Only Hospitals Would Get Payment Increase Under MedPAC Recommendations

MedPAC made its 2014 payment recommendations to Congress late last week:

    • 1% increase for hospital inpatient and outpatient
    • 0% for ASCs, LTCHs, IRFs, SNFs, Home Health
    • 0% for outpatient dialysis bundled payment
    • Rebasing SNFs, which would result in a 4% cut in payments the first year
    • Rebasing home health on a two-year basis starting 2013, rather than a four-year basis starting next year.

Click here for MedPAC’s 435-page report.


CMS Proposes Part B Payment After Part A Denial

CMS is proposing to revise its position on rebilling for claims denied by Medicare contractors, including recovery audit contractors. It appears that hospitals will generally be eligible for Part B payment following the denial of a Medicare Part A claim, for those services that would have been reasonable and necessary had the beneficiary been treated as a hospital outpatient. Click here for an excellent two-page summary of the proposed rule from our health policy team. More here from CMS.


RACs Costing Hospitals Hundreds of Millions in Response Programs

Hospitals spent a total of $242,776,250 in managing their RAC response programs during the fourth quarter of 2012, according to an American Hospital Association analysis. The survey showed that 63% of all responding hospitals reported spending more than $10,000 on RAC response programs during the fourth quarter. 43% spent more than $25,000, while 13% spent more than $100,000. Click here for additional details.


Medicare, Again, Revises Readmission Penalties Formula

For the second time, Medicare has revised its formula for calculating penalties for hospitals with excessive readmissions, according to reports out last week. The new calculation reduces penalties for 1,246 hospitals and increases them for 226 organizations, according to Kaiser Health News, which analyzed data provided by CMS. Click here for a copy of the six-page CMS correction notice. Click here for the KHN list of hospitals’ with corrections, listed by state.


Dem, GOP 2014 Budgets Diverge on Health Care

There are enormous differences between the GOP House and Democratic Senate budgets released last week and approved by committees in both chambers. The House would repeal Obamacare and cut health spending by $2.72 trillion over 10 years. The Senate would not repeal Obamacare, eliminate the recently imposed budget sequester, raise taxes about $1 trillion over 10 years and cut health care spending about $27 billion over 10 years. Click here for a very good summary prepared by our staff. Click here for the 114-page Senate budget document. Click here for the 91-page House budget.


Congress Likely to Complete 2013 Budget This Week; Health Program Cuts Likely

The Senate is likely to complete action this week on a Continuing Resolution budget that will keep the government operating through September 30, 2013. The House has already passed similar legislation.  The Senate bill strips $200 million from the $500 million appropriated for the health reform law’s Community Care Transitions program (CCTP) designed to help transfer Medicare patients from hospitals to home-based care or other settings. The bill also rescinds $10 million from the$15 million authorized to fund the Independent Payment Advisory Board, and more than $6 billion set aside for CHIP enrollment performance bonuses. Click here for the Senate summary.


MedPAC Broadens Site Neutral Payment Review

MedPAC’s March meetings focused on some familiar issues, including site neutral payment policy.  MedPAC is expanding its analysis beyond the Evaluation and Management payment cuts they proposed since early last year. They are now looking at specific cardiac imaging services, and a broader array of differences in payments between physician offices, ASCs and HOPDs for similar services. Click here for a very good SHC summary of the MedPAC meetings.


MacPAC Recommendations Target Medicaid “Churning”

The Medicaid and CHIP Payment and Access Commission (MacPAC) recommended in a report to Congress last week that lawmakers reduce the administrative burden on states for the frequent changes in eligibility for the two programs based on fluctuations in income. The report targets such “churning” and urges Congress to create an option for states to enroll eligible individuals for a full year in Medicaid or CHIP, regardless of a change in income during the year that would otherwise end their eligibility.  Click here for the 220-page report.


Regulators Reveal Plans for Exchange Reviews

State and federal regulators have begun detailing how they plan to make sure that health plans have enough providers in their networks next year as the health care law gets fully implemented. In the federal exchange, the Center for Consumer Information and Insurance Oversight (CCIIO) is asking health plans to submit applications if they want to participate in the exchanges. Federal officials hope to notify plans quickly if they find any deficiencies, so that plans can revise their applications and resubmit them. Deficiency notices are expected to go out before mid-June. States that are partnering with the federal government can use different timelines, as long as they send their findings and the list of approved plans by July 31. Click here for the 57-page letter CCIIO sent to insurers.


