medicare reimbursement

Federal bill would link Medicare hospital pay to quality

Anne Zieger — Wed, 26 Nov 2008 03:18:40 -0500

Now here's a bill that would scare me a bit if I were a hospital administrator--even if it was inevitable (and it is) that such a measure would be written. Sens. Max Baucus (D-MT) and Chuck Grassley (R-IA) have drafted legislation that would link Medicare reimbursement for inpatient hospital care to the quality of that care rather than the number of services provided.

Yes, this is the way things have been going for some time, between the drive to bundle care--as Geisinger has done with some procedures--and quality incentives, but this definitely takes things a step further in the direction of so-called "value-based purchasing." (Value-based purchasing: now there's a concept that's a million times easier to talk about than to actually realize.)

The bill would kick off the new policy in fiscal 2012 and be phased in over four years through FY 2016. Medicare reimbursement levels would be based on quality standards from a list of measures from several groups, including the National Quality Forum.

To learn more about this bill:
- read this Kaiser Daily Health Policy Report article

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Updates on regulatory risks

Anne Zieger — Thu, 19 Jun 2008 10:23:28 -0400

Because everyone uses healthcare, regulators take a shot at the system from time to time to prove that they're paying attention. Still, things are particularly intense this year, with tax issues and financing questions looming larger than they have before. With tax exemptions for non-profit hospitals under scrutiny, the use of tax-exempt bonds being examined, endowment use being questioned, and the ongoing carnival of changes that is Medicare reimbursement, you'll see a fair amount of discussion at the show around agency rule-making.

Among hospital types, expect to see some furrowed brows over the impending Form 990, Schedule H, in which not-for-profit hospitals will report on their charitable activities to the IRS. Given that some Congressional hospital critics, like Sen. Chuck Grassley (R-IA), have questioned whether some hospitals deserve not-for-profit status at all, filling out the Schedule H will be a high-stakes exercise. (As we've mentioned elsewhere, the June 25th educational session on how to cope with the new Form 990 is likely to be a standing-room-only affair.) Of course, the trade show exhibit floor will feature quality time with consultants like Grant Thornton, who are offering to help with the problem, too.

While you're at the show you may also wish to check out the buzz on what's happening in patient collections in your colleagues' home states--as it seems that state legislatures are pretty interested in how hospitals deal with uninsured and self-pay patients. In Illinois , for example, the legislature is considering a bill that would set limits on what hospitals would be allowed to charge and collect from some uninsured patients. And the Minnesota legislature recently passed a bill (later vetoed by the governor) that would have banned providers from collecting, using or sharing medical debt information to qualify patients prior to providing elective services. It seems likely that other states are going to get involved in these issues in coming months, too.

OH hospital seeks Medicare exemption for cancer care

Wed, 11 Jun 2008 06:59:54 -0400

For years, officials at University Hospitals Case Medical Center have worked to get an exemption from DRG limits on Medicare reimbursements that would funnel $3 to $5 million into its coffers to aid in delivering cancer care. This cash inflow could go a long way into boosting the organization into the top ranks of cancer care in the U.S. However, UH Case is now facing a fight over their requested Medicare exemption spurred by The Cleveland Clinic, which is not eligible for the exemption UH Case wants. Cleveland Clinic has begun lobbying Congressional reps to see that UH Case doesn't get what it's after.

Since 1983, only 11 cancer hospitals have gotten this exemption, which can only be awarded if Congress enacts specific legislation. Until recently, UH Case's odds for getting such a Congressional favor looked good. Now, with Cleveland Clinic lobbying against the change, it's hard to tell what UH Case's odds are.

To learn more about the dispute:
- read this article from The Cleveland Plain Dealer

Providers make rapid progress on using NPI in claims

Wed, 04 Jun 2008 06:59:58 -0400

When CMS kicked off the National Provider Identifier program a couple of weeks ago, a significant minority of Medicare and Medicaid claims were being rejected--with as many as one-quarter of claims filed bouncing, according to one vendor. Just a week later, however, CMS has reported that providers' filings had gotten much better, fast. According to the agency, most intermediaries were reporting that over 90 percent of claims were NPI-compliant, with some reporting 100 percent compliance. The problems that remained largely involved providers using legacy numbers for their secondary provider identifier field, which should also include the provider's NPI, CMS noted.

To learn more about CMS's report:
- read this HFMA News item

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Case study: ND system must cut $15M in costs

Wed, 14 May 2008 06:59:54 -0400

It's a sign of the times. Struggling with the boogeymen faced by most of its peers, including inadequate reimbursement and rising uncompensated care levels, Fargo, N.D.-based MeritCare Health System is cutting a substantial $15 to $30 million from its budget. It's not that the system is in trouble--it had excess income of about $19.5 million last year, and admissions were up as well--but clearly, execs aren't happy with the trends they see.

The not-for-profit system, which had approximately $800 million in annual net revenue, performed $24 million of health service last year for which it no longer expects to be paid, and also delivered about $2.5 million in charity care. Also, execs are worried about Medicare reimbursement, which is set about 80 percent of the national average.

To address these issues, MeritCare may leave about 300 positions vacant as employees leave, consolidate some of the system's 18 clinics and delay clinic renovations, said Bruce Pitts, the system's executive vice president for clinical services. But the system won't postpone salary raises, as that could hurt retention, Pitts said.

To learn more about MeritCare's plans:
- read this ModernHealthcare article (reg. req.)
- read MeritCare's annual report (.pdf)

Medicare hospital payments may climb $4 billion

Wed, 16 Apr 2008 06:59:58 -0400

Under the terms of a new proposed rule, Medicare reimbursement for inpatient hospitals may go up by almost $4 billion. The new rule would apply to patients who are discharged from hospitals during fiscal 2009, which begins on Oct. 1, 2008. However, the increase doesn't come without its own pricetag. Not only is the agency planning to expand the list of "never events" for which it won't compensate hospitals, it's also adding 43 new quality measures for which hospitals will have to report data if they want the full annual payment update.

To learn more about the rule:
- read this HFMA News brief

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