CMS releases hospital Medicare payment proposed rule

At the agencies

On June 26, the Centers for Medicare and Medicaid Services (CMS) proposed a new rule to complete the fourth and final year of its project to transition its home health payment system to a standardized 60 day episode payment rate, national per-visit rates, and non-routine medical supplies conversion factors. Under the proposed rule, CMS would cut the amount it pays to over 11,000 home health agencies by approximately 1 percent in 2017. In total, this reduction amounts to a $180 million drop in reimbursements from CMS. The rule would additionally require home health agencies’ quality reporting programs to include preventable readmission rates, estimated per-person Medicare spending, reporting on discharge to the community, and medication reconciliation as new measures for calculating 2018 reimbursements, as mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014.

According to data released on June 30 from CMS, drug and device makers have reported $7.52 billion in payments to or investments from doctors and teaching hospitals in 2015. The $30 million dollar increase from the previous year is a result of increased industry backed research, although, general payments to doctors for speaking fees and meals as well as doctor ownership and investment interests actually declined slightly. Novartis, spent the most with data showing $539 million in financial interests with doctors, a 40 percent increase from 2014. These statistics are available as part of the Affordable Care Act’s required reporting. This data release includes 11.9 million records of payments to almost 619,000 doctors and more than 1100 teaching hospitals.

On July 6, CMS released a new proposed rule that would remove pain management questions from the Hospital Value-Based Purchasing program’s patient survey in order to reduce the pressure placed on clinicians to overprescribe pain medications. The rule would also implement section 603 of the Bipartisan Budget, thereby cutting payments to certain off-campus outpatient departments by no longer paying those facilities under the Hospital Outpatient Prospective Payment System.  Additionally, Medicare would reduce its electronic health records reporting period from a full year to 90 days. Finally, the proposed rule introduces new measurements of care quality to the Hospital Outpatient Quality Reporting Program and the Ambulatory Surgical Quality Reporting Program.

On July 7, CMS proposed a new rule that introduces reforms to the Diabetes Prevention Program and Medicare Advantage plans. Under the proposed rule, providers would be permitted to bill diabetes prevention services to Medicare starting in 2018. Additionally, providers and suppliers that contract with Medicare Advantage (MA) would be required to undergo screening and to be enrolled in Medicare. Finally, physicians would be required to confer with a clinical decision support tool regarding specific services before being paid for advanced imaging services.

For more information on this topic, or to learn how Baker Tilly healthcare specialists can help, contact our team.