Category Archives: Uncategorized

Medicare proposed changes would cut home health reimbursement

Posted on by • Posted in Uncategorized • Tagged , , , , , , • Leave a comment

http://www.healthcarefinancenews.com/news/home-health-agencies-concerned-about-cuts-proposed-medicare-payments?mkt_tok=eyJpIjoiTXpOa01qUXhaVGd5TnpkaiIsInQiOiJudFozOHVLS1VVNXZZRE42Y0RmTWdIZHpkOU0yNERUSmlXU0VCMlJDMEFyMmVTUUc4aVwvcXRVc0gzXC9ndUdJVjhHT1drZkkzdDhBVFhHZ3BHVjI1NmhIVHY1RmNXSENVdWtwb3RVVnVtaFNWbXNFdnBzb0JVenRcL1ZuR1p0MW0zRyJ9

Home health agencies could see decreases of $80 million in 2017 and $950 million in 2019.

Home health providers object to the Centers for Medicare and Medicaid Services’ proposed rule that would reduce Medicare payments by 0.4 percent, or $80 million, in 2018, and up to  $950 million in 2019.

The Partnership for Quality Home Healthcare is especially concerned about a groupings model proposal starting in 2019 that  would change the unit of payment from 60-day episodes of care to 30-day periods of care and places patients in payment groups based on how they fit in six clinical categories.

“CMS is proposing a major reform to home health reimbursement without having worked collaboratively with industry partners like the Partnership and we expect to be included in payment reform development going forward,” said Partnership Chairman Keith Myers. “We question whether CMS has the unilateral authority to make such a proposed change without action by Congress.”

CMS said the six clinical groups used to categorize 30-day periods of care are based on the patient’s primary reason for home healthcare.

The new model could result in a $950 million Medicare payment cuts for home health providers in 2019 if it is implemented in a non-budget neutral manner, according to Home Health Care News. If implemented in a partially-budget-neutral manner, it could reduce payments by $480 million, the report said.

CMS is not proposing a revision to the split percentage payment approach in the change to a 30-day period. However, the agency said it is proposing to phase-out of the split percentage payment approach in the future and is soliciting feedback now.

For 2018, Medicare payments to home health agencies would be reduced by 0.4 percent, or $80 million, based on the proposed policies, CMS projects.

The $80 million decrease reflects the effects of a $190 million increase from a 1 percent home health payment update, a $170 million decrease from a -0.97 percent adjustment to the 60-day episode payment rate to account for nominal case-mix growth, and a $100 million decrease due to the sunset of the rural add-on provision.

The Medicare Access and CHIP Reauthorization Act, or MACRA extended until Jan. 1, 2018 the rural add-on, which increased by 3 percent the payment amount otherwise made for home health services in a rural area.

Additionally, the proposed rule for 2018 refines the home health value-based purchasing model. It revises the applicable measure for receiving performance scores for any of the home health consumer assessment of healthcare providers and systems, or HHCAHPS.

The Partnership for Quality Home Health Care said it plans to release an analysis of the proposed payment model and its impacts on home health delivery.

The coalition is concerned that Affordable Care Act directives for high-risk beneficiaries to receive access to home health services would result in disproportionate cuts to provide the care if the payments are implemented as drafted.

Tuesday’s home health rule is among several proposals that reflect a broader strategy by CMS to relieve regulatory burdens for providers, support the patient-doctor relationship in healthcare and promote transparency, flexibility, and innovation in the delivery of care, CMS said.

“CMS is committed to helping patients and their doctors make better decisions about their healthcare choices,” said CMS Administrator Seema Verma. “We’re redesigning the payment system to be more responsive to patients’ needs and to improve outcomes. The new payment system aims to encourage innovation and collaboration and to incentivize home health providers to meet or exceed industry quality standards.”

Shift in physician workforce towards specialists fuels primary care shortage, potential spending growth

Posted on by • Posted in Uncategorized • Tagged , , , , , , , • Leave a comment

http://www.healthcarefinancenews.com/news/shift-physician-workforce-towards-specialists-fuels-primary-care-shortage-potential-spending?mkt_tok=eyJpIjoiTXpOa01qUXhaVGd5TnpkaiIsInQiOiJudFozOHVLS1VVNXZZRE42Y0RmTWdIZHpkOU0yNERUSmlXU0VCMlJDMEFyMmVTUUc4aVwvcXRVc0gzXC9ndUdJVjhHT1drZkkzdDhBVFhHZ3BHVjI1NmhIVHY1RmNXSENVdWtwb3RVVnVtaFNWbXNFdnBzb0JVenRcL1ZuR1p0MW0zRyJ9

Areas with more primary care physicians have lower spending per beneficiary, better care, patient satisfaction and lower death rates, authors say.

