AHA urges MedPAC to re-evaluate LTCH proposals   06/14/2013
The AHA yesterday expressed deep concern with Medicare Payment Advisory Commission research on a potential reform approach that would eliminate the long-term care hospital prospective payment system and make all payments for LTCH services under the inpatient PPS. “We are deeply concerned that the commission has not adequately justified the need for such extreme reforms, especially considering how drastically they differ from its prior goal of using criteria to define the type of patient who is appropriate for admission to an LTCH,” AHA Senior Vice President of Public Policy Analysis and Development Linda Fishman wrote in a letter to MedPAC. “Rather than continuing on this radical path toward elimination of the LTCH PPS, we urge the commission to consider more reasonable reforms that would maintain the LTCH PPS for a narrower range of appropriate cases.” MedPAC staff discussed this reform at its April meeting and defined a new subcategory of patients – chronically, critically ill patients. In its letter, AHA said MedPAC’s proposed CCI criterion “is arbitrary and excludes appropriate LTCH patients,” and that the commission “presented no clinical rationale for excluding from the CCI category many cases with the highest acuity levels.”
AHA urges Congress to focus on 'real reform,' not further post-acute cuts   06/14/2013
In a statement submitted today to the House Ways and Means Health Subcommittee, AHA expressed deep concern with certain budget and regulatory proposals that would further reduce Medicare payments for long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities and home health providers. Submitted for a hearing on the issue, the statement opposes the president’s fiscal year 2014 budget proposals for an additional market basket reduction for all post-acute care providers, a return to the 75% Rule for IRFs, and site-neutral payments for certain IRF and SNF procedures. It also expresses deep concern with the Centers for Medicare & Medicaid Services’ FY 2014 proposal to allow the 25% Rule for LTCHs to expire; CMS research on a policy that would shift a majority of LTCH cases to the inpatient prospective payment system; and Medicare Payment Advisory Commission research on reform approaches that would eliminate the LTCH PPS. “The AHA believes we need real reform, not the further ratcheting of post-acute care provider payments as outlined in the president’s budget proposal, and by CMS and MedPAC,” the statement adds, and includes a bipartisan list of alternatives to cutting payments for hospital services.
MedPAC issues June report to Congress   06/14/2013
The Medicare Payment Advisory Commission today submitted its June report to Congress, which includes a chapter reviewing several proposals to expand site-neutral payments, a discussion the commission expects to continue this fall. One proposal would expand the site-neutral policy to 66 additional ambulatory payment classifications, reducing hospital payments by another $900 million. Another more targeted proposal would equalize payment between physician offices and hospital outpatient departments for three high-volume cardiac imaging APCs, reducing hospital outpatient payments by $500 million. In addition, the report discusses equalizing payments for certain surgical services commonly furnished in ambulatory surgical centers, which would reduce hospital payments for 12 surgical APCs by $590 million. In January 2012, MedPAC recommended Congress reduce total payments for 10 hospital evaluation and management (E/M) services to the level paid under the physician fee schedule, a policy that would reduce payments to hospital outpatient departments by $1 billion. “AHA believes that it was premature and ill-advised for MedPAC to include a site-neutral payment policy chapter in its report,” said Joanna Kim, AHA vice president for payment policy. “Given the complexity involved in crafting a site-neutral payment policy, we believe that a more robust analysis of impact should have been conducted before this issue was committed to a published chapter. The impact of these potential cuts is very significant. Although MedPAC staff did not provide exact estimates, based on the information provided, the impact of implementing site-neutral payments as described in the chapter would likely be well over $2 billion in a single year, reducing payments to the chronically underfunded Medicare outpatient system by 5.5%, and reducing hospitals’ Medicare outpatient margins from negative 11% to negative 17%, all else being equal.”
MACPAC issues June report to Congress   06/14/2013
The Medicaid and CHIP Payment and Access Commission (MACPAC) today released its annual June report to Congress. Among other key issues, the report examines eligibility and coverage for maternity services under Medicaid and the Children’s Health Insurance Program, which pay for almost half of all U.S. births; and challenges in implementing the recent increase in Medicaid physician payment for primary care services. The Patient Protection and Affordable Care Act mandates maternity care for those covered by health insurance exchange plans and requires coverage of other pregnancy-related services. “Because separate eligibility pathways based on pregnancy will continue under the ACA, the possibility of churning exists among Medicaid, CHIP, exchange coverage, and uninsurance as women gain and lose eligibility based on pregnancy,” the commission said. In January, the ACA increased Medicaid payment rates for primary care physicians to Medicare levels in 2013 and 2014. “Interviews with states, providers and managed care organizations highlight concerns about the time allotted to implement the provision, difficulty in identifying eligible providers, and challenges in making the system modifications necessary for the increased payment,” the commission said.
TN hospitals reduce early elective deliveries 75% in seven months   06/14/2013
Hospitals participating in the “Healthy Tennessee Babies are Worth the Wait” partnership reduced preventable early elective deliveries by 75% over seven months, to 3.5% of all births, according to data released this week by the Tennessee Hospital Association. “The early results of this innovative collaboration are proof that when Tennesseans focus their energy and understanding on a health issue, they can change behaviors that lead to unnecessary health risks and additional cost,” said THA President Craig Becker. In addition to THA, partners in the initiative include the Tennessee Center for Patient Safety, Tennessee Initiative for Perinatal Quality Care, state Department of Health and March of Dimes. The AHA Board of Trustees last year adopted a formal position supporting policies to eliminate early-term, non-medically necessary deliveries, which research has shown can increase health complications for babies.
CMS issues proposed program integrity rule for Health Insurance Marketplace   06/14/2013
The Centers for Medicare & Medicaid Services today issued a proposed rule outlining program integrity guidelines for the Patient Protection and Affordable Care Act’s Health Insurance Marketplace and premium stabilization programs. According to CMS, the rule also proposes standards for enrollee satisfaction survey vendors, handling of consumer complaints by issuers in the Marketplace, and provisions meant to ensure smooth operation of Marketplaces, protect consumers and give flexibility to states. The proposed rule will be published in the June 19 Federal Register with comments accepted for 30 days. For more information, see the CMS factsheet.