Posts Tagged ‘CMS’

Primary Care Gets a Break

Tuesday, July 30th, 2013

There’s no question that primary-care physicians have long been spurned by the fee-for-service model that doesn’t recognize or reimburse fully the time spent with patients. Well, internists had a pretty good summer. Firstly , the CMS “proposed creating new evaluation-and-management codes for non face-to-face activities relating to the coordination of care for patients with two or more chronic conditions”.  And, now a bipartisan draft bill from the House Energy and Commerce Committee’s health subcommittee extends that to care coordination between multiple physicians and other suppliers and providers of services.The number of chronic patients is expected to rise to 171m by 2030.
The CMS proposal solicited public comment on whether general third-party designation of a practice as a medical home could be considered evidence that the practice was up to the task of providing care-coordination services. But the draft of the House bill specifically mentions the National Committee for Quality Assurance’s (NCQA) medical home and patient-centered specialty practice recognition programs.

Part of the solution is to recognize practices as medical homes so they qualify under the new payment model.  Thus far, the NCQA program has designated 5,770 practices as medical homes.

“We are particularly pleased the draft includes expedited recognition of patient-centered medical homes as an approved alternative payment model for medical practices,” Dr. Jeffrey Cain, AAFP president of The American Academy of Family Physicians, said. That said, Cain did add that family doctors are “disappointed that the subcommittee’s draft does not include a provision to specify a higher base-payment rate for those services provided by primary-care physicians,” Cain said.

Primary care has long been affected by dwindling reimbursements — In the 20th annual Modern Healthcare Physician Compensation Survey, family physicians finished last among the 23 specialties tracked – and a consequent migration of family physicians towards hospital employment. Medical students are increasingly avoiding family medicine (the number of students selecting careers in primary care has declined by 41% in the last decade), leading to an expected shortage of 44,000 primary care physicians by 2025.

Healthcare’s Early Hope?

Tuesday, June 25th, 2013

We have a couple of promising trends emerging from the recent reports. Consumers saved $3.9 billion in premiums last year, according to an analysis released today from the CMS. Why? Because Obamacare stipulates that insurers must spend at least 80% of their premium dollars on medical expenses.

Called the MLR provision or the “80/20” rule, it forces insurers to lower their rates or improve coverage to meet the standard.  And, if they don’t comply, a rebate is issued to the patients. This year, 8.5 million Americans will receive $500 million in rebates. On top of this, they saved more than $3.4 billion from lower premiums in 2012.

All of this comes a t a time when spending in general is trending down. PricewaterhouseCoopers’ Healthcare Research Institute (HRI) now predicts that U.S. medical costs in 2014 will spike by 6.5 percent, a full percentage point lower than the organization’s estimate of 7.5 percent for 2013. The net growth rate in healthcare costs, after accounting for benefit design changes such as higher deductibles, will be about 4.5 percent. The truth is that this is part of a longer-term trend. Between 2009 and 2011, total health spending grew at the lowest annual pace in the last five decades, at just 3.9 percent a year. In contrast, between 2000 and 2007, those annual growth figures ranged between 6.2 and 9.7 percent.

The reasons are familiar: the move to less costly outpatient settings to deliver care; the sluggish recovery which has tempered healthcare spending (the Kaiser Family Foundation thinks this is three-quarters of the reason for lower spending); new models for delivering care; and aspects of Obamacare (like the 80/20 rule for example). Then there’s all the waste that reform has gone after.  According to government data, hospital readmissions dropped by nearly 70,000 in 2012, and this trend is expected to accelerate through 2014.

Still, we have a long way to go and a few years of bending the cost curve don’t make up for decades of exorbitant increases. According to the Kaiser Family Foundation, the average American’s cost of care has gone up 140 percent over the past 10 years, while wages only went up 40 percent.  Still, the numbers offers hope that we are starting to gain some ground.

Medicare, Medicaid Head Rallies Insurance Companies

Thursday, September 30th, 2010

Controversial CMS chief wants insurers to work with healthcare providers to make reform work.CMS administrator Donald Berwick has asked the insurance industry to work in good faith to implement healthcare reform in a timely manner. Dr. Berwick made his plea at a Medicare conference sponsored by America’s Health Insurance Plans, the health insurance industry’s trade group.

