On March 6-7, 2014, the Medicare Payment Advisory Commission (MedPAC) is meeting to discuss a number of Medicare payment and policy issues, including: site-neutral payments for select conditions treated in inpatient rehabilitation facilities and skilled nursing facilities; developing payment policies to promote the use of services based on clinical evidence; measuring quality in Medicare delivery systems; payment for primary care; aligning Medicare benchmarks across payment models; and Medicare Advantage risk adjustment.
The Food and Drug Administration (FDA) has just announced that it will hold a public hearing March 25 and 26, 2014 to obtain input on the Agency’s current process for reviewing over-the-counter (OTC) drugs. This is a significant advancement in FDA’s long-standing plan to overhaul the OTC drug system. According to the announcement, the Agency’s OTC drug review “needs a critical examination at this juncture to examine whether and how to modernize its processes and regulatory framework.”
Teeing up the importance of the public hearing, Dr. Janet Woodcock, the Director of FDA’s Center for Drug Evaluation and Research (CDER), informed the Wall Street Journal that the Agency was “looking for creative ideas about how to improve the process.”1 According to Dr. Woodcock, “The current system isn’t working well for the public or for us.” Additional details are available after the jump.Continue Reading...
CMS has announced that it is holding series of meetings in May and June to discuss pending application for the 2015 Healthcare Common Procedure Coding System (HCPCS) update. The dates are as follows:
- May 20 & 21, 2014 -- Drugs/Biologicals/Radiopharmaceuticals/Radiologic Imaging Agents
- May 28, 2014 -- Supplies and Other
- June 3, 2014 -- Durable Medical Equipment (DME) and Accessories; and Orthotics and Prosthetics (O&P).
Additional information, include preliminary coding determinations, will be posted in advance of each meeting.
The Federal Trade Commission (FTC) has scheduled a workshop on March 20-21, 2014 to examine developments in the U.S. health care industry, including those related to implementation of health care reform legislation and other trends related to cost, quality, access, and care coordination. Specifically, the workshop will address the following five topics:
- Professional Regulation of Health Care Providers -- how accreditation, credentialing, licensure, and scope of practice rules may affect competition and consumers.
- Innovations in Health Care Delivery -- including retail clinics and telemedicine that may offer significant cost savings while maintaining or improving quality of care and expanding consumer access to care.
- Advancements in Health Care Technology – implications of technology such as electronic health care records, health data exchanges, technology platforms for health care payers and providers, and certain other consumer-oriented technological advances.
- Measuring and Assessing Quality of Health Care – how developments in measuring and assessing health quality may impact competition and health care choices.
- Price Transparency of Health Care Services – how improved price transparency impacts costs to consumers and its potential to facilitate price coordination among health care providers.
On February 24, 2014, CMS is hosting a town hall meeting to discuss the future of the Physician Compare website and how to improve the information presented to consumers. For instance, CMS is seeking feedback on additional measures that might help consumers identify quality care, and measures to accurately and completely represent the various Medicare specialties. CMS is also considering including additional information such as Board Certification and other medical qualifications. Related resources are posted on the CMS website. CMS is accepting written comments on this topic until March 3, 2014.
On February 26, 2014, CMS is hosting a call to discuss the National Partnership to Improve Dementia Care in Nursing Homes, which includes as a goal reducing the use of unnecessary antipsychotic medications in nursing homes. This call will focus on the role of surveyors in the implementation of the partnership, the importance of leadership, and the correlation between proper pain assessment and antipsychotic medication use.
On February 4, 2014, CMS will host a follow-up Special Open Door Forum call on the two-midnight benchmark for inpatient hospital admissions included in the FY Medicare inpatient prospective payment system final rule. The call will provide an opportunity allow hospitals, practitioners, and other interested parties to ask questions on the physician order and physician certification, inpatient hospital admission and medical review criteria included in the new policy.
On January 9, 2014, the House Energy and Commerce Health Subcommittee is holding a hearing on “The Extenders Policies: What Are They and How Should They Continue Under a Permanent SGR (Sustainable Growth Rate) Repeal Landscape?” The so-called extenders are measures that secure the continuation of various temporary Medicare payment and policy revisions impacting hospitals, physicians, therapy providers, and certain other provider types that are routinely extended by Congress (most recently as part of the Pathway for SGR Reform Act).
