On July 14, 2014, the Centers for Medicare & Medicaid Services (CMS) published its proposed rule to update the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC) Payment System rates and policies for calendar year (CY) 2015. The following are highlights of this major rulemaking:Continue Reading CMS Issues Proposed CY 2015 Medicare OPPS/ASC Rule
Quality Reporting
CMS Proposes ESRD PPS Update for CY 2015
By Debra A. McCurdy on
On July 11, 2014, CMS published a proposed rule to update the Medicare end-stage renal disease (ESRD) PPS for CY 2015, which CMS anticipates would increase total payments to all ESRD facilities by 0.3% compared to CY 2014. While CMS projects that the ESRD market basket update, as adjusted for MFP, would have been…
CMS Proposes 0.3% Cut in Medicare Home Health PPS Rates for CY 2015
By Debra A. McCurdy on
Today CMS released its proposed rule to update Medicare home health prospective payment system (HH PPS) rates for CY 2015. CMS estimates that the rule would reduce Medicare payments to home health agencies by approximately $58 million (-0.3%) in 2015 compared to 2014 levels. Specifically, while CMS anticipates a 2.2% home health payment update percentage…
CMS Plans Series of Calls this Month on Medicare Dialysis Quality Programs
By Debra A. McCurdy on
On July 10, 2014, CMS is hosting a national provider call to discuss the new Five Star Rating system that will be added to Dialysis Facility Compare (DFC) in October 2014. Among other things, the call will address the methodology used to calculate the ratings and how to access and preview the ratings. In addition,…
CMS Plans Medicare Quality “Star” Ratings for Hospitals, Dialysis Facilities, Home Health
By Debra A. McCurdy on
On June 18, 2014, CMS announced in a blog posting that it is planning to add a “Five Star” quality rating system to the Hospital Compare, Dialysis Facility Compare, and Home Health Compare websites on Medicare.gov. The agency will start making the new quality ratings available later this year and into early 2015. CMS…
CMS Finalizes ACA Exchange, Insurance Market Standards for 2015 and Beyond
By Debra A. McCurdy on
On May 27, 2014, CMS published a final rule updating ACA Affordable Insurance Exchange and insurance market standards beginning in 2015. Among other things, the rule addresses standards related to: standardized consumer notices regarding insurance product discontinuation and renewal; Qualified Health Plan (QHP) quality data reporting to support quality ratings for plans on the…
CMS Proposes FY 2015 Update to Inpatient Psychiatric Facility PPS
By Debra A. McCurdy on
On May 6, 2014, CMS published a proposed rule that would update prospective payment rates for Medicare inpatient hospital services provided by inpatient psychiatric facilities (IPFs) for FY 2015. Under the proposed rule, the federal per diem base rate would be increased by 2.0%, reflecting a market basket increase of 2.7%, offset by a…
CMS Proposes FY 2015 Update to Medicare IRF PPS
By Debra A. McCurdy on
On May 7, 2014, CMS published its proposed rule to update Medicare payment policies under the inpatient rehabilitation facility (IRF) PPS for FY 2015. Under the proposed rule, rates would be updated by a 2.1% increase factor, which reflects a 2.7% market basket update, reduced by a -0.4% MFP adjustment and a -0.2 percentage…
CMS Releases Proposed Medicare Inpatient PPS/LTCH Update for FY 2015
By Debra A. McCurdy on
Late on April 30, 2014, CMS released the advance text of its proposed rule to update the Medicare acute hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system (PPS) for fiscal year (FY) 2015.
With regard to IPPS hospitals, the rule would provide for a 1.3% operating payment rate update…
CMS Posts First Medicare Inpatient Psychiatric Facility Quality Data
By Debra A. McCurdy on
On April 17, 2014, CMS announced that it making inpatient psychiatric facility quality data available as part of the Hospital Compare website. Specifically, CMS is now posting data for the period of October 1, 2012 through March 31, 2013 regarding the following measures: Hours of Physical Restraint Use; Hours of Seclusion Use; Post-Discharge Continuing Care…
GAO Offers Recommendations for Improvements to CMS Physician Feedback Efforts
By Debra A. McCurdy on
A recent GAO report looked at how private health care entities provide performance data to physicians, and how such practices could be used to improve CMS efforts to provide feedback to providers. The GAO determined that the nine health insurers and statewide collaboratives it reviewed typically employ multiple benchmarks (e.g., peer group averages or past…
CMS Issues Call for PQRS Quality Measures
By Debra A. McCurdy on
On May 1, 2014, CMS will begin accepting recommendations for potential Physician Quality Reporting System (PQRS) quality measures for 2016 and future rulemaking years. Quality measure proposals also will be considered for use in other physician quality programs, including the Value Based Modifier, Physician Compare, and the Medicare Shared Savings Program.
CMS Announces System to Collect Hospice Care Data Beginning July 1, 2014
By Debra A. McCurdy on
On April 8, 2014, CMS published a notice announcing that it is establishing a new “system of records” to collect data to support the Hospice Quality Reporting Program. The new “Hospice Item Set” (HIS) is a standardized mechanism for abstracting data from a patient’s medical record to confirm that the appropriate assessments were made and…
FTC Workshop on Health Care Competition (March 20-21)
By Debra A. McCurdy on
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
…
CMS to Host “Physician Compare Town Hall Meeting” (Feb. 24)
By Debra A. McCurdy on
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…
CMS Call: ESRD Quality Incentive Program Payments (Jan. 15)
By Debra A. McCurdy on
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.
Medicare Home Health PPS Rates Cut 1.05% Under Final 2014 Rule
By Debra A. McCurdy on
Under the final Medicare home health PPS (HH PPS) rule released on November 22, 2013, payments in 2014 will be cut by 1.05% (about $200 million) compared to 2013 levels (and compared to a -1.5% cut forecast in the proposed rule). This reduction reflects a 2.3% home health payment update, which is more than offset…
CMS Call on IRF Quality Reporting Requirements (Nov. 14)
By Debra A. McCurdy on
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 resources available to IRFs to assist with
CMS Special Open Door Forum on LTCH Quality Reporting (Nov. 21)
By Debra A. McCurdy on
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.
CMS Call on 2015 Value-Based Payment Modifier (Sept. 24)
By Debra A. McCurdy on
On September 24, 2013, CMS will host a call for providers on “Program Year 2012 Quality and Resource Use Report – Mapping a Route to Success for the 2015 Value-Based Payment Modifier.” The call will focus on the 2012 Quality Resource Use Reports (QRURs), which illustrate how a group would be impacted by the final…