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
Medicare reform is a hot topic on the agenda for the bipartisan congressional budget committee whose Dec. 13 deadline for a compromise deal on a federal spending plan is looming. Both political parties have proposed raising the Medicare eligibility age and premiums on older adults, among other changes.
In the midst of this debate, two policy experts will join AHCJ’s topic leader on aging, Liz Seegert, to help members understand: Continue reading
Image by U.S. Pacific Air Forces via flickr.
Judi Kanne, a registered nurse and freelance writer for Georgia Health News took a look at dental care for seniors and found that her state, and many others, have been coming up short.
She interviewed elderly patients who sought care at Mercy Care, a downtown Atlanta charity clinic.
One of them was 71-year-old Johnnie Collier who told her he went there to get a tooth extracted that had been hurting him for years.
Despite the work of such charity clinics, Kanne wrote, millions of older adults are unable to get the dental services they need.
Then she offered a good summary of the predicament. Continue reading
Here’s a sign that paying more for better care and paying less for inadequate care is taking hold in a significant way. The federal Centers for Medicare & Medicaid Services (CMS) reported this week that 1,231 hospitals will get a performance bonus in fiscal 2014 under its Hospital Value-Based Purchasing program and 1,451 hospitals will receive an overall decrease in Medicare payment. Fiscal 2014 is the second year of the VBP program.
“We think this second anniversary deserves recognition – it’s a sign that value-based purchasing in Medicare is becoming routine,” wrote Patrick Conway, MD, in a blog post on the CMS site. Conway is CMS’ chief medical officer and director of the Centers for Clinical Standards and Quality.
“The Affordable Care Act gave CMS many new tools to convert Medicare from a program that paid for decades on automatic pilot into one that deliberately pays to promote better health,” Conway added. “Now, thanks to one of these tools, the Hospital Value-Based Purchasing program, Medicare is no longer a program that just pays the bills. Acute-care hospitals across the country not only are paid more for higher quality care, they also have skin in the game.” Continue reading
A new report from the Dartmouth Atlas Project documents the wide variations of use of drug therapies by Medicare patients across the U.S., shedding additional light on how geography plays an important role in quality and cost of care.
Dartmouth researchers also find that the health status of a region’s Medicare population accounts for less than a third of the variation in total prescription drug use, and that higher spending is not related to higher use of proven drug therapies. The study raises questions about whether regional practice culture explains
differences in the quality and quantity of prescription drug use.
For example, heart attack victims in Ogden, Utah, are twice as likely as those in Abeline, Texas, to be prescribed cholesterol lowering medication to reduce risk of another heart attack, an inconsistency which reflects how medicine is practiced in the United States, according to Jeffrey C. Munson, M.D., M.S.C.E., lead author and assistant professor at The Dartmouth Institute for Health Policy & Clinical Practice. Continue reading
With much of the attention focused on the Affordable Care Act and health exchanges this past week, it’s easy to forget that the annual Medicare open enrollment period kicks off on Oct. 15. Beginning Tuesday, older adults can compare options among available plans and make changes based on any shifting health, lifestyle, or personal needs until Dec. 7.
Beneficiaries can use this Medicare Annual Election Period to explore various Medicare plans, compare costs and options, and check whether providers or institutions accept certain plans. For example, those taking new medications, who relocate, are diagnosed with a chronic medical condition, or experience an accident or injury which changes their health status may want to add or drop certain benefits, or find a plan with lower co-pays. A move to a different state may require finding new physicians or joining a plan with different participating facilities in their new coverage area. Even if a person’s status remains the same, plans can change — benefits might be added or dropped, or prescription medications might go on or off formulary.
Health plans for 2014 are available at the Medicare.gov website, but visitors should be aware that information has not been updated since the government shutdown on Oct. 1. While beneficiaries can use the online tools to sign up or explore plans — including Medigap policies — any changes since the shutdown are not reflected in the results.
However, a CMS spokesperson said they are “are moving forward with online enrollment as planned.” Continue reading
While most of us are focused on the opening of the insurance marketplaces on Tuesday, Catherine Hollander, in the National Journal, takes a broader look at the history of changes in our health care system and how the Affordable Care Act might change things over time.
She asserts that the ACA is not the first or even biggest transformation of our health care system:
“Two overhauls were more radical than Obamacare will be next year: the dramatic rise of employer-sponsored insurance during the World War II era, and the adoption of Medicare and Medicaid in 1965.
A look forward at what health reform could mean for the country explains the coverage gaps left by the decisions to expand or not expand Medicaid in the states. The system will experience insurance reforms, more patients for doctors to see, innovations designed to save money and improve care and possibly a change in perception of people being rated on the state of their health.
