ICYMI: Notes from the field for September 2019

DATE: 10/07/2019

For this issue, we’ve brought together a lot of news about CMS initiatives and how various policies are impacting providers, payers and patients. These are what caught our attention this month—what’s on your mind?

New from CMS

  • CMS’ new Data at the Point of Care program has received a vote of confidence from the American Medical Group Association. The program, designed to give physicians access to Medicare beneficiary claims data directly within their workflows, promises to help accelerate the success of value-based initiatives. Hopefully, it serves as a successful pilot and encourages private payers to follow suit.
  • In not-so-good news, CMS made a calculation mistake that could impact Medicare payments at skilled nursing facilities. CMS has acknowledged the error and is issuing corrected value-based purchasing reports to impacted facilities. Fortunately, there’s no additional action needed from SNFs to protect their payments; once the corrected reports are available, CMS will automatically make adjustments.
  • Prior authorization has gotten a lot of attention lately, as doctors, payers and Congress wrestle with the issue. Some doctors argue that prior authorization, which aims to demonstrate that a proposed treatment is truly necessary, can unnecessarily delay care and increase administrative burdens — and over a quarter of doctors believe that prior authorization causes adverse events for patients. Payers, meanwhile, see it as a tool to control escalating costs.
  • Major cuts are coming to Medicaid Disproportionate Share Hospital payments starting in October. More than $4 billion is on the chopping block, but Congress approved a resolution delaying the cuts until at least Nov. 21. The senate is expected to take the issue up in October.
  • CMS has penalized more than 2,500 hospitals for high readmissions, withholding an estimated $563 million in Medicare payments to hospitals under the Hospital Readmissions Reduction Program. More than 80% percent of hospitals evaluated received a penalty.

Updates on policy changes and impacts

  • As alternative payment plans add new participants and gain momentum, there’s a challenge facing how payments are handled: patient overlap. When patients are beneficiaries of both Medicare Shared Savings Programs and bundled payments, which one should be prioritized when it comes to provider organizations getting paid? For the time being, CMS is paying bundled payments first, but that could always change.
  • The share of Americans with health insurance declined in 2018, despite the fact that fewer people are living in poverty than in the recent past. This reverses a trend set by the implementation of the Affordable Care Act and presidential candidates are blaming the current administration’s policies for the drop.
  • The Office of the National Coordinator for Health Information Technology has been pushing for a rapid increase in electronic data sharing, penalizing healthcare companies that silo data. The industry is pushing back, accusing ONC of doing too much too quickly.
  • A recent analysis from HCI focuses on the efficacy of drug monitoring programs. Finding out whether or not these program are actually helping is a difficult and complicated task. Read the recent analysis for more information.