DRUG COSTS RISING:

“More pharmaceutical companies are buying drugs that they see as undervalued, then raising the prices. It is one of a number of industry tactics, along with companies regularly upping the prices of their own older medicines and launching new treatments at once unheard of sums, driving up the cost of drugs.”


(Jonathan D. Rockoff and Ed Silverman, The Wall Street Journal)

PENALTIES KICK IN:

“Nearly 40% of health-care providers treating Medicare patients will have their payments docked 1.5% this year because they didn’t submit data on patients’ health to the government...Launched in 2007, the federal quality-reporting program is one of several meant to measure and spur improvements in quality. Providers—including doctors, nurse practitioners, physical therapists and others who bill Medicare, the federal program for the elderly and disabled—initially earned bonuses for complying. The Affordable Care Act introduced penalties for not participating, starting this year.”


(Melinda Beck, The Wall Street Journal)

Quote of the Day

"Medical reviewers [working for Medicare] have the benefit of hindsight, but they must be reluctant to substitute their judgment for that of the treating practitioner."


— Donna Thiel, an attorney with King & Spalding, in a letter she wrote to the government on behalf of Florida Hospital Orlando, which has been asked to return $11.5 million in Medicare overpayments

Today's Datapoint

8,000 people (as of April 13) had taken advantage of a special enrollment period created for taxpayers who owed a penalty for not having health insurance in 2014, CMS reported on April 20.

Proposed FY 2016 Medicare Payment And Policy Changes For Inpatient Psychiatric Facilities

FACT SHEET

 

April 24, 2015

 

Contact: CMS Media Relations

(202) 690-6145 | CMS Media Inquiries

 

Proposed FY 2016 Medicare Payment And Policy Changes For Inpatient Psychiatric Facilities

OVERVIEW: On April 24, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule outlining proposed fiscal year (FY) 2016 Medicare payment policies and rates for the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS).

The proposed rule also updates the Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program, which requires participating facilities to report on quality measures or incur a reduction in their annual payment update. This proposed rule would expand the measure sets in future fiscal years and change certain data reporting requirements for these measures.

The FY 2016 proposals are summarized below. SUMMARY OF PAYMENT UPDATES AND PROPOSED CHANGES TO THE IPF PPS Federal Per Diem Base Rate Update: CMS is proposing to update the estimated payments to IPFs in FY 2016 relative to estimated payments in FY 2015 by 1.6 percent (or $80 million). This amount reflects 2.7 percent IPF-specific market basket estimate less the productivity adjustment of 0.6 percentage point and less the 0.2 percentage point reduction required by law, for a net update of 1.9 percent. Estimated payments to IPFs are reduced by 0.3 percent due to updating the outlier fixed-dollar loss threshold amount.

Stand-alone IPF Market Basket and Labor Related Share for FY 2016: CMS is proposing an IPF-specific market basket to replace the Rehabilitation, Psychiatric and Long-Term Care (RPL) market basket. The proposed IPF market basket would be based on 2012 Medicare cost report data (the RPL market basket is based on 2008 data) for both freestanding and hospital-based IPFs. The proposed FY 2016 Labor Related Share (LRS) of the IPF-specific market basket is 74.9 percent, which is an increase from the FY 2015 LRS of 69.294 percent.

Wage Index: CMS is proposing to update the Core Based Statistical Areas (CBSAs) with the Office of Management and Budget (OMB) Bulletin No. 13-01 and 2010 US Census Data. To implement this update, CMS is proposing to adopt the newest OMB delineations for the FY 2016 IPF PPS wage index using a 1-year transition with a 50/50 blended wage index for all providers. The FY 2016 wage index for each provider would consist of a blend of fifty percent of the FY 2016 wage index using the current OMB delineations and fifty percent of the FY 2016 wage index using the revised OMB delineations.

As a result of the proposed adoption of the new OMB delineations for the FY 2016 IPF PPS wage index, 37 IPF providers would have their status changed from rural to urban, and therefore would lose their 17 percent rural adjustment. CMS is proposing a gradual phase-out of their rural adjustment, so that these 37 providers would receive two-thirds of the rural adjustment in FY 2016, one-third of the rural adjustment in FY 2017, and no rural adjustment for FY 2018 and subsequent years.

