneficiary does not exceed the growth in GDP.
However, as health care costs began to outpace inflation, the SGR began to fall short of the actual cost of health care services and Congress has repeatedly stepped in to suspend or adjust the payments (“doc fix”). Many physicians groups, including the AMA, have called for a more permanent, less formulaic, solution. Continue reading
The Centers for Medicare & Medicaid Services (CMS) released interim financial results for its various ACO and bundled payment initiatives today which show savings in excess of $488 million.* These included cost savings analyses for Medicare Accountable Care Organizations, Pioneer ACOs, the Physician Group Practice demonstration and expanded participation in the Bundled Payments for Care Improvement Initiative. Many of those programs are discussed in detail in the AHCJ tip sheet “Latest innovations in Medicare.”
“These innovative programs are showing encouraging initial results, while providing valuable lessons as we strive to improve our nation’s health care delivery system,” HHS Secretary Kathleen Sebelius said in a statement. “Today’s findings demonstrate that organizations of various sizes and structures across the country are working with their physicians and engaging with patients to better coordinate and deliver high quality care while reducing expenditure growth.”
CMS said that In their first 12 months, nearly half (54 out of 114) of the ACOs that started program operations in 2012 already had lower expenditures than projected. Of the 54 ACOs that exceeded their benchmarks in the first year, 29 generated shared savings totaling more than $126 million. These ACOs generated a total of $128 million in net savings for the Medicare Trust Funds. Medicare shares in any ACO savings generated from lowering the growth in health costs while meeting high quality care standards.
Final performance year-one results will be released later this year. Continue reading
The Medicare Rights Center, a national, nonprofit consumer service organization, just released its first report analyzing the top issues facing people who called its national consumer help line in 2012.
“Medicare Trends and Recommendations: An Analysis of 2012 Call Data from the Medicare Rights Center’s National Helpline,” details stories representative of the problems faced by older adults, their families, and those caring for them.
According to a press release, three major trends emerged from more than 14,000 questions fielded on the helpline: Continue reading
As Charles Ornstein pointed out, the Centers for Medicare and Medicaid Services announced that it will release payment information for individual physicians in response to Freedom of Information Act requests, beginning in March. The move will increase transparency while still protecting the privacy of Medicare beneficiaries, according to a blog post by Jonathan Blum, principal deputy administrator.
According to a story in Modern Healthcare, the AMA has warned the Obama administration that it will be walking a thin line between balancing physician privacy rights with release of payment data – and that poor execution of the policy could lead to an unfair breach of confidentiality for providers and patients. Continue reading
(Editor’s note: This is a revision of the original post, which is available on Ornstein’s Tumblr site.)
The Centers for Medicare and Medicaid Services (CMS) said yesterday that it will soon begin releasing data on payments to individual physicians in the Medicare program.
Why is this such a big deal?
Because it overturns a longstanding agency policy that for more than three decades had barred the release of this very information. And, it follows advocacy for greater transparency by numerous news organizations, including the Association of Health Care Journalists.
AHCJ’s board of directors last September sent a letter of comment to CMS asserting the public’s interest in release of this information. “As long as patient confidentiality is protected, we see no reason why taxpayers should not know how individual physicians are spending public dollars,” said the letter, signed by AHCJ executive director Len Bruzzese.
In 1979, a federal court in Florida granted an injunction that prohibited the U.S. Department of Health, Education and Welfare (the predecessor to the Department of Health and Human Services) from releasing data on how much physicians earned under the Medicare program.
A year later, the HEW department adopted a policy that stated, “the public interest in the Department’s disclosure of the amounts that had been paid to individual physicians under the Medicare program was not sufficient to compel disclosure under the Freedom of Information Act.” Continue reading
2014 promises to be a big year in health and aging – with plenty of stories on the horizon for health journalists:
Medicare payments, Alzheimer’s breakthroughs, long-term care financing, caregiving issues, the science of longevity, senior-friendly neighborhoods and technology are just some of the issues journalists will likely report on on during this coming year.
Medicare will see several important changes – the 2014 handbook is a handy reference to have nearby. The standard premium of $104.90 and $147 deductible for Part B–provider coverage, remains the same for most people; however, some higher-earning seniors may see their Medicare or Medicare Advantage premiums rise slightly or be affected by some taxes like the capital gains tax. Continue reading
Late Wednesday, the Centers for Medicare and Medicaid Services released its final hospital outpatient and ambulatory surgical center payment schedule for the 2014 fiscal year. A revised payment approach is designed to help hospitals and ambulatory surgical centers (ASCs) lower costs and strengthen Medicare’s long-term stability. One single code describing all outpatient clinic visits will replace the current five levels. CMS said this will encourage more efficient delivery of outpatient facility services by packaging the payment for multiple supporting items and services into a single payment for a primary service similar to the way Medicare pays for hospital inpatient care.
According to a story in Modern Healthcare, the move was triggered, in part, because too many hospitals practice upcoding – illegally picking billing codes that reimburse at higher rates than actual services provided. In a statement, Rick Pollack, executive vice president of the American Hospital Association said they are “extremely disappointed” with the new rule, which may hurt hospitals’ ability to provide outpatient care. The organization contends that CMS did not use accurate data when forecasting future reimbursements. “CMS has put hospitals in the difficult position of having only 35 days to implement significant changes in Medicare’s policies, procedures and payment formulas,” Pollack said. Continue reading