Hollander, putting things into perspective, points out there is still a lot we don’t know about how Obamacare is going to play out and whether it can shift the entire health care system.
(Hat tip to Phil Galewitz)
AHCJ’s board of directors called on the federal government to release data on physician payments and utilization of services in the Medicare program.
In a letter sent Tuesday (PDF) to the Centers for Medicare and Medicaid Services, the board said the release of the information is “long overdue.”
“The value of such information to the public far outweighs any privacy claims of physicians,” said the letter, signed by AHCJ executive director Len Bruzzese. “As long as patient confidentiality is protected, we see no reason why taxpayers should not know how individual physicians are spending public dollars.”
The letter came in response to CMS’ call for comments last month about whether and how it should release data on physician spending in Medicare Part B, the outpatient component of the program. A U.S. District Court in Florida overturned a 1979 injunction that had blocked the public release of data identifying payments to individual doctors. Dow Jones, which publishes The Wall Street Journal, challenged the injunction.
“The U.S. District Court was correct in lifting the 1979 injunction in response to dramatic changes in the health care landscape over the past three decades,” AHCJ’s letter said. “Beyond that, we believe an informed public makes better health care decisions.”
AHCJ cited stories by The Wall Street Journal and the Center for Public Integrity as examples of how reporters can use physician claims data for stories in the public interest. But it said those stories would have had wider resonance if the organizations were able to name physicians and allow members of the public to look up their own doctors. Continue reading
Despite the Obama administration’s focus on cutting health care costs and fraud in the Medicare and Medicaid systems, the office charged with investigating such things plans to cut 400 staffers by the end of 2015.
Fred Schulte at The Center for Public Integrity reports that the news came to light during a June 24 congressional hearing about prescription drug abuse in Medicare.
The Department of Health and Human Services’ Office of Inspector General is responsible for investigating fraud and abuse in the system. Last year the office shut down investigations into 1,200 complaints because of a lack of resources, according to Gary Cantrell, deputy inspector general for the OIG Office of Investigations.
Cantrell blames the cuts on “a mix of budgetary issues which he called ‘expiring funding streams.’” Schulte reports that no one at HHS would discuss the situation.
Schulte has previously reported on electronic health records and linked them to higher health care costs. He points out one potential impact of the cuts:
One major project that’s likely to be scaled back is an ambitious plan to “identify fraud and abuse vulnerabilities” in electronic health records. The federal government is spending about $36 billion in economic stimulus funds to help doctors and hospitals purchase the digital technology in the hopes that it will ultimately reduce waste from duplicative tests and make health care more efficient and less costly.
The OIG’s 2013 Work Plan outlines the office’s focus and new and ongoing projects, including reasonableness of Medicare payments, coding of medical equipment claims, questionable billing patterns, review of claims submitted by “error-prone” providers and more. Meanwhile, ProPublica, the Center for Public Integrity, The Wall Street Journal and other publications have documented fraudulent and wasteful practices in Medicare.
A decision announced Friday would allow the public and journalists access to Medicare claims data about individual doctors.
An injunction barring release of the data had been in place for 33 years, “when a federal court in Florida sided with the American Medical Association’s contention that doctors’ right to privacy trumped the public’s interest in knowing how tax dollars were spent,” according to John Carreyrou of The Wall Street Journal.
“Dow Jones & Co., The Wall Street Journal’s parent company, challenged the injunction in 2011 after the Journal published a series of articles showing how the information could be used to expose fraud and abuse in the $549 billion health-care program for the elderly and disabled.”
Wall Street Journal reporters, who negotiated for eight years worth of data if they did not publish identities, wrote a series of stories about Medicare data, showing that the federal government isn’t taking advantage of the data it has to detect fraud. The Wall Street Journal’s articles have offered a window into the forces driving up health spending and shown that analyzing the data can reveal abuse and fraud in the Medicare system.
“The public has a right to know how much physicians are being paid by Medicare and what services they are providing patients,” said AHCJ President Charles Ornstein. “With analysis and context from journalists, the data could help patients make informed decisions and provide necessary oversight of billions of dollars in federal spending.”
Carreyrou reports the American Medical Association “is considering its options on how best to continue to defend the personal privacy interests of all physicians.”
“The Crushing Cost of Care,” by the WSJ’s Janet Adamy and Tom McGinty, won first place in the Health Policy (large) category of the 2012 Awards for Excellence in Health Care Journalism.
Read more about the Medicare data and the fight to open it to the public: