News Clips
Washington Post: Medicare payments to hospital outpatient centers are in Congress's crosshairs (4/25) – The House Energy and Commerce Committee is picking a fight with the nation’s powerful hospital lobbies. The panel is holding a legislative hearing today on an array of draft bills focusing on transparency and competition in the health-care system. And several pieces of legislation are aimed at authorizing Medicare to pay hospitals the same as doctors’ offices for certain types of care no matter where the service is performed, which would reduce payments to hospitals. These types of proposals, known as site-neutral payment policies, have drawn the ire of the nation’s hospitals for years — and this time is no different. But it’s an idea many health experts have long championed, contending it’s a way to curb health-care consolidation and ensure costs to the Medicare program aren’t higher than necessary.
Milbank Quarterly: Century-Long Trends in the Financing and Ownership of American Health Care (4/25) – For-profit ownership of most health care subsectors has risen in recent decades and now predominates in several (including nursing facilities, ambulatory surgical facilities, dialysis facilities, hospices, and home health agencies). However, most community hospitals remain not-for-profit. Additionally, over the past century, a growing share of physicians identify as employees. Meanwhile, the comprehensive taxpayer-financed share of health care spending has increased dramatically from nine percent in 1923 to 69 percent in 2020, with taxpayer-financed subsidies to private expenditures accounting for much of the recent growth.
Medical Economics: Start of 2023 indicates agenda for year, CMS leaders say (4/25) – While the medical community agrees that integrating behavioral health and primary care is critical to better patient outcomes, making that happen means disrupting the status quo. Industry stakeholders are rethinking the current reimbursement structure to promote integrated care. But to shift the current paradigm, payers and providers must work together to navigate uncharted territory. Roughly 15 percent of primary care visits in the U.S. address a behavioral health concern, according to recent data from Health Affairs. Yet, full integration of services is rare, making it difficult for primary care providers to help patients find appropriate behavioral health services.
Behavioral Health Business: Payers Must Create Infrastructure to Support Behavioral Health Providers Moving Towards Value-Based Care Contracting (4/24) – Actions so far in 2023 will lead to more program changes for beneficiaries, physicians, and health care across the nation, according to leaders of the CMS. CMS leaders have proposed a new Universal Foundation of quality performance across its health care programs, Fleisher said. “This initiative prioritizes outcomes that are meaningful (for) patients, reduces burden and duplication for clinicians, facilities and health insurers, while moving towards a building block approach that will align CMS quality programs,” Fleisher said. “This universal foundation of quality measures will apply to as many CMS quality rating and value-based care programs as possible, with additional measures added on depending on the population or setting.”
Hospice News: CMMI Deputy Director Ellen Lukens: CMS to Take Multifaceted Approach to Palliative Care (4/21) – The Center for Medicare & Medicaid Innovation (CMMI) is considering a broad spectrum of payment models that could integrate palliative care. Palliative care providers offer a diverse range of services designed to meet their patients’ complex needs, and forthcoming payment model demonstrations will reflect this heterogeneity, fashioned with inclusive, yet measurable tools, Ellen Lukens, deputy director of CMMI said at the Hospice News Palliative Care Conference in Washington D.C. This could include demos that fuse palliative care into Accountable Care Organization (ACO) or primary care programs, among others. “In terms of models, in general, we’re really thinking about how we leverage accountable care and primary care models and other models to provide flexibility to do different things in things like palliative care,” Lukens told Hospice News at the conference. “It’s really important to give providers and other entities that are testing these models tools to be successful. Thinking about where we go from here, that’s a really important context as we think about the future of palliative care.”
Healthcare Dive: When will the ER catch up with value-based care? (4/20) – We can expect that, through the remainder of 2023, healthcare providers will alter their decision-making matrix from if they will take the leap toward assuming risk to when they will do so. Getting there has meant the introduction of new programs that qualify as alternate payment models, giving providers more options for participation — with two important changes. First, as models demonstrate success in terms of cost and quality improvements, we expect a shift away from voluntary programs in favor of mandatory participation. Second, there will be stricter limits on upside-only models, eventually eliminating these options completely. It’s curious that with so many new options, including the older fee-for-service model, we still can’t take the pressure off the front door of our hospitals, namely the emergency department.
Forbes: Why Provider Network Management Is Important For Health Plans In 2023 (4/19) – The shift from fee-for-service to value-based care in order to pay providers based on the value they provide to patients rather than the number of services they provide is increasing the payment calculation complexities. However, we're seeing that many providers continue to be paid fee-for-service. All information about the providers is necessary for the production of a comprehensive and up-to-date provider directory that members can use to find physicians, hospitals or other healthcare services that their health plan covers. Health plans need to be able to adapt quickly to these changes to remain competitive and provide high-quality, cost-effective care. Effective provider network management can help payers identify new providers and services that can enhance their networks and meet the evolving needs of their members.
STAT: Congress targets reducing hospital outpatient payments in new bills (4/19) – House Republicans are floating several draft bills that would significantly affect the hospital industry, including some with far-reaching policies that would authorize Medicare to pay hospitals the identical amount for the same service, regardless of where the service was performed. The bills — which are far from clearing Congress and being signed into law — would address a problem that legislators and policymakers have targeted for years. Hospitals increasingly have acquired physician offices and converted them into “hospital outpatient departments.” Nothing about the clinics changes — the services and IV drugs patients receive are exactly the same — except that the hospital then bills patients and health insurers additional “facility fees.” Hospitals have argued the added payments, worth tens of billions of dollars annually, help cover their overhead costs. But patient groups, insurers, and policymakers say the higher payments lead to unwarranted profiteering and more consolidation.
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