Judge Sides With Hospitals Over Medicare Payments For Clinic Visits
U.S. District Judge Rosemary Collyer said in her ruling that the Trump administration overstepped its authority when issuing its so-called site-neutral pay policy. The decision is a big win for hospitals, who in their original complaint led by the American Hospital Association projected cuts of about $380 million this year and $760 million in 2020. In other CMS news: skilled-nursing facilities and bundled radiation therapy payments.
Judge Tosses CMS' Site-Neutral Pay Policy
A federal judge on Tuesday overturned the CMS rule that cut Medicare payments for some hospital clinic visits, siding with hospitals who sued to prevent the changes. U.S. District Judge Rosemary Collyer in Washington ruled that the Trump administration had exceeded its authority when it expanded the so-called site-neutral pay policy to evaluation and management services at off-campus hospital clinics. The goal was for Medicare to pay the same rate to hospitals as to independent physicians. (Luthi, 9/17)
CMS Overhauls SNF Payment Model
Skilled-nursing providers continue to gear up for a reimbursement overhaul next month, a transition they hope will reward outcome-based care but could also hurt therapy-oriented facilities. The CMS is scrapping the fourth iteration of what’s called the resource-utilization group framework, which primarily bases pay on the volume of therapy services. In its place will be the Patient Driven Payment Model based on acuity and other data-driven characteristics akin to bundled payments. (Kacik, 9/14)
Medicare's Bundled Radiation Therapy Payments Could Impact Quality
Oncology providers have come out against a proposed rule to bundle Medicare payments for radiation therapy, claiming it will put them at excessive financial risk and stifle innovation. Freestanding radiation therapy centers, physician group practices and hospital outpatient departments that provide radiotherapy services for 17 types of cancer in specific parts of the country would be required to accept bundled payments under the proposed rule. The fees would cover some services like CT scans, dose planning and treatment aids over the first 90 days, but it wouldn't pay for the total cost of care provided to Medicare beneficiaries. (Brady, 9/17)