Jim Pittman’s Post

This article from FierceHealthcare outlines the proposed 2.6% increase in Medicare payments for inpatient services in fiscal year 2025 by the Centers for Medicare & Medicaid Services (CMS). It discusses the potential impact of this increase on hospitals, including an estimated $2.9 billion rise in payments compared to fiscal 2024. The article also mentions other proposed changes, such as updates to quality measures and penalties for low-performing hospitals, while highlighting the ongoing importance of federal reimbursement policies for healthcare providers. https://lnkd.in/e82ZmCcV #healthcare #cms #inpatient #payments

Disproportionate Share Hospital (DSH) is a significant Medicaid program that provides approximately $20 billion annually to hospitals through a well-established federal-state partnership. While federal regulations govern the allocation of these funds to eligible hospitals, there is limited information available regarding how states distribute payments beyond these criteria. In Pennsylvania, numerous hospitals, particularly those located in underserved regions, are facing challenges due to low reimbursement rates from both government and private payers. This financial strain compels hospitals to reduce costs, which can adversely affect patient care and the range of services offered. Safety-net hospitals in low-income communities are especially vulnerable to these challenges, potentially leading to closures and diminished access to healthcare services for their communities. This situation places additional pressure on neighboring healthcare systems to absorb the increased demand for care. Furthermore, lower reimbursements hinder the recruitment and retention of healthcare professionals, exacerbating the existing staffing shortages. This creates a self-perpetuating economic cycle that hospitals find difficult to break free from. Indeed, Pennsylvania's Medicaid reimbursement rates are notably low compared to the national average, placing a significant burden on hospitals within the state. This low reimbursement environment poses challenges for hospitals in Pennsylvania, as they strive to maintain financial stability while delivering high-quality patient care. Addressing this issue is crucial to ensuring the long-term viability and sustainability of the healthcare system in the state. https://lnkd.in/e7MH4gGX

well worth the read if you are in managed healthcare.

🚨 New Centers for Medicare & Medicaid Services final ruling came out Friday in the setting of narrower operations margins across our medical centers and a need to support upstream factors affecting health and healthcare. CMS will: 💠 Increase operating payment rates for certain acute care hospitals (ACH) in FY 2025, projected to be 2.9%. ACHs that 1) receive CMS payments under the IPPS, 2) successfully participate in the Hospital Inpatient Quality Reporting program, and 3) are “meaningful” users of electronic health records. 💠 Provide higher payments when a patient is experiencing housing insecurity. 💠 Promote access to treatments that could help support rural and underserved communities. 💠 Fund additional GME positions that help support the workforce with many serving underserved communities. 💠 Enhance safety and emergency preparedness. 🚨 CMS also is finalizing a 5-year mandatory CMS Innovation Center model, Transforming Episode Accountability Model (TEAM), beginning 2026, to test whether episode-based payments for five common, costly procedures performed at participating acute care hospitals would reduce Medicare expenditures while preserving or enhancing the quality of care. 💠 Includes: lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedure. 💠 Incentivizes improved coordination between health care providers during surgery, plus services provided during the 30 days that follow. 💠 CMS will provide participants with a target price that will represent most Medicare spending during an episode of care, which will include the surgery (including the hospital inpatient stay or outpatient procedure) and items and services following hospital discharge (e.g. SNF stays or provider follow-up visits). 💠 To increase equity, CMS will allow safety net hospitals to participate in a track with lower levels of risk and reward and a pricing methodology that includes adjustments to account for underserved individuals 💠 Includes a voluntary Decarbonization and Resilience Initiative, promoting sharing decarbonization outcomes and address threats to patient health presented by climate change. 💠 Meant for acute care hospitals paid under the Inpatient Prospective Payment System (IPPS) and among qualifying CBSAs. CBSAs include counties with at least one core urban area of at least 10,000 people, as well as adjacent counties with a high level of social and economic integration. CMS plans to select about 25% of eligible CBSAs. Hospitals may also voluntarily opt in to participate. #Episodesofcare #CMS #Upstream #Safetynet #Decarbonization #GME #healthpolicy #Healthcareonlinkedin

