Value Based Purchasing and Health Care Reform

CMS Releases Proposed Changes to Hospital and Physician Payment Systems for 2012

For additional information, see the following:

CMS PROPOSES POLICY AND PAYMENT CHANGES FOR OUTPATIENT CARE IN HOSPITALS AND AMBULATORY SURGICAL CENTERS (Centers for Medicare & Medicaid Services Press Release 7/1/2011)

Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2012 (Proposed Rule 7/1/2011).  Scheduled to be published in Federal Register on July 19, 2011.

CMS PROPOSES POLICY, PAYMENT RATE CHANGES FOR THE PHYSICIAN FEE SCHEDULE IN 2012 (Centers for Medicare & Medicaid Services Press Release 7/1/2011) 

Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical Center Payment; Hospital Value-Based Purchasing Program; Physician Self-Referral; and Provider Agreement Regulations on Patient (Proposed Rule 7/1/2011).  Scheduled to be published in Federal Register on July 18, 2011. 

CBO Releases SGR Alternatives Analysis

As stated in the document linked below, "[t]he Congressional Budget Office (CBO) projects that, under current law, payment rates for physician services will be reduced by 29.4 percent in 2012. That large reduction called for under current law follows several years of legislative action to either maintain or increase physician payment rates under the Medicare program when those rates were otherwise scheduled to decrease under the provisions of law known as Medicare’s Sustainable Growth Rate (SGR) mechanism. Such legislative actions have overridden the SGR."

For additional information, see the following link:

Medicare's Payment to Physicians: The Budgetary Impact of Alternative Policies (Congressional Budget Office - June 2011)

 

CMS Announces Pioneer ACO Model Request for Applications

"The Pioneer ACO Model is a [Center for Medicare and Medicaid Innovation] initiative targeted at organizations that can demonstrate the improvements in financial and clinical performance with respect to the care of Medicare beneficiaries that are possible in a mature ACO."

For additional information, see the following links:

See the CMS Announcement: Medicare Program; Pioneer Accountable Care Organization Model: Request for Applications (Federal Register) (5/20/2011)

Learn more about the Pioneer ACO Model on the Center for Medicare and Medicaid Innovation website.

ONCHIT Announces "Meaningful Use" Conference Call - May 19, 2011

Today, the Office of the National Coordinator for Health Information Technology announced that CMS will hold a national provider education call to provide an opportunity for eligible hospitals, CAHs and eligible professionals to learn about the meaningful use requirements of the Medicare and Medicaid EHR Incentive Programs.  The call is scheduled for Thursday, May 19 at 2:30 p.m. EDT. 

Registration will close at 2:30 p.m. EDT on May 18, 2011, or when available space has been filled.

For more information or to register for the call, click here.

 

FTC Announces Public Workshop on Antitrust and ACOs - May 9th

On Monday, May 9, 2011, the Federal Trade Commission (FTC) will host a workshop to seek input on the Proposed Statement of Antitrust Enforcement Policy, which discusses how the federal antitrust agencies will enforce U.S. antitrust laws when competing health care providers create new Accountable Care Organizations (ACOs) under the Affordable Care Act of 2010. The Act encourages physicians, hospitals, and other health care providers to integrate their health care delivery systems in order to improve the quality and reduce the costs of health care services for U.S. patients.

The workshop will be held from 10:00 a.m. - 1:00 p.m. at the FTC Conference Center in Washington, D.C.

For more information, see the FTC Antitrust and Accountable Care Organizations Workshop Announcement (5/2/2011)

HHS Announces Partnership for Patients

For additional information, see the following links:

Partnership for Patients (Healthcare.gov)

Partnership for Patients Announcement by Secretary Sebelius (4/12/2011)

ACO Proposed Rule Released; Federal Agencies Request Comments

HHS News Release (3/31/2011): "The U.S. Department of Health and Human Services (HHS) today released proposed new rules to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs).  ACOs create incentives for health care providers to work together to treat an individual patient across care settings – including doctor’s offices, hospitals, and long-term care facilities. The Medicare Shared Savings Program will reward ACOs that lower health care costs while meeting performance standards on quality of care and putting patients first.  Patient and provider participation in an ACO is purely voluntary."

HHS News Release: Affordable Care Act to improve quality of care for people with Medicare (3/31/2011)

Read the ACO Proposed Rule (published in Federal Register on April 7, 2011): Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations (Comments due by June 6, 2011)

Read the Federal Trade Commission/Department of Justice Proposed Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program (3/31/2011) (Comments due by May 31, 2011)

Read the IRS Guidance and Solicitation of Comments (Notice 2011-20) (Comments due by May 31, 2011)

HHS Releases Fraud & Abuse Report; Medicare, Medicaid & CHIP Final Rule



For additional information, see the following:

HHS Press Release: Health Care Fraud Prevention and Enforcement Efforts Recover Record $4 Billion; New Affordable Care Act Tools Will Help Fight Fraud (1/24/2011)

The Department of Health and Human Services and Department of Justice Health Care Fraud and Abuse Control Program Annual Report For Fiscal Year 2010 (January 2011)

Medicare, Medicaid, and Children's Health Insurance Programs; Additional Screening Requirements, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions and Compliance Plans for Providers and Suppliers (Final Rule) (1/24/2011)

MedPAC to Recommend Pay Increase for Hospitals and Physicians

For additional information, see the articles below:

"The Medicare Payment Advisory Commission (MedPAC) voted to recommend to Congress that inpatient and outpatient Medicare hospital payments rise by 1 percent in fiscal 2012....  The commission also decided to recommend that payment rates under the physician fee schedule should grow by one percent, and those for ambulatory surgery centers should increase by .5 percent. MedPAC will issue the recommendations to Congress in March."

MedPAC's Take: Hospitals, Doctors Should Get a 1 Percent Bump in Payment Rates (Commonwealth Fund/CQ Health Beat) (1/18/2011)

"The Medicare Payment Advisory Commission voted last week to recommend to Congress a 1 percent increase in Medicare hospital inpatient and hospital outpatient prospective payment system rates for 2012, in addition to a 1 percent pay rate increase for physicians."

MedPAC recommends 1 percent pay increase for doctors, hospitals (Healthcare Finance News) (1/18/2011)

CMS to hold PQRS Town Hall Meeting February 9th

On December 15^th, the Centers for Medicare and Medicaid Services (CMS) announced a Town Hall Meeting, scheduled from 10 a.m. until 4 p.m. (EST) on February 9, 2011, to discuss the Physician Quality Reporting System (previously known as the Physician Quality Reporting Initiative (PQRI)). According to the Notice published in the Federal Register (75 FR 78247), the purpose of the Town Hall Meeting is to “solicit input from participating stakeholders on the individual quality measures and measures groups being considered for possible inclusion in the proposed set of quality measures for use in the 2012 Physician Quality Reporting System and key components of the design of the Physician Quality Reporting System."  Measure developers, eligible professionals, professionals associations, such as medical specialty societies, and other interested stakeholders are invited to participate, in person or by teleconference.

The Town Hall Meeting will be held at the Central Building of CMS in Baltimore, Maryland.  Written comments for discussion at the Town Hall Meeting must be received by 5 p.m. (EST) on January 21, 2011.