Obama Administration’s Revamp Of Two-Midnight Rule Receives Mixed Feedback From Health Industry
In other developments from the Centers for Medicare and Medicaid Services, a pilot program will test value-based insurance under Medicare Advantage while the Chicago Tribune reports on the impact of the agency’s obscure “hold-harmless rule” on Medicare beneficiaries’ Social Security checks.
Modern Healthcare: Retooled Two-Midnight Rule Gets Mixed Reviews
Providers and policy experts are split on the Obama administration’s proposal to salvage the controversial two-midnight rule with a series of modifications intended to mollify its many critics. In a proposed payment rule posted in July, the CMS said it plans to allow physicians to exercise judgment to admit patients for short hospital stays on a case-by-case basis. The CMS also said it would remove oversight of those decisions from its administrative contractors and instead ask quality improvement organizations to enforce the policy. Recovery audit contractors, meanwhile, would be directed to focus only on hospitals with unusually high rates of denied claims. (Dickson, 9/1)
Modern Healthcare: Medicare Advantage Plans To Test Value-Based Insurance Design
The CMS Innovation Center unveiled a new demonstration program Tuesday that will allow Medicare Advantage insurers to encourage the use of clinically valuable services by lowering out-of-pocket costs for enrollees. The demo is part of the Affordable Care Act’s push to lower healthcare costs and improve clinical quality in the Medicare program. Policy experts also believe value-based insurance design may resolve some of the problems associated with high-deductible health plans, which are becoming more prevalent among employers and in the individual insurance market. (Herman, 9/1)
Tribune Content Agency: Obscure Rule May Hike Medicare Premiums For Some
Approximately 25 percent of Medicare enrollees are facing a considerable hike in their Part B premiums in 2016. The other 75 percent are protected by something called the “hold-harmless rule.” Most Medicare recipients have their Part B premiums automatically deducted from their monthly Social Security benefit. Medicare premiums have historically grown at a rate that outpaces the cost of living adjustments (COLAs) added to their Social Security payment. This creates a potential situation in which retirees could see their benefit checks decrease from one year to the next. To prevent this bite being taken, the hold-harmless rule was put in place. (Raphaelson, 9/1)
Also, a new study offers insight on how Medicare beneficiaries pick a hospital –
Modern Healthcare: Patients Much More Likely To Choose Hospital That Employs Their Doctor
When patients have to go to the hospital, they’re likely to choose a facility where their doctor is employed, a new study suggests. The study surveyed Medicare patients who are treated by hospital-employed doctors. Hospital ownership of doctors’ medical groups “dramatically increases” the probability that those patients will go to the hospitals that employ their doctors, report Stanford University’s Lawrence Baker, Daniel Kessler and Kate Bundorf in a working paper for the National Bureau of Economic Research, a not-for-profit research organization. (Evans, 9/1)
Meanwhile, Medicare claims cost Kmart –
Reuters: KMART Pays $1.4M Over Allegations It Illegally Lured Medicare Beneficiaries
KMart, a U.S. discount department chain owned by Sears Holdings Corp, has paid $1.4 million to resolve allegations it violated the False Claims Act, the U.S. Justice Department said on Tuesday. The company illegally used drug manufacturer coupons and gasoline discounts to convince beneficiaries of the Medicare healthcare insurance program for the elderly to fill their prescriptions at its pharmacies, according to the Justice Department. (Lambert, 9/1)
This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.