Experts Say SGR was Destined to Fail

According to experts, the sustainable growth rate (SGR) Medicare payment formula was “almost certain to fail” because it was “flawed from the beginning, due largely to a lack of precedent for tying such a formula to economic growth.” Because the economy was strong in the mid-90’s, many people did not think it would give large fee increases like it did later when the economy slowed down. Experts also agree that the SGR formula failed to limit volume growth and that basing the formula on overall physician spending meant that individual doctors had no incentives to make their practices more efficient since no single provider would have any effect on overall payments.

The move to repeal the SGR made some headway in Congress last year.

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Attention: Home Health & Hospice Providers

The annual User/Login ID Recertification for the FISS Part A Online (DDE) and/or DME-Jurisdiction B (CSI) systems will begin in the near future. If you use one of these systems, please be prepared. Every user that has a currently active User/Login ID to access one of these systems assigned prior to November 1,2013 must complete the recertification. Users that were assigned a User ID or had their ID reinstated after November 1, 2013 will not need to recertify until the 2015 Recertification. This is for recertification of your National Government Services’ User ID only. If you have access to multiple regions, you will need to check with the carriers of each region for their recertification procedures.

If you have any questions and/or concerns, please feel free to contact the National Government Services Electronic Data Interchange (EDI) Help Desk:

  • Jurisdiction 6 (J6): 877-273-4334
  • Jurisdiction K (JK): 888-379-9132
  • Jurisdiction B DME: 888-379-3810

Medicare ACOs Slow Spending

CMS has reported that nearly half of the organizations in its largest test of accountable care slowed Medicare spending, but only 29 of the 114 ACOs saved enough to receive bonus payments. In April 2012, CMS launched its shared-savings program, one of two Medicare accountable care initiatives aimed at saving money and improving quality in exchange for the chance to keep some of the savings it produced.

The shared-savings program launched with 27 organizations and added another 87 organizations three months later. During the first 12 months of the effort, Medicare spending was lower than projected among 54 of the ACOs; 29 ACOs reduced Medicare spending enough to keep $126 million.The shared-savings program has expanded to more than 340 ACOs.

The Medicare Pioneer ACO program, the second of the two Medicare accountable care initiatives, had similar results. Nine of the 32 Pioneer ACOs dropped out after the first year; seven switched to the shared-savings program and the remaining 23 organizations saved Medicare $147 million. Nine saved enough to receive a share of the amount.

Experts have called Medicare’s accountable care results promising.

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Report: Healthcare Jobs Among Fastest-Growing Occupations this Decade

According to the most recent 10-year projections from the Bureau of Labor Statistics (BLS), healthcare jobs will account for one in six new jobs in the next decade. The BLS predicts that registered nurses, nursing assistants, personal care aides, and home health aides will have the most employment increases, adding 1.6 million jobs now through 2022. RNs are expected to grow 19.4 percent (526,000 jobs) and home health aide jobs will increase 48.5 percent (424,000 jobs). However, because healthcare spending is growing slower than the economy for the first time since 1997, some experts believe BLS’ predictions might already be “deflating” although they acknowledge that it is difficult to predict the “unknowable future.”

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1 in 4 American Families Struggle to Pay Medical Bills

According to a new survey released by the National Center for Health Statistics at the CDC, one in four American families struggled to pay their medical bills in 2012. The survey also found that the lack of health insurance increased the burden of medical debt. According to an expert at the Kaiser Family Foundation, the main reason why families declare personal bankruptcy is because they’re unable to pay their medical bills which can lead to other financial woes. The ACA is expected to help with medical bills, although it will not completely prevent medical debt.

A separate study by the Kaiser Family Foundation found that 70 percent of people reporting problems with medical debt were insured; cost-sharing and out-of-pocket costs were the leading contributors to debt.

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Former Medicare Admins Propose SGR Repeal Compromise

A group of former Medicare administrators have proposed a compromise on the sustainable growth rate (SGR) formula for Medicare payments. Instead of permanently repealing the SGR, they are calling for a five-year suspension, believing it to be “a middle ground between permanent repeal and the short-term patches used in the past.” The plan would suspend the SGR for five years, implementing the first half of the 10-year repeal legislation currently in Congress. Experts believe the five-year plan to be less expensive for Congress to finance; they also believe it would give providers more time to adjust to new payment models, like accountable care organizations (ACOs).

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Survey: U.S. Nursing Programs Are Struggling

According to the latest survey from the American Association of Colleges of Nursing (AACN), nursing programs throughout the country are struggling to educate the future workforce even as the demand for nurses continues to rise. The AACN surveyed 84% of nursing schools with baccalaureate and/or graduate programs and found that from 2012 to 2012, there was only a 2.6% increase in the enrollment of entry-level baccalaureate registered nurse programs, the lowest numbers in five years. However, the survey did find that there is a demand for continuing education among currently practicing nurses; in 2013, the number of students in RN to BSN programs increased 12.4%.

Because of faculty shortages, lack of funding, and lack of clinical placement sites, more than 53,600 qualified applicants were turned away from 610 entry-level programs last year.

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