CMS announces provider comparison tool

At the agencies

On August 19, the Centers for Medicare and Medicaid Services (CMS) announced it will be introducing a comparison tool in six states’ HealthCare.gov websites. The tool would allow individuals to compare provider networks in their county for 2017. The Obama administration had previously announced the tool, but had stated it would be available in all states. CMS did not specify which six states would pilot the comparison tool.

Following a Freedom of Information Act request, CMS released data on the hospitals which received money in the 2015 $1.5 billion Medicare billing settlement. The data shows the payments for the 2,022 hospitals which settled 346,000 reimbursement claims for treating Medicare patients admitted on or before October 1, 2013. In 2014, the government offered to pay hospitals 68 percent of the value of inpatient claims that had been stalled in the Medicare hearings and appeal process.

On August 25, CMS released data regarding Medicare accountable care organizations (ACOs) which showed that the organizations generated $446 million in savings last year. Of the 392 organizations participating in the Shared Savings Program, 119 achieved enough savings to receive a portion of that money. However, nearly half of participants did not generate any savings. ACOs have been a primary tool that CMS is using to move providers away from traditional fee-for-service Medicare programs, with a goal to have 50 percent of Medicare payments flowing to alternative methods by 2018.

On August 31, as part of the FDA’s Opioids Action Plan, the agency announced that it will now require almost 400 products to display its “black box” warning, informing consumers of the dangers of taking opioids and a class of anti-anxiety drugs known as benzodiazepines together. Both varieties of drugs depress the central nervous system, and simultaneous usage carries the risk of sleepiness, respiratory depression, coma and death. According to the FDA, the number of patients who were prescribed both types of drugs increased by 41% from 2002 to 2014.

On the Hill

A new report from the Government Accountability Office (GAO) reports that an increase in the use of drug coupons in the private sector may have resulted in Medicare paying higher prices for physician administered drugs. According to the GAO, 18 of 29 coupons providing high expenditure Medicare Part B drugs had an average sale price (ASP) 0.7 percent higher than actual market price. An equilibrium would mean $69 million less in Part B spending, if ASP equaled the effective market price.

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