The composition of the healthcare workforce is shifting towards specialty physicians while primary care growth has gone flat, and according to a Health Affairs blog post, this trend could mean healthcare spending goes up not down.

Labor represents more than half of health care costs, and clinical workforce is a major driver of use and pricing, authors wrote, and there is plenty of support establishing a link between primary care-centered health systems and lower spending. Specifically, areas with more primary care physicians have lower spending per beneficiary, better care and patient satisfaction and lower death rates.

“Given this, many existing payment reform strategies prioritize primary care, and the success of these reforms will require a vibrant–and likely growing–primary care workforce,” the authors wrote.

Health Affairs delved into the Bureau of Labor Statistics’ Occupational Employment Statistics files between 2005 and 2015, focusing their analysis on limited our analysis to ambulatory health care services, hospitals, and nursing and residential care facilities. There was an overall net increase of 2.6 million jobs over this period, six percent of them being physicians. While the number of primary care jobs rose by roughly eight percent, the number of specialist jobs increased six times faster. Also, the overall share of the physician workforce constituted by primary care fell from 44 to 37 percent, the blog said.

These trends raise concerns for access to care and spending. While in theory, the presence of more specialists in a given market could give way to more competition, lower prices and spending and better outcomes, public payer fees are set administratively and not necessarily susceptible to competition. Hospital/physician integration, patient preference could also hinder competition.

The trend of more specialists working in health systems that charge facility fees on top of already expensive prices for care, and the notoriously large salaries specialists make will also likely drive spending upward, authors said.

In light of the aforementioned belief that the strong presence of primary care providers reduces healthcare spending, the workforce trends may be cause for concern. Moreover, they add urgency to previous recommendations from various agencies aimed at bolstering primary care, like MedPac‘s suggestion that the Medicare fee schedule be altered to reflect the value of primary care and close disparities in the fee schedule that overcompensate certain specialists. HRSAhas recommended in the past the medical school funding be funneled toward students who will work in family medicine and other categories.

“If we are to bend the cost curve, we likely need to move more aggressively on fee schedule changes, payment reform, and workforce policies,” the authors said.

CHS announces hospital sales worth $1.5B in revenue amidst ‘disappointing’ 2nd quarter losses

Posted on by • Posted in Uncategorized • Tagged , , , , , , , • Leave a comment

http://www.healthcarefinancenews.com/news/chs-announces-more-hospital-sales-amidst-disappointing-2nd-quarter-losses?mkt_tok=eyJpIjoiTXpOa01qUXhaVGd5TnpkaiIsInQiOiJudFozOHVLS1VVNXZZRE42Y0RmTWdIZHpkOU0yNERUSmlXU0VCMlJDMEFyMmVTUUc4aVwvcXRVc0gzXC9ndUdJVjhHT1drZkkzdDhBVFhHZ3BHVjI1NmhIVHY1RmNXSENVdWtwb3RVVnVtaFNWbXNFdnBzb0JVenRcL1ZuR1p0MW0zRyJ9

System is already knee deep in the planned divestitures of 30 hospitals; additional sales are part of shift to “smaller stronger” portfolio.

In addition to the planned divestitures of 30 hospitals,  struggling Franklin, Tennessee-based Community Health Systems announced during an earnings call Wednesday that they are looking at the additional sale of a group of hospitals that carries a combined $1.5 billion in annual net operating revenue.

CHS has already completed 20 of the 30 other planned sales, with 11 being sold in May and another nine deals having closed as of July 1st. The remaining 10 hospital sales are expected to close by September 30th, CHS said.

CHS’ financial health continued its downward slope, with a net loss of $137 million or $1.22 per diluted share in the second quarter of 2017. Their net operating revenue was down 9.7 percent to $4.1 billion. The company’s operating results for the second quarter reflected a 10.8 percent decrease in total admissions. On a same-store basis, both admission and adjusted admission dropped 2.5 percent year over year from 2016, financial documents showed.

Wayne T. Smith, chairman and chief executive officer of Community Health Systems said their focus is now on shifting to a “smaller, stronger portfolio of assets.”

“Obviously, we are disappointed with our performance during the second quarter. Our financial results reflect weaker than expected volumes, which negatively affected our net revenue and Adjusted EBITDA performance. We are seeing better results in certain areas, and we continue to work on a number of initiatives to drive operational and financial improvements.”

