Bipartisan Senate Team Wants To Move On Site Neutral Payments
Sens. Bill Cassidy, R-LA, and Maggie Hassan, D-NH, unveiled their support for a bill that would begin paying hospital outpatient facilities lower Medicare reimbursements much more consistent with what other places of service receive for the same services – known as “site-neutral” payments. The bill would equalize payments for common outpatient services at hospital-owned offsite locations, ambulatory surgery centers, and other clinics.
Check out my blog on site neutral payments here: https://www.healthcarelabyrinth.com/it-is-time-for-site-neutral-payments-in-our-healthcare-system/ . We know that the lack of site neutral payments cost us huge sums and we need to reform this in Medicare. Commercial payments would then be transitioned as many commercial plans base rates on Medicare. The hospital lobby’s ridiculous arguments may finally be giving way to common sense. Kudos to Cassidy and Hassan. We need full site neutral payments as quickly as possible.
There is the possibility of inclusion in a lame deck session bill. Wisely, their bill would use some savings to support rural and other critical hospitals.
(Article may require a subscription.)
#siteneutral #hospitals #medicare
https://www.modernhealthcare.com/politics-policy/senators-look-expand-site-neutral-payment-policy
Elevance Health Also Suing CMS For 2025 Star Ratings
So now we have United, Humana, Centene, and Elevance Health all filing lawsuits on Star Year 2025 calculations against the Centers for Medicare and Medicaid Services (CMS).
I will read the whole complaint this weekend, but the Elevance suit seems more along the lines of Humana’s hard-hitting filing, which also has raised structural and procedural issues with Star ratings in addition to challenging certain 2025 Star measure calculations. Elevance’s suit says plans deserve to see all the data necessary to calculate Star measures.
As hard as it is to sue the person that pays so much to you, Humana and Elevance are not wrong on this.
(Article may require a subscription.)
#cms #stars #medicareadvantage #elevancehealth #unitedhealthcare #centene #humana
https://www.modernhealthcare.com/legal/elevance-health-medicare-advantage-star-ratings-lawsuit-cms
Wakely Surveys States On Medicaid Rate Setting
There is a huge divide between states’ and Medicaid managed care plans’ views on the adequacy of Medicaid rates. Plans say that rates have not kept up with rising adversity in the rolls due to Medicaid enrollment losses tied to the return of redeterminations. States maintain they are following their rules and increasing rates.
Wakely’s survey found the following on the rate-setting approaches states are taking (and the bullets are pulled directly from Wakely’s findings to ensure accuracy):
- 24 of 27 states segmented the population in the base and rating period into stayers/ leavers/ joiners or similar groupings, estimated cost relativities and applied adjustments between base and rating periods for expected changes due to changing mix, with the other three taking three completely different approaches.
- 20 of the states are using a claims-based cost or utilization relativity comparison. Four states use both claims and risk scores. Three states use only risk scores.
- Ten states have incorporated moderate to significant methodology changes as new information has emerged over the course of the unwinding, including changes to the basis of comparison, addition or change of cohorts to the cohort segmentation model, and use of changing lists of expected and actual member disenrollments.
- At least seven of the surveyed states explicitly adjusted costs for this phenomenon (churn) because it wasn’t implicitly reflected in their cohort segmentation. This is particularly likely to be necessary for models based on risk score comparison, since members experiencing churn may have higher costs in the period immediately after re-enrolling that may not be reflected within their risk scores.
The survey seems to indicate states are seeking to incorporate ways to ascertain changing adversity. Whether the rates are truly adequate is another question.
#medicaid #managedcare #rates #healthplans
https://www.wakely.com/blog/medicaid-unwinding-wakely-rate-adjustments/
Hospital Margins Improve
Hospital operating margins went up for a second consecutive month, according to Strata. The median year-to-date operating margin for hospitals nationwide rose to 5.1% in September, up from 4.9% in August and 4.8% in July. Health systems had poorer results.
#hospitals #margins
https://www.healthcarefinancenews.com/news/hospital-margins-climb-51-september
Medicare FFS Provider Rates Finalized
The Centers for Medicare and Medicaid Services (CMS) finalized many rate hikes for 2025 today. Medicare home health payments will see increases of 0.5% next year. Dialysis providers will see increases of 2.7% next year. Outpatient hospital facilities and ambulatory surgical centers will get a 2.9% hike next year. And as expected, CMS also finalized a major physician rate cut. Physicians will see a 2.9% cut in the 2025 rate.
See my recent blog on the need for a permanent and fair fix to Medicare physician rates. Doctors note this is the fifth year in a row that Congress will have to intervene to stop the cut and potentially provide some increase. One proposal being circulated would reverse the cut and award a temporary 1.8% increase.
Recent doc fix blog: https://www.healthcarelabyrinth.com/docs-need-rate-relief-in-medicare-program/ .
Additional article: https://www.modernhealthcare.com/policy/medicare-home-health-end-stage-renal-disease-payments-cms-2025 and https://www.fiercehealthcare.com/providers/cms-finalizes-29-pay-increase-outpatient-facilities-ascs-new-maternal-health-mandates and https://www.modernhealthcare.com/policy/medicare-physician-payment-cut-2025-final-rule-cms and https://www.modernhealthcare.com/policy/outpatient-hospitals-medicare-pay-2025-cms-final-rule
(Some articles may require a subscription.)
#medicare #providers #rates
— Marc S. Ryan