On February 12, 2014, the HHS Office of Medicare Hearings and Appeals (OMHA) is hosting a forum to: provide updates to OMHA appellants on the status of OMHA operations; furnish information on OMHA initiatives designed to mitigate a growing backlog in the processing of Medicare appeals at the OMHA level of the administrative appeals process; and discuss measures that appellants can take to make the administrative appeals process work more efficiently.
A January 15, 2015 CMS call will focus on the 2016 Medicare End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP). Among other things, the call will cover the final measures, standards, scoring methodology, and payment reduction scale that are applied to the payment year 2016 program.
CMS is hosting a provider call on January 14, 2014 to discuss the Medicare inpatient hospital admission and medical review criteria (also known as the 2-Midnight Rule) included in the FY 2014 Medicare inpatient prospective payment system/long-term care hospital final rule. During the call, CMS will present case scenarios on the application of the rule to sample medical records and address frequently-asked questions received from providers.
CMS is holding a meeting on February 12, 2014 to discuss fiscal year (FY) 2015 applications for add-on payments for new medical services and technologies under the Medicare hospital inpatient prospective payment system (IPPS). CMS invites interested parties to present their comments, recommendations, and data regarding whether the FY 2015 new medical services and technologies applications meet the substantial clinical improvement criterion. The deadline for registration and submission of presenter information is January 21, 2014.
CMS has scheduled a meeting of the HOP Advisory Panel on March 10-11, 2014. Among other things, the panel will address: whether procedures within an APC group are similar both clinically and in terms of resource use; APC group weights; packaging of hospital outpatient prospective payment system services and costs; and the appropriate supervision level (general, direct, or personal) for individual hospital outpatient therapeutic services. Registration is required.
On December 17, 2013, CMS is hosting a call to provide an overview of the quality reporting provisions in the 2014 Physician Fee Schedule (PFS) final rule (which has not yet been released). The call will provide details on how an eligible professional or group practice can meet the criteria for satisfactory reporting for the 2014 Physician Quality Reporting System (PQRS) incentive and 2016 PQRS payment adjustment (including a discussion of criteria for satisfactory participation under the new qualified clinical data registry option). The call also will provide updates on the Electronic Health Record (EHR) Incentive Program and Physician Compare.
On December 3, 2013, CMS will host a National Provider Call to provide an overview of the value-based payment modifier (VM) under the final 2014 Medicare Physician Fee Schedule final rule (which has not yet been released). CMS will also describe how the VM is aligned with the reporting requirements under the Physician Quality Reporting System (PQRS).
On November 14, 2013, CMS is hosting a call on ACA quality reporting program requirements for inpatient rehabilitation facilities. According to the CMS announcement, the call will address issues and concerns IRF providers experienced during the first reporting period and how they can be avoided, along with resouces available to IRFs to assist with reporting.
A November 12, 2013 CMS call will focus on the physician order, physician certification, inpatient hospital admission, and medical review criteria that were adopted in the final FY 2014 Inpatient Prospective Payment System/Long-Term Care Hospital final rule. In short, under this new policy, if the ordering practitioner expects a beneficiary’s surgical procedure, diagnostic test or other treatment to require a stay in the hospital lasting at least two midnights, and admits the beneficiary as an inpatient based on that expectation, it is generally appropriate that the hospital receive Medicare Part A payment. The order must also be documented in the medical record in accordance with the regulations, and a physician must certify the medical necessity of hospital inpatient services. CMS recently posted updated subregulatory instructions related to review guidelines and other implementation issues.
A November 21, 2013 CMS call will provide an update on data collection and reporting requirements, time frames, and submission deadlines under the Medicare Long-Term Care Hospital (LTCH) Quality Reporting Program.
On November 22, 2013, CMS is hosting a Special Open Door Forum to discuss the design and implementation of the Medicare Intravenous Immune Globulin (IVIG) Demonstration. The purpose of the demonstration is to evaluate the impact of providing payment for items and services needed for the in-home administration of IVIG for the treatment of primary immune deficiency disease.
CMS is hosting a call on November 25, 2013 to discuss progress to date in implementing the National Partnership to Improve Dementia Care in Nursing Homes. The partnership is focused on delivering person-centered, comprehensive, and interdisciplinary care and reducing the use of unnecessary antipsychotic medications in nursing homes. The target audience for the call is consumer and advocacy groups, nursing home providers, surveyor community, prescribers, professional associations, and other interested stakeholders.