Morning Briefing
Summaries of health policy coverage from major news organizations
Hospitals Increasingly Embrace Medicare Bundled Payments
Forbes: Medicare Bundle Payment Gains Momentum With Hospitals, Nursing Homes
Even when medical care providers aren’t forced to accept bundled payments from Medicare that could cost them money if the care isn’t better and costs aren’t in check, they are willing to embrace such new reimbursement. New data from research firm Avalere Health indicates about 9 percent of U.S. acute care hospitals and 7 percent of skilled nursing facilities are voluntarily assuming financial risk by participating in the latest phase of the Centers for Medicare & Medicaid Services’ Bundled Payments for Care Improvement Initiative. (Japsen, 8/20)
Modern Healthcare: Hospitals Remain Stressed, But Don't Blame The ACA
Healthcare providers have gotten some balance sheet relief thanks to a greater number of paying patients over the past couple of years. But bankruptcy filings suggest the industry has recovered more slowly than the improving economy would suggest. It's not the Affordable Care Act by itself that's pushing healthcare providers into bankruptcy, but a combination of forces including litigation, payment delays and even bad merger agreements. (Kutscher, 8/20)
CQ Healthbeat: CMS Gets Backing For Alternative Payment Tests
Congress' top advisers on Medicare gave their backing this week to plans to force hospitals and home health agencies to participate in pilot payment programs that carry financial risk, a move that could help shield the big government health program from provider backlash. The Medicare Payment Advisory Commission said it supports a proposed program that would test bundled payments on hospitals that perform hip and knee replacements in 75 selected regions of the country. MedPAC also offered largely positive views for a plan to force home health agencies in nine states to participate in a test where reimbursements might be raised or cut based on performance. The observations were made in separate comments submitted to the Centers for Medicare and Medicaid Services about two proposed rules. (Young, 8/20)
Bloomberg: Medicare Fraud Is Committed Well Beyond U.S. Borders
On the streets of Managua, the shuttle bus wrapped in a giant ad for free health care stood out. “Medicare for people living abroad,” it proclaimed above the image of a cheerful older woman playing golf. But Medicare, the American public health insurance program for the elderly and disabled, isn’t available in Nicaragua or anywhere outside the U.S., except in emergency circumstances. The clinic advertised, Nostrum Medical Center, had a way around that: Patients were required to provide a U.S. address, so their visits could be billed to American taxpayers. Before the Nicaraguan scheme and a related one in the Dominican Republic were shut down last fall, the U.S. government paid out $25 million from 2011 to 2014 for medical care received by more than 1,000 foreign residents who signed up using post office boxes, mail-forwarding services, or the addresses of friends or relatives in Florida to conceal that they lived overseas. “We were a little bit astonished by the brazenness of the conspirators in this case, particularly with their widespread and open marketing,” says Shimon Richmond, the special agent in charge of the Miami regional office of the inspector general of the U.S. Department of Health and Human Services (HHS), which oversaw the investigation. (Armstrong, 8/20)