QUALITY MEASURE UPDATES AND OTHER IPFQR PROGRAM CHANGES

Background on the IPFQR Program. The IPFQR Program is a pay-for-reporting program established by the Affordable Care Act (ACA) and added to the Social Security Act. IPFs are subject to a reduction of two percentage points in their annual payment update for failure to meet administrative and data reporting requirements on certain quality measures. Our current IPFQR Program measure set includes 14 measures. CMS proposes to increase the IPFQR Program measure set to 16 measures by proposing the addition of five measures and the removal of three measures. The proposed rule also proposes several policies that would lessen the burden on reporting entities.

Measures Proposed for Adoption for FY 2018 Payment Determination and Subsequent Years

• One Tobacco Treatment Measure. TOB-3 - Tobacco Use Treatment Provided or Offered at Discharge and a subset measure TOB-3a Tobacco Use Treatment at Discharge (NQF #1656) measures patients 18 and older who have used tobacco products and who were referred to counseling and received or refused a prescription for cessation medication upon discharge, and the subset measure includes only those patients who received counseling and cessation medication at discharge.

 

• One Substance Use Measure. SUB-2 - Alcohol Use Brief Intervention Provided or Offered and a subset measure SUB-2a Alcohol Use Brief Intervention (NQF #1663) measures patients 18 and older to whom a brief substance-abuse intervention was provided, or offered and refused, and the subset measure includes only those patients who received a brief intervention.

 

• Two Transition Record Measures.

 

• Transition Record with Specified Elements Received by Discharged Patients (Discharges from an Inpatient Facility to Home/Self Care or Any Other Site of Care) (NQF #0647) measures the percentage of patients discharged from an inpatient facility, or their caregivers, who received a transition record with specified elements at the time of discharge.

 

• Timely Transmission of Transition Record (Discharges from an Inpatient Facility to Home/Self Care or Any Other Site of Care) (NQF #0648) measures the percentage of patients discharged from an inpatient facility for whom a transition record was transmitted to the health care setting designated for follow-up care within 24 hours of discharge.

 

• One Screening for Metabolic Disorders Measure. Screening for Metabolic Disorders measures the percentage of discharges with an antipsychotic prescription for which a structured metabolic screening for (1) BMI; (2) blood pressure; (3) glucose or HbA1c; and (4) a lipid panel elements was completed in the past year.

 

Measures Proposed for Removal

Beginning with FY 2017 Payment Determination. HBIPS 4 (Patients Discharged on Multiple Antipsychotic Medications) is proposed for removal due to the loss of NQF endorsement, and because CMS believes that HBIPS-5 Patients Discharged on Multiple Antipsychotic Medications with Appropriate Justification sufficiently includes the data that HBIPS-4 was intended to collect.

 

Beginning with FY 2018 Payment Determination. HBIPS 6 (Post-Discharge Continuing Care Plan Created) and HBIPS 7 (Post-Discharge Continuing Care Plan Transmitted to Next Level of Care Provider Upon Discharge) because these measures would be duplicative of two measures CMS is proposing for FY 2018 and the measures proposed for removal are not as robust as the proposed new measures.

 

 

Other Changes CMS is also proposing changes to the data reporting requirements for IPFQR Program measures. Specifically, CMS is proposing to require IPFs to report measure data as a single, yearly count rather than by quarter and age because obtaining data for each quarter and by age is burdensome to providers and the resultant number of cases is often too small to allow public reporting. In addition, CMS is proposing to require IPFs to report aggregate population counts for discharges as a single, yearly count rather than by quarter. CMS is also proposing to change sampling requirements to give providers the option of obtaining one global sample for most measures, rather than having different sampling requirements for different measures. CMS believes that uniform sampling will decrease provider burden and allow streamlined procedures.

CMS will accept comments on the proposed rule until June 23, 2015. The proposed IPF PPS rule can be downloaded from the Federal Register at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-09880.pdf or www.federalregister.gov/public-inspection

It will publish at the Federal Register on May 1, 2015 will be available online at: https://federalregister.gov/a/2015-09880

Factoid

Nearly 90 percent of providers are using mobile devices for patient engagement. While respondents were most likely to engage patients with app-enabled portals (73 percent), only 36 percent indicated that use of these portals is a highly effective means of engaging patients. at top 100 hospitals. Source - HIMSS

Quote of the Day

There are "a lot of folks inside CMS who just think if you are serving a lot of vulnerable beneficiaries, low-income duals, then you just need to work harder and need no special treatment."


— John Gorman, executive chairman and founder of Gorman Health Group, LLC, told AIS's Health Plan Week for a story on CMS's final 2016 Medicare Advantage payment rates