MHA's Executive Briefing

Health Leaders Speak Out About MedPAC's Proposed Lower Payments for 2010

A draft recommendation to Congress released by the Medicare Payment Advisory Commission (MedPAC) Dec. 10 has hospital officials concerned about payments for the year. The draft, which can still be revised before the full MedPAC panel votes on it in January, provides for a full "market basket" update for fiscal 2011 outpatient and inpatient hospital payments.

The data "reinforces our concerns about the Medicare buy in proposal that's currently part of the Senate health reform bill," said American Hospital Association President and CEO Rich Umbdenstock.

Read more here.

AHA applauds proposed Medicare Advantage rule change

The American Hospital Association strongly supports the Centers for Medicare & Medicaid Services’ proposal to exempt hospitals and other health care entities that participate in the traditional Medicare program from separate compliance training requirements under the Medicare Advantage program, the association said in a comment letter on Dec. 8. “The AHA strongly supports and appreciates this proposed change to compliance training, which will help eliminate unnecessary burden and cost on hospitals,” the letter states.

Hospitals that participate in the traditional Medicare program are already certified as meeting the Medicare Advantage training and education requirements, the letter notes.

CMS publishes MPFS rule in Federal Register

On November 25, CMS published in the Federal Register the 2010 Medicare physician fee schedule (MPFS) final rule. CMS had previously released a display copy of the rulemaking.

View the 2010 MPFS final rule.

[ via Medicare Weekly Update ]

House OKs Bill to Stop Medicare Physician Cuts

The House of Representatives, voting 243 to 183 mostly along party lines on Nov. 19, approved a bill (HR 3961) that would prevent a 21% cut in the Medicare physician payment rate scheduled at the beginning of January 2010. Instead, as proposed under the House measure, physicians would receive a 1.2% annual increase.

Read more here.

HHS revises how it calculates improper Medicare payments

The Department of Health and Human Services on Nov. 17 announced a 7.8% improper payment rate for Medicare fee-for-service payments in 2009, up from 3.6% in 2008. The program this year modified the medical review process used to identify improper payments based on recommendations from the HHS Office of Inspector General, members of Congress and the Centers for Medicare & Medicaid Services.

Improper payments include those that may have been paid incorrectly and do not necessarily reflect fraud. The agency announced an 8.7% national payment error rate for Medicaid in 2008, down from 10.5% in 2007.

It has temporarily suspended reporting of an error rate for the Children’s Health Insurance Program pending a final rule for the Payment Error Rate Measure program. For more information, see the HHS “fact sheet.”

[ via AHA News Now ]

Obama Plans to Sign Executive Order to Target Medicare Waste, Fraud

More than $98 billion in taxpayer money spent by government agencies was wasted in fiscal 2009—with nearly half of it ($54 billion) coming from improper payments related to Medicare fee-for-service, Medicaid, and Medicare Advantage, according to government findings released Nov. 17 by the White House. President Obama is expected to sign an executive order within the week that will focus on eliminating government waste and fraud, particularly in Medicare and other benefit programs.

Read more here.

AHA Regulatory Advisory: Medicare Outpatient PPS and ASC Final Rule for CY 2010

On October 30, the Centers for Medicare & Medicaid Services (CMS) released the outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) final rule for calendar year (CY) 2010. Major policies in the rule include:

• A market basket update of 2.1 percent for hospitals that reported data on outpatient care in 2009. Hospitals failing to report will receive a reduced update of 0.1 percent in 2010.

• In attempting to address the impact of its 2009 OPPS final rule “clarification” on the supervision of outpatient therapeutic services furnished on the hospital’s campus prior to 2009, CMS seems to understand that its “clarification” was more a change in policy and explicitly acknowledges that applying that standard in all cases would be inappropriate.

• Revised policies for physician supervision of outpatient services, beginning in 2010, that include allowing certain non-physician practitioners to directly supervise hospital outpatient therapeutic services. In addition, for outpatient therapeutic and diagnostic services provided in the hospital or in an on-campus provider-based department of the hospital, CMS will no longer require the supervising professional to be physically present in the department. Instead the supervisor must be present on the same campus of the hospital and immediately available to assist.

• A new methodology to pay for separately payable drugs and biologicals, which results in a payment rate of average sales price (ASP) plus 4 percent.

• No new quality measures are added for 2011 reporting purposes; the agency is finalizing a data validation process for 2011.

The rule also updates payments for ASCs using more recent outpatient PPS data to determine the ASC payment weights, rates and conversion factor.

Comments on specified technical provisions of the OPPS and ASC final rule are due to CMS by December 29. The rule takes effect January 1, 2010.

If you are an MHA member and would like a copy of the AHA Regulatory Advisory emailed to you, contact Shawn Lea at (800) 289-8884, (601) 368-3237 or slea@mhanet.org.

What If All Your Reimbursement Was Medicare?

I'm guessing you wouldn't like it very much if all your reimbursement came from Medicare, considering that all I've heard over the years is how Medicare significantly underfunds the cost of care in its reimbursements, leaving hospitals to cross-subsidize by negotiating deals with commercial insurers that pay better. But if healthcare reform passes, and even if the public option pays you as much as 99% of costs, much higher than Medicare, you still come out way behind over time.

Read more from Philip Betbeze at HealthLeaders Media Corner Office here.

Heart, Cancer Doctors Get Break On Scheduled Medicare Pay Cuts

"Heart and cancer doctors will get a smaller fee cut next year from Medicare, the U.S. government program for the elderly, than the Obama administration first sought in a move to shift money to family physicians,"Bloomberg reports. Earlier this year, Medicare officials said they would cut 10 percent of payments for the two specialties. Now, they plan on making the reductions over four years, instead.

Read more here.

AHA supports proposed occupational mix survey changes

The American Hospital Association “strongly supports” proposed changes to the data reporting period and deadline for the hospital wage index occupational mix survey, the association said in a comment letter on Nov. 2. The survey collects data every three years on the occupational mix of hospital employees, which is used to adjust the wage index.

For the 2010 survey, CMS proposes to change the reporting period to a calendar year from the current July-June fiscal year, and give hospitals six months to complete the survey rather than two. Occupational mix data for pay periods in CY 2010 would be due by July 1, 2011 and applied to the fiscal year 2013, 2014, and 2015 wage indices.

The AHA said the proposed changes will increase the survey’s accuracy and response rate. The association further recommends that CMS exempt from the survey hospitals that left the Medicare program before Jan. 1, 2010, and include categories from both the current and forthcoming cost reports in the survey’s list of nursing cost centers.