Doctors, Hospitals Bemoan Inadequate 2025 Medicare Payment Rates

Healthcare Dive: Physicians, Hospitals Decry 2025 Medicare Payment Rates
Despite their payments rising, hospitals decried the update as inadequate. Powerful lobby the American Hospital Association argued the rates will make it harder for hospitals to invest in patient care, cybersecurity and their workforce. “Medicare’s sustained and substantial underpayment of hospitals has stretched for almost two decades, and today’s final outpatient rule only worsens this chronic problem,” Ashley Thompson, the AHA’s senior vice president of public policy analysis and development, said in a statement. (Pifer, 11/4)

Stat: Medicare To Pay For Mental Health Apps Under New Rule
Medicare regulators on Friday finalized rules to pay for some mental health apps, a breakthrough for digital therapeutics companies that have struggled for a foothold in the health care system. The new rule creates codes that allow clinicians to bill Medicare for providing the apps and related services to their patients. Beginning January 1, 2025, the codes will enable payment for mental health apps authorized by the Food and Drug Administration under a specific regulation that includes just a handful of treatments for conditions like depression and substance use disorder. (Aguilar, 11/4)

Axios: What Hospitals Stand To Lose As Supreme Court Tackles Medicare Payments
About $1.5 billion in annual Medicare payments to hospitals will be on the line Tuesday when the Supreme Court hears arguments in a case over whether the federal government shortchanges facilities that care for low-income seniors. Why it matters: It's the latest legal skirmish over so-called disproportionate share payments that have steadily declined in recent years but are a lifeline for hospitals that treat a substantial number of poor patients, who typically are sicker and have more complex needs. (Goldman, 11/5)

Also —

The Washington Post: Medicare Advantage Insurers Fear Losing Millions Over A Few Bad Phone Calls
As the biggest Medicare Advantage insurers see it, something as minor as a dropped phone call can now cost them hundreds of millions of dollars.Around the time Medicare open enrollment started last month, the insurance giants Humana, Centene and subsidiaries of UnitedHealthcare filed lawsuits alleging they stand to lose substantial revenue because a tiny number of unsuccessful customer service phone calls hurt their 2025 Medicare Advantage scores — costing them customers or multimillion-dollar bonuses they otherwise stood to get from the federal government. (Najmabadi, 11/4)

Newsweek: Americans Willing To Pay More For Medicare To Expand Access
Amajority of Americans would support paying higher premiums for Medicare if necessary to cover Alzheimer's treatments, according to a new survey commissioned by the Alliance for Aging Research. The poll, which was conducted by Lake Research Partners and Public Opinion Strategies, discovered 82 percent of Americans support requiring Medicare and insurance companies to cover the Alzheimer's treatments. That includes 65 percent who favored that policy even if it increased health insurance premiums. (Blake, 11/4)

Stat: Private Medicare Plans Get Billions For Veterans Who Get VA Care
Under names like “Patriot Plan,” “Courage MA,” and “Honor” plan, all of the major private Medicare insurers are courting veterans directly, selling plans that their ads say complement their Veterans Affairs coverage with benefits like dental and vision. These Medicare Advantage plans are quite popular — almost 42% of all Medicare-eligible veterans had one in 2022. (Bannow, 11/4)

AdvaMed: AdvaMed Calls On Medicare To Cover Supplemental Imaging As Part Of Breast Cancer Screening 
AdvaMed, the Medtech Association, called on Medicare in a letter sent Friday to cover supplemental imaging for women with heterogeneously and extremely dense breast tissue, noting the life-saving value of the additional screening and the pressing health equity needs Medicare coverage of these critical services would address. “While supplemental imaging increases the effectiveness of detecting breast cancer in women with dense breast tissue, cost, availability, and insurance coverage limit its use,” Scott Whitaker, AdvaMed President and CEO, wrote to leaders at the Centers for Medicare & Medicaid Services. (11/4)

Hospice News: Longer Hospice Stays Among Dementia Patients Save Medicare Dollars
Hospice utilization has tripled among patients diagnosed with Alzheimer’s disease and related dementias (ADRD) during the past two decades. The trend has ignited concerns about these patients’ lengths of stay, as well as praise for hospices’ cost-savings potential. Massachusetts Institute of Technology (MIT) researchers analyzed Medicare fee-for-service claims spanning between 1999 and 2019, including data on hospice billing, patient enrollment, hospitalizations, health costs and chronic condition indicators. Roughly 14.7% of ADRD patients utilized hospices services in 2019, nearly triple the 4.4% of patients who received this care in 1999, according to the research, which was published in the National Bureau of Economic Research. (11/4)

In Medicaid updates —

Roll Call: Biden Wants Medicaid Doctors To Talk To Parents About Firearms
The Biden administration wants more health care providers to talk to parents about keeping their kids safe around firearms, as data shows kids are increasingly dying by suicide, accidents and homicides involving guns. The Centers for Medicare and Medicaid Services has given states the green light to allow Medicaid providers to counsel parents and caregivers of children about firearm safety and injury prevention. (Hellmann, 11/4)