Today’s Hot Topics in Medicare News

drug prices

AHA defends ideas to cut backlog of Medicare appeals

BY KELLY GOOCH: The American Hospital Association is standing by its recommendations on reducing a backlog of Medicare appeals and suggests that critics of the recommendations may benefit from the backlog.

The recommendations, which address  a backlog at the administrative law judge level, are part of a brief filed by the AHA June 22 in its case against HHS.

But the Council for Medicare Integrity has come out against the recommendations, saying they are “unconscionable” given  integrity program reforms. (read more)

Transitional care management services reduce mortality, Medicare costs

BY ALAINA TEDESCO: Significant reductions in mortality and Medicare costs occurred in the month after transitional care management services were provided, according to research published in JAMA Internal Medicine.

“Medicare adopted transitional care management (TCM) payment codes in 2013 to encourage clinicians to furnish TCM services after beneficiaries were discharged to the community from medical facilities,” Andrew B. Bindman, MD, from the Agency for Healthcare Research and Quality at HHS, and Donald F. Cox, PhD, retired from the Office of the Assistant Secretary for Planning and Evaluation at HHS, wrote. (read more)

Medicare Part D premiums down, CMS says, as administration aims to curtail swelling drug costs

BY MARTY STEMPNIAK: Premiums for nursing home residents’ prescription drug plans have dipped for the second year in a row, in what the administration hopes is a sign that efforts to curb prescription costs might be taking hold.

The Centers for Medicare & Medicaid Services announced Tuesday that it’s projecting the average basic premium for Medicare Part D drug plans in 2019 at about $32.50. That’s a 3.2% dip from the $33.59 spent by seniors the previous year. (read more)

CMS Moves Medicare Payments for Skilled Nursing Facilities to Value

BY JACQUELINE LAPOINTE: CMS recently finalized a rule that will shift the Medicare payment system for skilled nursing facilities (SNF) away from fee-for-service and toward value starting in 2019.

The federal agency will make the move by implementing the Patient-Driven Payment Model on Oct. 1, 2019.

The Patient-Driven Payment Model is a case-mix reimbursement model that will pay skilled nursing facilities for a patient’s needs, rather than the volume of service he receives. The model will use ICD-10 diagnosis codes, patient characteristics, and other clinically relevant factors to classify patients. (read more)

EDITORIAL: The desperate pitch of ‘Medicare-for-all’

BY THE GAZETTE EDITORIAL BOARD: Democrats need an economic message for November’s election, in an environment of wage growth, record-high employment, soaring home ownership, and other improving economic factors.

That is why we hear so much about “Medicare-for-all.” Notable among these politicians are Vermont Sen. Bernie Sanders, a likely 2020 presidential candidate, and U.S. Rep. Jared Polis — Colorado’s Democratic nominee for governor.

The Medicare promise probably sounds good to a lot of people who want swift resolution to the health care crisis. It lacks the negative stigma of “socialized medicine,” or its euphemized siblings “single payer” and “universal health care.” (read more)


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