Today’s Hot Topics in Medicare News

Horsford, Hardy Divided on Health Care, ‘Medicare-For-All’

BY ASSOCIATED PRESS: Two former Nevada congressmen squaring off for the U.S. House seat they each once held are divided on how to address health care.

Democrat Steven Horsford and Republican Cresent Hardy spoke about health care and other issues Wednesday at an event hosted by the Hispanics in Politics organization.

Horsford held Nevada’s 4th District seat for one term until losing to Hardy in 2014. Hardy lost two years later to Democrat Ruben Kihuen. (read more)

Representatives Respond to Medicare Reimbursement Proposal Concerns

BY JENNIFER MORALES: As thousands of physicians, including those providing infectious diseases and HIV care, cited damaging impacts of a Centers for Medicare & Medicaid Services proposal to slash reimbursements for evaluation and management of complex cases, lawmakers are signing onto a letter asking the agency to delay action on the move. The letter, launched by Representatives Earl Blumenauer (D-OR), Brad Wenstrup (R-OH), Marsha Blackburn (R-TN) and Doris Matsui (D-CA) asks the Centers to allow time for medical groups and others affected by the proposal to develop an improved alternative to the proposed rule change.

The current proposal, released in July, would collapse the number of levels determining reimbursement for physicians’ evaluation and management of patients through face-to-face encounters from the current 10 levels (five levels for new patients, and five for established patients) to just two levels for each of the two categories of patients. Proposed with the stated intention of reducing administrative paperwork, the new structure would differentiate only between the most routine and easily managed cases, and complex cases that can include patients with multiple infections, conditions that compromise immunity, antibiotic resistance, post-transplant care, and psychosocial issues as well as other conditions that may challenge access to care and the success of treatments. The resulting reimbursements would be slightly higher for the first, simpler level, but lead to a nearly 40 percent reduction in reimbursement to physicians providing the most complex care through face to face evaluation and management. Evaluation and management, or E/M, accounts for more than 90 percent of care provided by infectious diseases and HIV physicians. (read more)

Physician-led ACOs saw savings in Medicare program

BY HEALTHCARE DIVE: The large savings for physician-led ACOs is a departure from a 2017 evaluation of the MSSP program. That report showed just one-third of ACOs in the program achieved savings, though they outperformed their FFS counterparts on most quality measures.

The new study also comes after CMS released new data that found the MSSP saved Medicare $314 million after bonuses paid to ACOs in 2017. Also, the Patient-Centered Primary Care Collaborative’s 2018 Evidence Report in August found that Medicare ACOs with primary care physicians who have patient-centered medical home experience are more likely to save money and show higher quality scores. All of these studies are a win for physician-led practices. (read more)

Hospital resources strained as Medicare reimbursement for MRI-compatible cardiac devices lags

BY JEFF LAGASSE: MRI-compatible cardiac rhythm management devices, such as pacemakers and implantable cardioverter defibrillators, have gained significant market share in recent months — and that’s placing a growing strain on hospital resources.

A new report from Vizient finds that Medicare continues to reimburse at the rate established for standard device implants, despite their higher cost. The result is an increase in total spend for CRM devices of 8 percent based on current adoption rates, which translates to a greater than $400 million estimated cost increase for hospitals. (read more)

Donald Trump wrongly says Social Security and Medicare are stronger

BY JON GREENBERG: President Donald Trump is rejecting the image of policy chaos and bitter staff infighting captured in the latest book by Washington Post editor Bob Woodward.

At a meeting with Kuwait’s leader Sheikh Al-Sabah, Trump called the book “fiction” and said in contrast to what it describes, no administration has gotten more done on tax cuts, deregulation and the courts than his. And the accomplishments don’t end there. (read more)

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