CMS is open to delaying Merit-based Incentive Payment Program

At the agencies

The Centers for Medicaid and Medicare Services (CMS) proposed several possible solutions to address physicians’ concerns that there is not enough time to prepare for the January 1, 2017 rollout of the MACRA Merit-based Incentive Payment System. These potential solutions include providing an alternative start date, shortening reporting periods, and helping physicians become familiarized with the new payment schedule. CMS has indicated it is open to publishing an interim final rule in the fall to take into account feedback on the new payment system.

New statistics from CMS reveals that health spending in the US grew by an average of 5.8 percent in 2015, compared with 5.3 percent in 2014, on account of an aging population that requires more health care services, an increase in medical prices, and expanded coverage resulting from the Affordable Care Act. CMS projects that the growth of health spending in 2016 will be smaller at just 4.8 percent due to slower Medicaid enrollment rates; however the growth rate is expected to pick back up in later years. CMS estimates that health care spending will average a 6 percent growth rate from 2020-2025 and will make up 20.1 percent of the total economy by 2025. Additionally, CMS predicts that total government health care expenditures will increase by 47 percent by 2025 and will cost around $2.7 trillion.

The Food and Drug Administration (FDA) has proposed creating an independent National Evaluation System for Health Technology where patients, providers, and companies can quickly identify safety issues with medical devices and share thoughts on how to improve the products’ performance. The FDA believes increased post-market evaluation of devices that includes integrated clinical registries, electronic health records, and data about claims over the device’s entire lifespan could help reduce the pre-market evaluation requirements that slow down the availability of risky but important medical devices. The proposed evaluation center would additionally provide information on development pathways to help spur more innovative technologies. The Administration’s Sentinel Initiative would provide the foundation for the system after it begins to incorporate unique device identifiers (UDIs).

CMS released a new report assessing the impact of efforts to improve program integrity, such as deterring improper payments; properly screening healthcare provides; using advanced analytics to assess waste, fraud, and abuse; and collaborating with federal and external partners to reduce fraud. CMS found that every dollar spent on program integrity efforts during fiscal years 2013-2014 saved Medicare $12.40. These integrity improvement measures saved Medicare, Medicaid, and CHIP $42 billion overall during that same period, representing between 68-74 percent of total savings.

The Department of Justice (DOJ) charged three Florida health providers for working together to defraud Medicaid and Medicare in the amount of one billion dollars. The DOJ claims the three assisted living providers billed unnecessary services to Medicare and Medicare and also received compensation for referring other health providers that did the same. The three providers were additionally charged for admitting thousands of beneficiaries who did not qualify for skilled nursing home care and for obstructing justice by avoiding trial. The case is the largest instance of health care fraud the DOJ has ever uncovered.

CMS will cut fiscal year 2017 payments by 2 percent for inpatient rehabilitation facilities (IRFs) that did not meet their 2015 quality reporting program standards. IRF providers have until August 19 to submit a request for CMS to reconsider these cuts. CMS will also reduce fiscal year 2017 funding for Long-Term Care Hospitals (LTCHs) that did not meet their respective 2015 quality reporting program standards.

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