CMS gives $2.4 billion boost to inpatient hospitals for fiscal year 2018 with final uncompensated care rule

Posted on by • Posted in Uncategorized • Tagged , , , , , • Leave a comment

http://www.healthcarefinancenews.com/news/cms-gives-24-billion-boost-inpatient-hospitals-fiscal-year-2018-final-uncompensated-care-rule?mkt_tok=eyJpIjoiTXpOa01qUXhaVGd5TnpkaiIsInQiOiJudFozOHVLS1VVNXZZRE42Y0RmTWdIZHpkOU0yNERUSmlXU0VCMlJDMEFyMmVTUUc4aVwvcXRVc0gzXC9ndUdJVjhHT1drZkkzdDhBVFhHZ3BHVjI1NmhIVHY1RmNXSENVdWtwb3RVVnVtaFNWbXNFdnBzb0JVenRcL1ZuR1p0MW0zRyJ9

Inpatient hospitals will see increase of $800 million over the previous year, but long-term care facilities face $110 million cut in payments.

CMS Final Rule for the 2018 Medicare Inpatient Prospective Payment System will give hospitals an overall $2.4 billion raise in fiscal year 2018, the agency said.

Due to the combination of payment rate increases, other policy changes and adjustments acute care hospitals will see $6.8 billion in payments for uncompensated care, an increase of $800 million over the previous year, CMS said.

Medicare payments to inpatient psychiatric facilities will rise by $45 million, or roughly one percent. However, long-term care hospitals will decrease by $110 million in fiscal year 2018.

The changes will affect 3,330 acute care facilities and roughly 420 long-term care hospitals for discharges happening after October 1, 2017. The new rule incorporates CMS’ finalized proposal to use data from its National Health Expenditure Accounts in its estimate of the rate of uninsurance, which is used in calculating the total amount of uncompensated care payments available.

Long-term care hospitals will be facing a cut. Under the 2018 final rule, CMS projected payments will drop roughly 2.4 percent, or $110 million in FY 2018, which is “due in large part to the continued phase in of the dual payment rate system.” However, this amount is actually smaller than the previously projected cut of 3.75 percent, which was first proposed back in April.

CMS has also finalized its proposal for a one-year regulatory moratorium on the payment reduction threshold for patient admissions for long-term care hospitals in FY 2018 while they continue to evaluate the policy, CMS said.

U.S. governors urge Trump to make insurance payments

Posted on by • Posted in Uncategorized • Tagged , , , , , , , • Leave a comment

https://www.reuters.com/article/us-usa-healthcare-idUSKBN1AI28L

Image result for U.S. governors urge Trump to make insurance payments

Democratic and Republican U.S. governors on Wednesday urged the Trump administration, as well as Congress, to continue funding payments to health insurance companies that make Obamacare plans affordable, calling it critical to stabilizing the insurance marketplace.

Republican President Donald Trump, frustrated that Obamacare survived attempts to repeal it, has threatened to cut off about $8 billion in subsidies that help control costs for low-income Americans under the Affordable Care Act, Democratic former President Barack Obama’s signature domestic initiative.

“The Administration has the opportunity to stabilize the health insurance market across our nation and ensure that our residents can continue to access affordable health care coverage,” said a statement by the Health and Human Services Committee of the National Governors Association.

“A first critical step … is to fully fund CSRs (cost-sharing reduction payments) for the remainder of calendar year 2017 through 2018,” the statement said, adding this was needed as Congress and the administration address long-term reform efforts.

The committee is led by Virginia Governor Terry McAuliffe, a Democrat, and Massachusetts Governor Charlie Baker, a Republican. Earlier this year, the governors sent a letter calling on Congress to fully fund the cost-sharing payments.

Some Congressional Republicans have joined Democrats in urging Trump to continue the payments. Republican Senator Lamar Alexander, chairman of the health committee, said Tuesday the president should pay the subsidies through September while lawmakers work on bipartisan legislation to fund the outlays for another year.

But the Senate’s No. 2 Republican John Cornyn hesitated when asked Wednesday if he would support such legislation.

“I’ve said before that I’m not in favor of throwing money at insurance companies without reform, so that’s going to be the nature of the conversation,” Cornyn told reporters outside his office.

Asked what reforms he’d like to see, Cornyn mentioned the “skinny” Obamacare repeal bill the Senate voted down last week. Among other things, it would have repealed the requirement that every American have health insurance or pay a penalty.

Insurers say that the cost-sharing payments are passed onto customers in the form of lower deductibles and co-pays that make care more affordable for low income Americans.

Insurers are finalizing 2018 premium rates for the individual Obamacare market, with many saying their decision hinges on government guarantees for cost-sharing subsidies.

Molina Healthcare Inc said on Wednesday it would stop selling Obamacare plans in Utah and Wisconsin, joining a slew of health insurers that have exited Obamacare markets amid uncertainty over the healthcare law.

