Congress returned on Monday with just a few weeks until they adjourn to campaign. The Senate is set to adjourn by September 23 while the House could be in session for as little as 2 weeks. Here’s a look at what happened while Congress was in recess.
Payment reforms rewarding value
CMS offers settlement over patient status denials
CMS has offered an “administrative agreement” to hospitals granting partial payment for denied claims prior to October 2013. This is an effort to resolve a growing backlog of pending RAC and other appeals.
One Pioneer drops out and new design elements TBD
Sharp Healthcare announced that it’s exiting the ACO Pioneer program. While CMS hasn’t made any official announcements, it appears that the participant list has shrunk from 32 to 22 over the course of the last 2 years. The issues Sharp and other departed Pioneers have raised are in line with those that Premier brought to the Innovation Center’s attention back in March. Premier submitted comments calling for greater upside incentives, and changes to the benchmarking and risk adjustment.
State and Federal budget pressures
Healthcare costs projected to increase
CMS’s actuary released a report projecting that, although healthcare growth held steady at a low of 3.6 percent last year, it’s expected to increase to 5.6% in 2014. Responding to the actuary analysis in a Health Affairs article, a Harvard economist and former vice chair of MedPAC concludes that, absent a tax raise, physician payments or program benefit cuts would be necessary to keep Medicare going. The increased costs of pharmaceuticals (particularly specialty drugs) will continue to be a major challenge for the healthcare system.
Health information technology empowered
Meaningful help
The final Meaningful Use rule was released detailing the new timeline for EHR Meaningful Use Stages 2 and 3. In the rule CMS delays Stage 2 for another year to 2016 and Stage 3 to 2017. Beginning in October of this year (FY15) hospitals will be penalized for failure to comply.
ICD-10 testing, testing
CMS is conducting 3 testing periods for ICD-10, which all facilities and providers are required to implement by October 1, 2015. CMS said the testing weeks are designed to “instill confidence in the provider community that CMS and the Medicare Administrative Contractors are ready and prepared for the ICD-10 implementation.” Becoming ICD-10 compliant is completely dependent on supporting documentation entered into the medical record by your patient care providers and their support teams.
Growing exchanges and narrow networks
Winners and losers of finalized CMS automatic re-enrollment policy
CMS finalized a HealthCare.gov policy that will automatically re-enroll individuals into their current plan with the same subsidies if they don’t choose a new plan by December 15 (open enrollment begins on November 15). The policy will benefit insurers and hospitals by maintaining insurer population stability, reduce administrative costs and decrease the potential for uncompensated care.
Coverage expansion
Post-election re-evaluation on Medicaid expansion
There will be a re-evaluation of Medicaid expansion after the election in states that have opposed expansion. These states will likely consider different expansion approaches, more like what has been done in Arkansas, Pennsylvania, Indiana and Michigan.
Report shows hospital benefits of Medicaid expansion
The PwC Health Research Institute released a report demonstrating Medicaid expansion’s positive impact on hospitals. Some health systems have seen uncompensated care decrease by almost 50 percent.
What's next?
- MedPAC holds its first meeting of its 2014-15 cycle on Thursday and Friday.
- On September 12, the House is likely to clear a “clean” continuing resolution, which may be the only piece of legislation that will pass before the election on November 4.
This post appeared first at Action for Better Healthcare.