How does it do this? Through the Medicaid Drug Rebate Program. Medicaid.gov explains: The Medicaid Drug Rebate Program is a partnership between CMS, State Medicaid Agencies, and participating drug manufacturers that helps to offset the Federal and State costs of most outpatient prescription drugs dispensed to Medicaid patients. Approximately 600 drug manufacturers currently participate in [...]
Read the rest of this entry »CMS Chronic Conditions Dashboard
CMS has just released a new interactive tool that allows users to examine chronic conditions among Medicare beneficiaries. The CMS Chronic Conditions Dashboard presents statistical views of information on the prevalence, utilization and Medicare spending for Medicare beneficiaries with chronic conditions. The Dashboard displays information on a set of predefined chronic conditions available in the [...]
Read the rest of this entry »Medicare Reimbursement for Outpatient Therapy
Today I review Medicare’s approach for paying for outpatient therapy visits. The content draws largely from CMS and MedPAC sources. What is outpatient therapy Outpatient therapy includes physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services. Who can provide outpatient therapy? Institutional Facilities Hospitals Skilled nursing facilities (SNF) Comprehensive outpatient rehabilitation facilities (CORF) [...]
Read the rest of this entry »How Medicare Measures Hospital Quality
There are many ways that Medicare evaluates hospital quality. Medicare conducts patient surveys (i.e,. HCAHPS). Medicare has hospitals report a variety of process of care measures through the Inpatient Quality Report (IQR) Program. Medicare uses data that Centers for Disease Control and Prevention (CDC) collects via the National Healthcare Safety Network (NHSN) tool to measure [...]
Read the rest of this entry »Is Medicare the main driver of excessive U.S. Health Spending?
This chart has been floating around the blog-o-sphere. Is Medicare the reason that healthcare spending in the US is so much higher than other developed countries? It turns out that this chart represents only federal government spending on healthcare. Medicare is certainly one of the contributing factors for why the U.S. spends more on healthcare than [...]
Read the rest of this entry »Will Medicare Reduce Your Hospial’s Reimbursement Rates?
Do you work at New York-Presbyterian in Manhattan? Massachusetts General Hospital in Boston? Both these hospitals, with large market shares in their cities, will see their Medicare payments reduced through the Hospital Value-Based Purchasing (HVBP) program. If you work at Cleveland Clinic or Intermountain Medical Center in Utah, on the other hand, Medicare will be [...]
Read the rest of this entry »Appropriate IME and DSH payments
Although Medicare has a set rate schedule, not all hospitals receive the same payment for providing the same service. Among the number of adjustments Medicare makes to its inpatient prospective payments rates are the indirect medical education (IME) and disproportionate share hospital (DSH). The goal of IME is to compensate hospitals for patient care costs [...]
Read the rest of this entry »PQRS in 2013
Some background: Created in March 2007, the PQRI established a financial incentive for eligible healthcare professionals to participate in a voluntary quality reporting program. By reporting on a minimum of 3 measures on a specified group of patients, a physician can earn a bonus payment of 0.5% on all of their Medicare billing for 2012. [...]
Read the rest of this entry »Medicare Payments Cut for Low-Quality Hospitals
In the past, Medicare basically paid hospitals the same amount for every type of admission regardless of quality. Of course, Medicare did adjust payments to hospitals based on the their cost of labor (hospital wage index adjustment), share of low-income patients (disproportionate share hospital payment), and number of medical school residents (indirect medical education payment), [...]
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