“We need your help, our nation needs your help,” Dr. Berwick said, noting that companies, CEOs, healthcare professionals and managers all play a role in achieving the objective, yet the insurance industry “can be among the keys of our success, the central part in navigating the success of healthcare reform.  We have a job to do, we need to make care better for America.”  Berwick told the audience that he plans to work with others at CMS to build relationships and partnerships to assure that the Patient Protection and Affordable Care Act works as intended.  “If we steadily work together to make care what it can become, trust will resurface and the rest will follow,’ he said.

Dr. Berwick, who President Barack Obama named to his post in a recess appointment that bypassed the Senate confirmation process, is not well liked by Republicans because he once wrote an article that praised Britain’s National Health Service, raising concern that he will introduce healthcare rationing.  He tried to allay those fears by saying “I urge lower costs without harming a hair on any patient’s head.  It’s a clear, stark reality.  Our healthcare system, in its current form, is not up to that job.  We cannot, with our current system of care, give Americans the care that they need and want and deserve.”

The most pressing issue is improving patient safety and cutting deaths that result from unnecessary medical errors, a specialty that Dr. Berwick developed when he headed the Institute for Healthcare Improvement.  He also called for improved prevention and treatment of diseases like obesity and depression.

HHS Focusing on Expanding Rural Hospitals’ Reach

Thursday, September 9th, 2010

HHS is working to enhance healthcare offered at rural hospitals.  The Department of Health and Human Services (HHS) is expanding CMS’ Rural Community Hospital Demonstration. The action is being taken as part of the Affordable Care Act and will set up 20 additional hospitals in states eligible for improved reimbursement for patient services.  To participate, these small community hospitals serving rural areas must be located in states with low population density, including Alaska, Arizona, Arkansas, Colorado, Idaho, Iowa, Kansas, Maine, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Utah or Wyoming.

The hospitals – which must be located in a rural area – can have no more than 51 beds, provide emergency-care services and must not be a designated critical-access facility.  According to HHS, the goal is to test “the feasibility and advisability of cost-based reimbursement for small rural hospitals that are too large to be critical access hospitals.  In recent years, hospitals in this category have experienced negative Medicare margins on inpatient services.  CMS is conducting an extensive evaluation of the demonstration, testing the benefits to the community and financial impact on participating hospitals.”

New York Public Hospital Facing a $1 Billion Loss

Tuesday, March 23rd, 2010

New York City public hospitals demonstrate difficulties of staying afloat.  That fact that New York City’s public hospitals could lose $1 billion illustrates the difficulty that healthcare systems face in their efforts to stay afloat.  New York City Health and Hospitals Corporation has projected a billion dollar loss through June 30, 2011, despite an expected infusion of “hundreds of millions of dollars” in retroactive Medicaid payments.

The Medicaid payout, as well as cost-cutting efforts and improvements to efficiency will help the 12-hospital system achieve an operating gain as of June 30.  Operations, however, will “burn through that at a pretty torrid rate,” notes system president Alan Aviles.  The growing demand for subsidized and free care during the recession, as well as cuts to Medicaid – which covers approximately two-thirds of the system’s patients – makes balancing the budget problematical.

New York’s public hospitals saw the number of uninsured patients grow by 4,000 in 2009, 36,000 in 2008 and 17,000 in 2007.  According to Aviles, the growth among the uninsured is leveling, but his system has limited capacity to accept new patients.  The $1 billion doesn’t include approximately $70 million in payment cuts and tax increases contained in the New York state budget for the fiscal year that begins in April.  The gloomy forecast assumes a $300 million cut to the system’s disproportionate-share payments, which are financial assistance given to hospitals that serve low-income patients.  Aviles is lobbying New York legislators to reinstate these by prioritizing such spending in the public health system’s favor.

“This highlights that as this economic downturn continues, that public hospitals and other safety net systems that serve a great number of Medicaid and uninsured patients are going to be increasingly reliant on disproportionate-share payments to keep their systems afloat and solvent,” Aviles said.