MedPAC’s rural Medicare payment recommendations and studies Jeffrey Stensland August 28, 2007 Opinions expressed today are my own and do not necessarily.

Slides:

Advertisements

Similar presentations

April 13, Matching Revenue Flows with the Populations Needs: The Experience in Maryland John M. Colmers VP, Health Care Transformation and Strategic.

Advertisements

Exhibit 1 NOTES: Other setting of usual care includes: neighborhood or family health center, free standing surgery center, rural health clinic, company.

AHA Task Force on Variation in Health Care Spending Report to the Institute of Medicine Committee on Geographic Variation In Health Care Spending and Promotion.

Inpatient Prospective Payment System: To Reform or Refine? Parashar Patel Vice President, Reimbursement & Outcomes Planning Boston Scientific Corporation.

1 CPE Cost Reports, Audits and WACs What You Need to Know September 26, :00 AM.

Health Reform and Rural Hospitals John Supplitt, Sr. Director American Hospital Association Indiana Rural Health Policy Forum.

1 CAH State Network Council Meeting Legislative/Policy Briefing August 29, 2011.

1 Wisconsin Veterans Homes Legislative Audit Bureau March 2011.

2010 Changes – Physician Fee Schedule Billing & Reimbursement for Consultations December 16, 2009.

Paying for Primary Care: Robert Graham Center Primary Care Forum Washington, DC Two CMS/CMMI payment experiments Jay Crosson March 25, 2014.

MedPAC Hospice Payment Adequacy Meeting Summary at a Glance: The Medicare Payment Advisory Commission (MedPAC) met 12/11/09 and commissioners heard a staff.

1 Controlling Costs in Medicare Jack Hoadley Research Professor Georgetown University Health Policy Institute Citizens’ Health Care Working Group Public.

MEDICARE HOME HEALTH RATE REBASING Medicare Home Health Rate Final Rule CMS Proposed Rule (July 3, 2013) /pdf/ pdfhttp://

Medicare Reimbursement for Physicians David A. Spahlinger MD Executive Medical Director, Faculty Group Practice June 3, 2003.

Graduate Medical Education Reimbursement and Residency Funding Prepared by: Erin E. Schneider, MD Emergency Medicine Resident, PGY-2 Oregon Health and.

Research and analysis by Avalere Health The Opportunities and Challenges for Rural Hospitals in an Era of Health Reform April, 2011.

Source: Congressional Budget Office, The Budget and Economic Outlook: 2014 to 2024, p. 58, February 4, Note: CBO estimate of $115 billion reflects.

Barbara McAneny MD. 2 3 » Legal entity through which the Affordable Care Act’s Shared Savings Program will be implemented » Comprised of groups of eligible.

-1- Washington State Medicaid Inpatient Reimbursement System Study Phase 2 Study Methodology Redesign Update September 26, 2006.

6/15/ Hospital Rate Setting Methods for State Fiscal Year 2011 June 15, 2010 Department of Health Services Division of Health Care Access and Accountability.

Rural Wisconsin Health Cooperative Critical Access Hospitals Better Medicare Financing For Smaller Hospitals Serving Rural Communities.

Health Insurance. Objectives for today Explain the origins of insurance Differentiate among types of insurance Explain reimbursement mechanisms Explain.

THE COMMONWEALTH FUND Developing Innovative Payment Approaches: Finding the Path to High Performance Stuart Guterman Assistant Vice President and Director,

Introduction to Medical Management – PPS and DRGs ISE 468 ETM 568 Spring 2015 Prospective Payment System Diagnosis-Related Groups.

Issues and Challenges Facing Medicare Mark L. Hayes.

What is a Critical Access Hospital ? Robert David, President UH Regional Hospitals – Richmond and Bedford Medical Centers.

1 HEALTH CARE REFORM – Implications for Provider Reimbursement Kenneth W. Kizer, MD, MPH Alaska State Hospital and Nursing Home Association Fairbanks,

Medicare, Medicaid, and Health Care Reform Todd Gilmer, PhD Professor of Health Policy and Economics Department of Family and Preventive Medicine 1.

FY 2005 Indigent Care Trust Fund Disproportionate Share Hospital Program Presented to House Appropriations Health Subcommittee June 23, 2005.

1 MEDICARE ADVANTAGE PLANS: MEDICARE COSTS IN 2007 Brian Biles, MD, MPH Department of Health Policy George Washington University June 3, 2007.

Healthcare Architecture: Information Sharing and Interoperability Perspectives from CMS CTO Henry Chao March 18, 2008.

Average operating margin of Alabama’s hospitals is 2.38 percent Average operating margin for rural hospitals is 1.1 percent Almost half of all rural hospitals.

Arizona Health Care Cost Containment System DRG-Based Inpatient Hospital Payment System Project Overview June 14, 2012.

National Rural Health Resource Center Keeping Rural Health Afloat in a Sea of Change 600 East Superior Street, Suite 404 I Duluth, MN I Ph

Percent of total Medicare population: NOTE: ADL is activity of daily living. SOURCES: Income and savings data from Urban Institute/Kaiser Family Foundation.

1 Medicaid Advisory Group Meeting October 20, 2010 Department of Health Services Division of Health Care Access and Accountability 1.

Return to Tutorials Tricia Neuman, Sc.D. Director, Medicare Policy Project Vice President, Kaiser Family Foundation For KaiserEDU June 2009 Medicare 101:

The Rural Policy Landscape August 22, 2006 Alan Morgan Chief Executive Officer.

“Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment.

Improving the Environment for Competition: More Efficient Purchasing in Traditional Medicare William Scanlon HealthPolicy R&D National Academy of Social.

