Michael Blumental’s Post

Here is the Medicare Fact Sheet on the 2025 OPPS proposed rule! https://lnkd.in/g3DnRDXQ

An whole smorgasbord of chronic #physician beefs exposed at a Senate hearing yesterday: declining #Medicare unit pricing, #PrimaryCare vs specialist payment (there’s that annoying budget neutrality thing), the cloister of the #AMA RUC dividing up the federal physician payment pie, administrative complexity in #quality measurement & reporting, the predictable prior authorization whining, the absence of a business case for coordination of care for the chronically ill in our fragmented fee-for-service third-party-payor “system”. But don’t expect any major reforms any time soon. It’s an election year & it’s taken 15 years for the dust to settle on #ObamaCare. Meanwhile, expect all the major #healthcare players will continue to snipe at one another each while driving to consume a larger portion of the US economy.

🔍 Exploring Site-Neutral Payments in Medicare 🔍 Medicare spending is on the rise, leading to a growing interest in site-neutral payments. Our latest brief, co-authored by Christopher Whaley, Dakota Rome Paul, MPH, and myself, dives into: 📜 The history of site-neutral payment discussions 📊 Evidence on site-of-care payment differentials 💡 Challenges and concerns from stakeholders 💰 Fiscal implications of implementing site-neutral payments 🔧 Potential policy options to address these payment disparities CAHPR at Brown University School of Public Health is working to fill the gaps in the literature by studying site-of-care payment differentials. We hope our researcher can provide guidance to policymakers on how to advance and improve policy options for site neutrality, including recommendations on how to reduce the potential impact on rural service lines.

The Inflation Reduction Act is having a strong impact on Medicare AEP 2025. I had initially thought that the CMS rule 2025 would be the primary source of angst, but it seems the landscape is shifting. 📉💊 #Medicare #Healthcare #InflationReductionAct #CMSRule2025

Since October 1, 2019, for Medicare A recipients, the Resource Utilization Groups (RUGS) IV is out and the Patient Driven Payment Model (PDPM) is in. The first two years of the transition were complicated by COVID and the PHE. But since May 2023 when the PHE ended, things have been getting back to normal. It is important to remember that although the reimbursement model has changed, the regulations outlined in the Centers for Medicare &… Read more at https://lnkd.in/evh_Wry2

Since October 1, 2019, for Medicare A recipients, the Resource Utilization Groups (RUGS) IV is out and the Patient Driven Payment Model (PDPM) is in. The first two years of the transition were complicated by COVID and the PHE. But since May 2023 when the PHE ended, things have been getting back to normal. It is important to remember that although the reimbursement model has changed, the regulations outlined in the Centers for Medicare &… Read more at https://lnkd.in/evh_Wry2

Today, CMS released the Announcement of Calendar Year (CY) 2025 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (the Rate Announcement). CMS’s goals for MA and Part D mirror their vision for the agency’s programs as a whole: to advance health equity; drive comprehensive, person-centered care; and promote affordability and the sustainability of the Medicare program. In the CY 2025 MA and Part D Advance Notice, CMS proposed updates to payment factors for CY 2025 and received a wide variety of comments. Under this CY 2025 Rate Announcement, payments from the government to MA plans are expected to increase on average by 3.70 percent, or over $16 billion, from 2024 to 2025. The federal government is projected to pay between $500 and $600 billion in Medicare Advantage payments to private health plans in 2025. This fact sheet discusses the provisions of the Rate Announcement, which can be viewed by goiong to: https://lnkd.in/gkartBtW and selecting “2025 Announcement.” This fact sheet discusses the provisions of the Rate Announcement, which can be viewed by going to: https://lnkd.in/gkartBtW and selecting “2025 Announcement.” MA payments from the government to MA plans are expected to increase by 3.70 percent on average from 2024 to 2025. This is an increase of over $16 billion in 2025 compared to 2024 in expected MA payments.  This increase represents the average expected payment update across plans, and thus, there will be variation among plans in terms of their plan-specific payment impacts, including plans that would see a larger or smaller impact year over year. For MA-PD plans and standalone PDPs, the Part D risk adjustment model finalized in the Rate Announcement is calibrated on 2021 diagnoses to predict 2022 expenditures.  Happy reading.

In their new Forefront article, David Meyers, Andrew Ryan, Jared Perkins, and Erin Fuse Brown from Brown University School of Public Health and Georgia State University discuss how gradual changes to risk adjustment are a step in the right direction, but there are other ways to get differential coding under control that CMS is not considering implementing. "Bottom line: There are no drastic changes proposed for the MA program in this year’s Advance Notice. This was widely anticipated, as the Biden administration may have wanted to avoid the appearance of Medicare cuts in an election year. Nonetheless, the Advance Notice includes some important provisions—while leaving out other potential reforms—that could have a lasting impact on MA. Here, we provide a high-level explanation of what CMS has proposed while highlighting potential modifications before the final rule is released." Read the full article here: https://bit.ly/48X4kqd

Rather than pushing policies that could disrupt Medicare Part D, we should focus on common-sense reforms that enhance the program. https://lnkd.in/eWpjPCaD I like common sense reforms. I'll start 1. eliminate deductibles for doctors services by changing to a copay per visit of $10. rezult increased access to primary care without large economic barriers. 3. a single fee schedule for outpatient services for physician and allied health providers. equal pay for equal work. result increase number of independent providers with lower costs. end subsidy of employed physicians.

Great to see this investment in Primary Care. In two years, the Labor government has increased Medicare rebates by twice as much as the former Liberal government did in its nine-year stint, through its $940 million in additional Medicare funding delivered last year and $900 million delivered this week, according to the Department of Health and Aged Care. The latest data published by the DoHAC showed 915,000 estimated additional free visits in May and an overall bulk-billing rate of 79% nationally. This marks a modest increase of 3.4 percentage points since the induction of the triple bulk-billing incentives. The biggest increases were seen in regional and rural areas, with an estimated 900,000 additional visits since the incentives, according to the government. While the RACGP championed the increases, GPs remained concerned that the low-ball MBS indexation of 3.5%, which took effect yesterday, would undercut any increase.