America's primary care shortage necessitates innovation in care delivery. A bill from Rep. Dan Crenshaw (R-TX) and Rep. Kim Schrier, MD (D-WA) will enable states to contract with direct primary care clinics to offer Medicaid patients reliable, lower-cost primary care. Primary care use is on the decline and Medicaid patients in particular struggle through long wait times and difficulty accessing care. Medicaid patients are often forced to choose between urgent care or expensive hospital ER visits to deal with routine and chronic conditions. The Direct Primary Care model gives patients virtually unlimited access to a primary care doctor for a monthly cost of $45-85/month. If state Medicaid programs contract with DPC clinics, patients would receive unlimited care for a flat rate, including walk-in appointments. Not only would H.3836 allow states to improve access to preventive care, it would also incentivize care in lower-cost and relationship-based settings. Research shows that use of DPC clinics reduces costs associated with expensive hospital ER visits and outpatient procedures. https://lnkd.in/gZFDVuy2

As the Centers for Medicare & Medicaid Services is empowering Accountable Care Organizations (ACO) with insights on how episodic “shadow bundles” impact their bottom line, ATI has the data, post-acute care, and operational expertise to help ACOs take the next step in implementation by managing their specialty care.  Brian Fuller recently spoke with Diane Eastabrook at Modern Healthcare about this.    Reach out to our #ValueBased Care expert Brian Fuller (bfuller@atiadvisory.com) to begin the conversation.   #PostAcuteCare #Healthcare #HealthcarePolicy

The Medicare Payment Advisory Commission's (MedPAC) scrutiny of the Acute Hospital Care at Home (AHCAH) waiver raises important concerns about the program's long-term viability and cost-effectiveness. While MedPAC's call for more data to determine if AHCAH can deliver better outcomes and reduce costs is valid, it's equally important to consider the broader context of healthcare delivery and patient preferences. The AHCAH model emerged during the COVID-19 pandemic and has seen strong patient support and improved clinical outcomes, reflecting a significant shift toward more flexible, patient-driven healthcare solutions. MedPAC's concerns about potential inefficiencies and higher per-unit costs should not be ignored, but focusing solely on these aspects may overlook AHCAH's potential for innovation. As technology and home healthcare infrastructure improve, the program will become more efficient and cost-effective, emphasizing refining the model rather than just comparing it to traditional inpatient care. Policymakers should extend the waiver to allow further study and refinement, ensuring decisions are based on comprehensive evidence and that the program can realize its full potential in a modern, patient-centered healthcare system.

**CMS Finalizes Medicare Payment Updates for FY 2025** The Centers for Medicare & Medicaid Services (CMS) has announced a final rule that will increase Medicare inpatient prospective payment system (IPPS) rates by a net 2.9% for fiscal year 2025. This adjustment aims to support hospitals that actively use electronic health records and submit quality measure data. The update reflects a 3.4% hospital market basket increase, offset by a 0.5% productivity cut, resulting in an overall payment increase of $2.9 billion. Key Points: - The payment update includes a $200 million decrease in disproportionate share hospital payments and a $300 million increase in new medical technology payments. - The American Hospital Association (AHA) has expressed concerns that these updates may worsen the financial challenges faced by hospitals, particularly in rural and underserved communities. - CMS finalized the Transforming Episode Accountability Model (TEAM), which mandates participation from inpatient PPS hospitals in specific areas starting January 1, 2026, covering five surgical episode categories. - Additional provisions include the adoption of new statistical areas for wage index determination, a separate payment for small independent hospitals, and the distribution of new graduate medical education slots. CMS has also implemented changes in quality reporting, including adding new patient safety measures and requiring hospitals to report data on acute respiratory illnesses weekly. These provisions will generally take effect on October 1, 2024. #Medicare #HealthcarePolicy #CMS #HospitalPayments #HealthTech #RuralHealth #PatientCare #QualityReporting #HealthcareInnovation

The Illinois Department of Healthcare and Family Services (HFS) proposed changes to the methodology used to calculate the rates for reimbursing providers through the Illinois Medicaid Practitioner Fee Schedule. The changes included $97.7M in rate increases and adjusting rates from generally reimbursing at 60% of Medicare to 72% of Medicare for most services. In response, EDPMA gathered leaders from the Illinois College of Emergency Physicians and American College of Emergency Physicians. Together, we submitted comments to HFS requesting that EPs be included in the rate adjustment, which would also include the $5M bonus, as emergency departments are the safety net for areas in the state with high concentrations of Medicaid eligible residents. See our comment letter: https://lnkd.in/g8HfvkjM See the HFS proposed changes: https://lnkd.in/gbGYjj5H

Earlier this month, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2025 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) final rule. With this modification, the Global Malnutrition Composite Score (GMCS) will add patients ages 18 to 64 to the current cohort of patients 65 years or older. Click the link to learn more about the final rule. https://lnkd.in/gVP3fc5S