CMS To Delay Rate Cuts To Physicians

CMS has said that it will hold physician claims for 14 calendar days and delay the 21% rate cuts that are otherwise set to take effect Wednesday. Last week, the Senate recessed without acting on H.R. 2, which has been approved by the House already. Senate officials want to reassure everyone that the two-week delay will not impact doctors. The Senate will have only two days to act on the bill before the rate cuts take chunks out of payments sent to doctors. The Senate reconvenes on April 13.

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Congress Proposes Bid to Reverse Dialysis Cuts

In January, Congress ordered the Federal Government to reduce spending: $500 million a year in excessive drug payments are being sent to dialysis clinics throughout the nation. Eight months later, the same members of Congress who implemented these cuts are fighting to reverse them. The dialysis industry, dominated by two companies—DaVita Healthcare Partners of Denver and Fresenius, based in Germany—have both seen their bottom lines improve since 2011, when the federal government first started making excessive payments. Until 2011, the government paid clinics for each dosage of an anti-anemia drug, Epogen which led to government concerns about excessive usage. These concerns ultimately lead Congress to convert to a flat fee for dialysis. The single bundled payment for each patient visit was created in an effort to eliminate the incentive of prescribing too many doses of Epogen, which research showed to be harmful to patients. Congress noticed the use of the drug plunged, while DaVita and Fresenius earnings margins rose immensely, prompting it to order a cut in the drug fee.

The proposed cut of $29.52 per patient visit from the previously planned $246 reimbursement for next year would affect many of the more than 5,000 dialysis clinics in the United States.

For years, end-stage kidney disease has been covered by the federal government, costing more than $32.9 billion a year — mainly for dialysis services. Approximately 90 percent of dialysis patients rely on some amount of federal assistance. Officials at Health and Human Services will issue a final rule by November 1st.

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Medicare Provisions In The Federal Budget

Many of the budget proposals and debt-reduction plans being considered by Congress include proposals that would achieve substantial savings from the Medicare program over time. The Kaiser Family Foundation recently offered a side-by-side comparison of the key Medicare provisions in four major budget and debt-reduction plans to offer insight into how the program factors in to the various proposals.

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Docs Seek Safe Harbor From PPACA

Medical associations long have been concerned that federal quality-of-care and payment reform measures, such as those authorized by the Patient Protection & Affordable Care Act (PPACA), could be used to fuel negligence accusations against individual physicians. As a result, states across the country and Congress are seeking to pass legislation based on an American Medical Association (AMA) model bill to prevent doctors from being exposed to medical liability.

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MedPAC: Medicare Should Reduce SNF Payments 4%

In a recent report to Congress, the Medicare Payment Advisory Commission (MedPAC) recommended Medicare payments to skilled nursing facilities should be cut 4% in 2014 and steadily reduced in subsequent years. The council also advised a decrease in rates to achieve $10 billion in savings by 2018.

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MedPAC Hospice Recommendations

Late last week, MedPAC released its annual report to Congress on payment policy. Below is a summary summary of recommendations for hospice.  Earlier today, HMS Healthcare Management Solutions posted the recommendations for home health on our blog. Click here to view.

Hospice Recommendations:

  • Congress should eliminate the update to the hospice payment rates for fiscal year 2014.
  • Congress should direct the Department of Health & Human Services (HHS) Secretary to change the Medicare payment system for hospice to:
    • have relatively higher payments per day at the beginning of the episode and relatively lower payments per day as the length of the episode increases,
    • include a relatively higher payment for the costs associated with patient death at the end of the episode, and
    • implement the payment system changes in 2013, with a brief transitional period.
    • These payment system changes should be implemented in a budget neutral manner in the first year.
    • Congress should direct the HHS Secretary to:
      • require that a hospice physician or advanced practice nurse visit the patient to determine continued eligibility prior to the 180th-day recertification and each subsequent recertification and attest that such visits took place,
      • require that certifications and recertifications include a brief narrative describing the clinical basis for the patient¡¦s prognosis, and
      • require that all stays in excess of 180 days be medically reviewed for hospices for which stays exceeding 180 days make up 40 percent or more of their total cases.