CMS Hosting National Exchange Call TODAY - Registration Required

CMS is hosting a National Health Insurance Marketplace Stakeholder Conference Call TODAY, Monday, March 18, 2013 at 2:00 p.m. – 3:00 p.m. ET. The goal of this national call is to keep stakeholders updated on the operational execution of the marketplace as well as for CMS to hear directly from individuals and organizations that will be able to utilize the new marketplace. This process will allow interested parties to understand how the Marketplace will work and when it will be ready. Click here to register for the call.


Top Lawmakers Want Medicare Advantage Rate Adjustment

Senate Finance Chairman Max Baucus (D-MT) teamed up last week with ranking Republican Orrin Hatch (R-UT) to urge Medicare officials to make a major adjustment to the rates Medicare will pay to private health plans next year. The two senators sent a letter to CMS urging that rates paid to Medicare Advantage plans in 2014 account for a likely fix later this year blocking a cut in Medicare payments to doctors. Insurance industry officials estimate that such an adjustment would turn a projected 8% rate cut into a 3% cut. Click here to read the letter. 95 House members sent a similar letter, click here to read it.


Health Prices Continue Slow Down

It has been 16 years since health care prices rose so slowly, according to an Altarum Institute report out last week. Healthcare prices in January rose only 1.5% from January 2012 prices, marking the lowest healthcare price growth since December 1997. January 2013 health expenditures grew at an annual rate of 4.1% compared with January 2012, for the fifth consecutive year of moderate spending growth. Click here for the four-page report.


White House Report Credits ACA with Health Spending Slowdown Impact

The White House has issued its latest economic report citing the health care law is partly responsible for the current slow down in health care spending. Specifically cited are reductions in excessive payments to Medicare Advantage plans, stronger anti-fraud efforts in Medicare, and changes in the provider payment system, such as the formation of ACOs that will extend the life of the Medicare trust fund by an anticipated eight years. It also cited the Hospital Value-Based Purchasing System that rewards hospitals for high quality care and reduces payments for poor performance. Click here for the 24-page chapter on health care.


Medicare PET Reimbursement Should Get Easier

In a move that should make PET reimbursement easier for most oncology applications, CMS last week proposed removing its longstanding requirement that FDG-PET scans of patients with solid tumors be reported to a national data registry. If approved, the proposal means that PET providers will no longer have to report data to the National Oncologic PET Registry (NOPR), the registry set up in 2006 to collect data on how PET was being used to manage patient care. CMS had required providers to report data to NOPR as a condition of reimbursement under its coverage with evidence development (CED) requirement. Click here for the story.


MACs Going After Double Payments for Wellness Visits

Medicare administrative contractors (MACs) will recoup money for annual wellness visits erroneously paid to both facilities and physicians for the same visit. CMS paid duplicate visits on the same patient on the same day because instructions to carriers wrongly permitted it. The erroneous claims date back to April 4, 2011, and could continue through March 31 because the fix won’t be implemented until April 1 of this year, according to transmittal 1190 published Feb. 15. Click here for the 6-page CMS document.


Bill Would Require Tax and Fee Disclosure on Patient Coverage Summaries

U.S. Rep. Greg Walden (R-OR) introduced legislation last week requiring insurers to let their customers know how much various taxes and fees in the Affordable Care Act contribute to their premium.  Walden’s bill would require insurers to itemize in annual coverage summaries the annual fee on health insurers, fees to fund the Patient-Centered Outcome Research Institute, reinsurance contributions, proposed fees on insurance exchange users, risk corridor payments, and risk-adjustment charges. Click here for a copy of the 6-page bill.


Spending on Advanced Cancer Treatments Not Linked to Survival: Study

Advanced cancer spending varied by up to 41% between high and low spending regions, according to a new study in the Journal of the National Cancer Institute. Medicare spending for advanced cancer significantly varies across regions, but there is no direct link between higher regional spending and improved patient survival, the study said. Click here for the study synopsis.


SuperBug Efforts Achieving Only Incremental Improvements: Survey

Hospitals have stepped up monitoring to stop the spread of the intestinal superbug Clostridium difficile, though those efforts so far are producing only incremental improvements, according to a survey of infection preventionists. The survey found that nine in ten said they had increased emphasis on environmental cleaning and equipment decontamination practices to address C. difficile infection since March 2010. Click here for the survey.


Obamacare Marks Third Anniversary This Week

This week marks the third anniversary of the passage of Obamacare. Not everyone is celebrating. House Republicans hope to repeal the law in their 2014 budget proposal. Senate GOP leader Mitch McConnell issued another statement last week calling for its repeal. Click here for his statement.