Anthem Inc, one of the largest sellers of these plans in 2017, has pared back offerings or mostly exited five states including California and may exit more.

White House budget director Mick Mulvaney told CNN the administration was still considering whether to end cost-sharing subsidies.

 

Bipartisan drive to pay health insurers faces Senate hurdles

Posted on by • Posted in Uncategorized • Tagged , , , , , , , • Leave a comment

http://abcnews.go.com/Health/wireStory/bipartisan-drive-pay-health-insurers-faces-senate-hurdles-48995691

Image result for political hurdles

A bipartisan Senate effort to continue federal payments to insurers and avert a costly rattling of health insurance markets faces a dicey future. The uncertainty shows that last week’s wreck of the Republican drive to repeal the Affordable Care Act hasn’t blunted the issue’s sharp-edged politics.

President Donald Trump is threatening to halt the payments in hopes of forcing Democrats to negotiate an end to the Obama-era law. The insurance industry and lawmakers from both parties say blocking the money would lead insurers to raise premiums for people buying individual policies and might induce companies to abandon some markets.

Into the fray has stepped Sen. Lamar Alexander, R-Tenn., chairman of the Senate Health, Education, Labor and Pensions Committee.

He said he will work with the committee’s top Democrat, Sen. Patty Murray of Washington state, on a bill next month that would pay insurers through 2018. In exchange, he wants Democrats to agree to make it easier for states to choose their own health coverage standards that insurers must provide, and not heed consumer-friendly requirements of former President Barack Obama’s law.

While that is an idea Democrats say they will discuss, it’s unclear whether the two parties can reach a deal.

For the GOP’s failed effort to repeal and replace Obama’s overhaul, Senate Republicans used special rules allowing passage by a simple majority. But this developing bill would need 60 votes to succeed. Republicans hold a 52-48 advantage in the Senate, which means Democratic backing will be crucial.

Democrats will be reluctant to strike an agreement that would pull back far on Obama’s protections, which include a set of services insurers must cover and guarantees that premiums for healthy and seriously ill people are equal.

“It’s going to be hard to get common ground,” said Sen. Chris Murphy, D-Conn., a committee member. “Republicans are going to want some initial flexibility” for coverage requirements, “and that’s not an easy thing to achieve.”

Republicans are divided, too.

Many, including Trump, have called the payments an insurers’ bailout. Conservatives are reluctant to continue payments to help sustain a law the GOP has pledged for years to toss out.

“I was a total repeal guy,” said Sen. Richard Shelby, R-Ala. “I don’t know if I want to prop it up.”

Added GOP Sen. Ted Cruz of Texas: “I think it’s a mistake to bail out insurance companies.”

Obama’s law requires insurers to reduce out-of-pocket costs such as deductibles and copayments for millions of low- and middle-income customers. It also requires the government to reimburse insurers for those costs.

But a federal court found that Congress hasn’t properly approved money to do that. Both Obama and Trump have continued making the payments as the case has dragged on.

Besides the outright opponents, some Republicans say they would be reluctant to support an Alexander bill unless whatever eased regulations Democrats agree to are worthwhile. It’s unclear what Alexander or other Republicans are willing to accept.

“We certainly should get some structural change to bring down premiums in exchange for that,” said Sen. Ron Johnson, R-Wis. “We can’t just throw money at the problem.”

That echoes what Senate Majority Leader Mitch McConnell, R-Ky., said last Friday after the Senate rejected the third health proposal he advanced, effectively sinking the repeal effort.

“Bailing out insurance companies with no thought of any kind of reform is not something I want to be part of,” McConnell said.

Alexander said Wednesday that he has kept McConnell apprised of his effort. Asked if he had received a commitment that McConnell would bring such legislation to the full Senate, Alexander said, “Well, he doesn’t know what bill we’re going to have.”

But Alexander does have allies.

“We’ll eventually repeal Obamacare and put something in its place,” said Sen. John Kennedy, R-La. “In the meantime, I think it’s very important not to see any Americans get hurt.”

If the GOP divisions persist, McConnell and House Speaker Paul Ryan, R-Wis., might have to decide whether to have votes on legislation opposed by substantial numbers of Republicans. That’s always an uncomfortable proposition for party leaders.

“That’s a question for McConnell,” said the second-ranking Democratic senator, Illinois’ Dick Durbin, said asked whether he thought the GOP leader would allow a vote on a bill opposed by many Republicans.

Durbin said if Republicans are truly concerned about keeping insurance markets stable, “they have to do something.”

Would Ryan support a measure like Alexander’s?

The speaker “believes repeal and replace is the best course of action and that the Senate needs to act,” spokeswoman AshLee Strong said.