California Healthline Daily Edition

Summaries of health policy coverage from major news organizations

CMS Proposes Medicare Reimbursement Changes, Increases for 2015

CMS has proposed increasing the number of quality measures used in the Medicare Shared Savings program for accountable care organizations, according to its proposed 2015 Medicare physician fee schedule released Thursday, Modern Healthcare reports.

The measures would place an even greater emphasis on patient outcomes.

Specifically, the number of quality measures used to assess ACOs would increase from 33 to 37. ACOs would need to meet the quality performance goals to earn bonus payments under the program. The new measures would include:

  • Whether patients say providers informed them about treatment costs;
  • The rate of patients who are admitted to skilled nursing facilities within 30 days of being discharged from a hospital; and
  • Unplanned readmissions for patients with diabetes, heart failure or more than one chronic condition for any reason.

In addition, CMS proposed:

  • Replacing a measure dealing with medication management;
  • Changing a requirement that ACOs adopt electronic health records; and
  • Eliminating some measures dealing with treatments for coronary artery disease, diabetes and ischemic vascular disease.

According to Modern Healthcare, the changes would bring the measures in line with those used in clinical practices and help simplify reporting.

Also in the proposal, CMS suggested adding new quality incentives for ACOs. The incentives would:

  • Require ACOs to meet certain quality targets while reducing health care spending in order to receive bonus payments; and
  • Allow ACOs to receive awards based on annual quality improvement.

Further, CMS requested comments on future quality measures for:

  • Care coordination;
  • Health outcomes;
  • Nursing home quality;
  • Prevention;
  • Elderly public health; and
  • Utilization (Evans, Modern Healthcare, 7/3).

CMS Proposes Payment Changes, Quality Measures for DME, Dialysis

In related news, CMS on Wednesday released a proposed rule that would change the way Medicare payments are made to dialysis providers and durable medical equipment suppliers, CQ HealthBeat reports.

Under the rule, payments to dialysis providers in 2017 and 2018 would be tied to new quality and performance targets. Dialysis providers that fail to meet a specific minimum quality performance score would be paid less than facilities that meet the target. Basic payment rates for the providers in 2015 would match 2014 rates.

The proposal also addressed the methods used to calculate payments to durable medical equipment suppliers, CQ HealthBeat reports (Reichard, CQ HealthBeat, 7/2).

CMS Proposes Increased Provider Payments

Also in related news, CMS detailed plans to raise Medicare outpatient payments by 2.1% for hospitals and by 1.2% for ambulatory surgery centers next year, Modern Healthcare reports.

The increased hospital payment rates were calculated based on a 2.7% market-basket increase, subtracting a 0.4% productivity adjustment and a 0.2% cut required by the Affordable Care Act. The surgery center increase reflected a 1.7% adjustment to the consumer price index, minus a 0.5% productivity adjustment.

Under the proposal, specific rural community hospitals would continue to receive higher payments. Meanwhile, hospitals that do not meet certainly outpatient quality reporting requirements would have their reimbursements reduced by 2%.

In addition, CMS proposed a bundled payment rate for ancillary services that have average costs of $100 or less. Services that would not be included in the bundled payments are:

  • Certain psychiatric-related services;
  • Drug administration-related services; and
  • Preventive services.

The rule would affect more than 4,000 hospitals and 5,300 ambulatory surgery centers. CMS estimated that it would pay hospitals nearly $56.5 billion under the proposed rules in 2015, up by $5.2 billion over 2014 payments. Meanwhile, ambulatory surgery centers would receive about $4.1 billion in Medicare payments in 2015, a $243 million increase over 2014.

CMS will accept comments on the proposed rules until Sept. 2. It is expected to release final regulations around Nov. 1 (Herman, Modern Healthcare, 7/3).

Meanwhile, CMS in a separate proposal said it will provide details for payments for physicians caring for Medicare patients with at least two chronic conditions, which it had finalized last year. CMS proposed that such payment changes go through the public notice and comment process before being implemented. The agency said it will aim to have a procedure for the policy ready for 2016.

The physician payment proposal will be published in the Federal Register on July 11. CMS will accept comments on the rule until Sept. 2 (Young, CQ HealthBeat, 7/3).

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