Overview of Hospice Payment Reform For VNAA Roundtable Robert J. Simione Managing Principal Simione Healthcare Consultants HOSPICE.

From Provider to Consumer Long-term Care and the Golden Years.

Kansas Hospital Association Legislative Update August 7, 2007.

Medicare Delivery Reform Mark E. Miller, Ph.D. Executive Director October 21, 2008.

Leila Samy, MPH Rural Health IT Coordinator Office of the National Coordinator for Health IT Hometown Health: Health IT and HIPAA Workshop September 26,

Trends across institutional settings in cost and service intensity for Medicare SNF care 1997 – 2003 Kathleen Dalton, PhD, RTI International Co-authors.

OIG WORKPLAN Hospitals and Hospice Acute-Care Inpatient Transfers to Inpatient Hospice Care We will determine the extent to which acute care hospitals.

HRSA Frontier Community Health Integration Project (FCHIP) Technical Assistance, Tracking and Analysis Program Guidance Overview Sarah Bryce July.

The Future of Medicare Advantage The Heritage Foundation September 10, 2008 James C. Capretta Fellow, Ethics and Public Policy Center

Changes for the Upcoming Federal Fiscal Year 2014 Developed by: Annie Lee Sallee HTH Revenue Cycle Education Specialist

Rural Health Care Past, Present and Future  The Hospital Survey and Construction Act (aka Hill-Burton Act)  Designed to provide federal grants.

Improving Patient-Centered Care in Maryland—Hospital Global Budgets

A Performance Monitoring Resource for Critical Access Hospitals, States, and Communities CAH Financial Indicators Report for Our Hospital CAH Financial.

Appendices. Appendix 1: Supplementary Data Tables Trends in the Overall Health Care Market.

FY 2005 Indigent Care Trust Fund Disproportionate Share Hospital Program Presented to Board of Community Health January 13, 2005.

Medicare Update May Agenda Medicare Access & CHIP Reauthorization Act of 2015 AHA Letter of February 13, 2015 to CMS MedPAC Report-Hospital short.

Medicare Part A and B:Basic Guide

Central Valley Care Transitions Collaborative

HomeTown Medicare Call 5/11/2016 Kerry Dunning, MHA, MSH, CPAR, RAC-CT Chief Senior Services Officer Presented By:

K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 0 Medicaid’s Origin Enacted in 1965 as companion legislation to Medicare (Title XIX)

Today’s Webinar: Meaningful Use Implications for Small Community and Critical Access Hospitals Audio Access Code: champions.

Kansas Hospital Association Legislative Issues August 23, 2006.

Session Overview - Introduction - Significance of Post‐Acute Care - Impacts of Post‐Acute Care Performance - Mandatory Elements of Reform - Understanding.

Supplementary Data Tables, Trends in Hospital Financing

Issues and Challenges Facing Medicare

Exhibit 1 Medicare Advantage Plan Payment Rates and Plan Bids Relative to Traditional Medicare, 2009 and 2017 Percent Note: Medicare Advantage plan bids,

Medicare and Hospitals

System Improvement Provisions of the Affordable Care Act

CAHMPAS Financial Indicators for Our Hospital

Presentation transcript:

MedPAC’s rural Medicare payment recommendations and studies Jeffrey Stensland August 28, 2007 Opinions expressed today are my own and do not necessarily reflect the views of MedPAC or any of its commissioners

2 17 national experts Nominated by Comptroller General for 3- year terms; can be renominated Make recommendations to the Congress and the Secretary of HHS Vote on recommendations in public Two standing reports to Congress; also various mandated reports Medicare Payment Advisory Commission

3 Promoting efficiency Section 1805 of the Social Security Act requires MedPAC to: -Make recommendations to Congress concerning Medicare payment policies -Review factors affecting expenditures for the efficient provider of services

4 Promoting equity The Commission has tended to recommend paying providers in the same market the same payment rates. - Ensure ASCs rates do not exceed hospital outpatient department rates (March 2004) - Do not pay Medicare Advantage plans more than the cost of FFS care (June 2005) - Give hospitals in the same town the same wage index (March 2007)

5 MedPAC rural recommendations to Congress that have been enacted “The Congress should raise the cap on the disproportionate share add-on a rural hospital can receive from 5.25 percent to 10 percent.” (cap raised in 2003) “The Congress should enact a low-volume adjustment to the rates used in the inpatient PPS.” (enacted in 2003) “The Congress should raise the inpatient base rate for hospitals in rural and other urban areas to the level of the rate for those in large urban areas, phased in over two years.” (enacted in 2003)

6 Recent MedPAC recommendations to CMS with rural implications “The Secretary should require the peer review organizations to include rural populations and providers when carrying out their quality improvement activities.” Recommendations for the Relative Value Scale Update Committee (RUC)

7 Mandated studies Critical Access Hospitals Rural provisions of the MMA

8 Findings from the CAH study CAHs inpatient, outpatient, and post-acute Medicare revenue rose by roughly $1,075,000 per CAH from 1998 to This is about $750,000 more than if the hospitals’ revenue had risen at the rate of the comparison group.

9 Future CAH research directions Old research -Lump all CAHs into one group -Focus on benefits to the hospital Potential new directions -Differentiate between types of CAHs -Focus on how CAHs affect patients

10 The type of value provided to patients differs among CAHs Isolated CAH (over 35 miles to the next facility) Small-town CAH (10-20 miles from next facility) Low-tech alternative to nearby high-tech hospital Nursing home CAH (limited capabilities)

11 Implications of the MMA MMA provisions increased rural hospital Medicare payments by $377 million per year (2.3% increase in PPS hospital payments) Rural Medicare margins (-3.0%) exceeded urban (-3.3%) for the first time in 2005.