The Senate Finance Committee convened a hearing to begin discussions on a potential overhaul of the Medicare physician payment system. The hearing highlighted concerns regarding low physician adoption rates for Medicare reimbursements related to advance care planning, administrative burdens like prior authorization, and disparities in Medicare Advantage (MA) payments compared to traditional Medicare. Committee members heard from the following witnesses… (Colocho, April 12, 2024) #Accountable Care Organizations, #Chronic Diseases, #Costs, #Demonstration Programs, #Insurance Reform, #Medicare Access and Chip Reauthorization Act of 2015 (MACRA), #Medicare Advantage, #Physicians, #Prevention, #Primary Care, #Rural Health, #Telehealth, #Transparency, #Value-Based Insurance Design

The Medicare Payment Advisory Commission (MedPAC) convened a session to discuss alternative approaches to lower payments for services provided in inpatient rehabilitation facilities (IRFs) for select conditions that are also treated in skilled nursing facilities (SNFs). This work builds upon MedPAC’s 2023 report on a unified payment system for post-acute care in which the Commission stated that policymakers may want… (Llamas, April 11, 2024) #Inpatient Rehabilitation Facilities, #Skilled Nursing Facilities

The Medicare Payment Advisory Commission (MedPAC) convened a follow-up session to examine Medicare Advantage (MA) encounter data completeness. In March, MedPAC staff compared encounter data to provider-reported data which showed that while data completeness is increasing, gaps remain (Impact Summary). In this session, MedPAC staff compared encounter data to plan-reported data, bid data and HEDIS data, which highlighted incremental improvements… (Eisen, 1/1/70) #Medicare Advantage, #Quality

Today, the Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2025 inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) proposed rule (press release, fact sheet), which applies to acute care hospital and LTCH payments beginning Oct. 1, 2025. Under the proposed rule, acute care hospitals would receive a 2.6 percent increase ($3.2 billion… (McClurg, April 10, 2024) #Demonstration Programs, #Disproportionate Share Hospitals (DSH), #Graduate Medical Education (GME), #Health Equity, #Hospitals, #Long-Term Care, #Long-Term Care Hospitals, #Quality

The Senate Finance Health Subcommittee hosted a roundtable panel discussion on opportunities to improve substance use disorder care in federal health programs. Roundtable participants shared their expertise in the treatment of substance use disorder, with particular insights on treatment for adolescents and providing care in community-based settings. The participants shared their collective frustration with barriers to prescribing methadone, prior authorization… (Marceno, April 10, 2024) #Health Equity, #Mental and Behavioral Health, #Opioids

The Health Resources & Services Administration (HRSA) released findings from the National Sample Survey of Registered Nurses (NSSRN) and hosted a roundtable with leaders from more than 25 nursing and health care organizations to discuss the future of the nursing workforce. Key findings of the NSSRN indicated increased diversity and higher educational attainment, but declining job satisfaction. The survey illuminated… (Eisen, 1/1/70) #COVID-19, #Quality, #Workforce

The Health Resources and Services Administration (HRSA) has taken steps to fortify the primary care workforce by increasing loan repayments through the National Health Service Corps (NHSC) Loan Repayment Program. HRSA has increased loan repayments by 50% for primary care providers, including M.D.s, D.O.s, OB-GYNs, pediatricians, nurse practitioners, certified nurse midwives, and physician assistants, who commit to practicing in areas… (Eisen, 1/1/70) #Graduate Medical Education (GME), #Primary Care

The House Energy and Commerce Chair Cathy McMorris Rodgers (R-WA) and Senate Committee on Commerce, Science, and Transportation Chair Maria Cantwell (D-WA) unveiled the American Privacy Rights Act (APRA), a draft federal privacy legislation aimed at establishing national data privacy rights (press release, section-by-section). This draft legislation represents a significant step towards establishing comprehensive national data privacy rights and protections for Americans. The primary… (Colocho, April 8, 2024) #Health Information Technology, #Privacy, #Public Health, #Transparency

The Center for Medicare & Medicaid Innovation (CMMI/Innovation Center) held a webinar to describe the new Accountable Care Organization (ACO) Primary Care Flex (ACO PC Flex) Model that was announced on March 19th (Impact summary). The model includes low-revenue Medicare Shared Savings Program (MSSP) ACOs and will test how prospective payments and increased funding can impact outcomes, quality, and costs while encouraging… (McClurg, April 5, 2024) #Accountable Care Organizations, #Health Equity, #Primary Care

The Centers for Medicare and Medicaid Services (CMS) released the Contract Year (CY) 2025 Policy and Technical Changes to the Medicare Advantage (MA) program and Medicare Prescription Drug Benefit Program (Part D) final rule (press release, fact sheet). What it is. The final rule includes proposals intended to enhance beneficiary protections, advance health equity, and improve access to behavioral health… (Llamas, McClurg, Slifer, Colocho, Marceno, Eisen, April 5, 2024) #Medicare Advantage