At the agencies
On Sept. 8, the Acting Administrator for the Centers for Medicare and Medicaid Services (CMS) announced via blog post the new options available to physicians for reporting Medicare data next year. The Medicare Access and CHIP Reauthorization Act (MACRA) created Merit-based Incentive Payment System (MIPS) begins January 2017. According to the blog post, doctors can choose to implement these MIPS requirements using three options. They can report a full year of data and be eligible to receive the full bonus depending on their performance under the law, report less than a year of MIPS-required data and receive a smaller bonus, or report some data for part of the year and not receive a bonus nor a penalty. Providers can avoid reporting MIPS data all together by participating in an advanced alternative payment model.
CMS has released data on Medicare readmission rates, claiming that the 8 percent decline in readmissions nationally shows the Affordable Care Act’s Hospital Readmissions Reduction Program is working. The data shows 49 states have seen Medicare 30-day readmission rates fall. In 43 states, the readmission rate fell by 5 percent and by 10 percent in 11 states. Vermont was the singular state to see readmission rates rise by 0.7 percent. The Department of Health and Human Services Secretary for Planning and Evaluation estimates Medicare beneficiaries have avoided 565,000 readmissions collectively since 2010.
CMS has finalized a rule intended to establish consistent emergency preparedness requirements for healthcare providers participating in Medicare and Medicaid. The new rule will reportedly increase patient safety during emergencies and provide greater coordination in response to natural and man-made disasters. Under the new rule, providers and suppliers are required to have a coordinated response with federal, state, tribal and local entities to ensure facilities are properly prepared for patients during emergencies.
A newly released GAO report has shown that 22 percent of generic drugs billed to Medicare Part D had, at a minimum, one price increase of 100 percent or greater between 2010 and 2015. The report showed generic Medicare Part D drug price increases have become more common in recent years. Between the first quarters of 2010 and 2011, only 45 drugs had a price increase of 100 percent or more, in comparison to the first quarters of 2014 to 2015 when 103 drugs similarly rose in price.
In the states
The Hawaii Medical Service Association (HMSA), Hawaii’s largest insurer, will begin paying physicians a standard monthly rate per patient. Doctors will receive between $20 to $80 dollars per patient, depending on the patient’s health status. Twenty percent of the doctor’s payment will be based on quality of care and the preventative services they offer. The move follows the Obama Administration’s goal of moving away from the fee-for-service system. HMSA argues the new payment model will encourage doctors and patients to communicate using electronic means, allowing doctors to spend more time with sicker patients. HMSA launched a pilot program with 100 primary doctors this past April but says it is too early to assess results.
In the courts
A group of nearly 100 hospitals asked the D.C. Circuit to retry their challenge to the Department of Health and Human Services (HHS) regarding how Medicare reimbursements are adjusted based on local labor costs. The group of 95 hospitals and 12 hospital owners claim that the judge in their original case improperly denied their summary judgment motion; that the government used outdated data when the reimbursement rule was originally implemented; and that HHS misled hospitals by changing the rule entirely rather than just clarifying an existing rule as promised.
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