News

Exactly how ready is the Centers for Medicare and Medicaid Services (CMS) to begin processing International Classification of Diseases, 10th Revision, (ICD-10) coded claims now, and how much more does it need to do before October 1, 2015, the mandatory implementation deadline? Six of Congress’ most powerful legislators are demanding to know.

The Centers for Medicare & Medicaid Services (CMS) used the proposed 2015 Medicare Physician Fee Schedule (MPFS) to create some carrots and sticks to encourage moving the care of more patients, particularly the growing percentage of beneficiaries with multiple chronic illnesses, into the lower-cost outpatient primary care setting.

As more conditions are cared for in the community setting rather than in hospitals, the jobs are moving along with the patients. The latest U.S. Bureau of Labor Statistics (BLS) report finds hospital hiring largely flat but physician office hiring up 4,000 jobs from the previous month and up 57,200 jobs from June of last year.

The Centers for Medicare and Medicaid Services (CMS) has proposed a 2.1 percent market basket update for services paid under the hospital Outpatient Prospective Payment System (OPPS) in 2015 and to update Ambulatory Surgery Center (ASC) payments by 1.2 percent next year.

Low-risk procedures performed in a hospital outpatient setting are reimbursed at a higher level than the same procedures performed in an ambulatory surgery center (ASC), but is there value in the higer payments for procedures done in hospital outpatient surgical departments? In proposed quality measure changes, the Centers for Medicare and Medicaid Services (CMS) aims to make it easier to compare quality between the two types of surgical settings.

Leaders from the Senate Finance Committee and House Ways and Means Committee have introduced the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), which would set quality standards and mandatory reporting deadlines for post-acute care provided by long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities and home health agencies.

The Meaningful Use attestation hardship exemption deadline passed on July 1 without any moves by the Centers for Medicare and Medicaid Services (CMS) to extend the date for when eligible providers can file for an exemption, despite the pleas of the American Medical Association (AMA) and the Medical Group Management Association (MGMA).

A Suffolk Superior Court Judge has put a three-week hold on the deal between Partners HealthCare System and the Massachusetts Attorney General’s office to allow comments from other stakeholders, including competing hospital systems and medical groups.

A definitive agreement may be signed as early as September. The potential affiliation would make Banner Health Arizona’s largest private employer with a combined 37,000 people, as well as make it the first non-profit statewide integrated care network.

The ongoing dispute between Highmark and UPMC in Pennsylvania had created considerably concern in the state over what would happen to patients with Highmark health plans who receive care from UPMC after 2015 when the contract between the two organizations ends.

On Wednesday, representatives of the Department of Health and Human Services (HHS), the Centers for Medicare and Medicaid Services (CMS) and the Government Accountability Office (GAO) were once again called upon by House republicans to explain what is being done to combat waste, fraud and abuse in Medicare. Their responses give a glimpse into the agencies current priorities, especially as they affect healthcare providers.

The goal of creating better care coordination is pushing traditional competitors into more collaborative agreements. The latest example comes from Missouri, where 5 health systems announced the formation of a new health network encompassing more than 9,300 employees and approximately 1,000 employed and affiliated physicians.