6 Ways Hospitals Can Survive the Onslaught of Medicare Cuts
- Provide an assessment of the current financial condition of the hospital.
- Explain the impending increased financial pressures and their likely impact on the organization.
- Solicit the support and assistance of the clinical leadership team.
Full Answer
Did hospitals lose money treating Medicare patients in 2016?
About three-fourths of short-term acute-care hospitals lost money treating Medicare patients in 2016, according to the Medicare Payment Advisory Commission (MedPAC), an independent agency established to advise the U.S. Congress on issues affecting the Medicare program.
What are the Medicare pay cuts?
Medicare Pay Cuts highlights cuts in payment rates for the year, how to avoid penalties, the AMA's fight against the Independent Payment Advisory Board provision, and the latest on other issues and laws.
Is there an easy fix for Medicare cuts?
This is unconscionable, and it's worse because there's an easy fix. Congress can direct the CMS to suspend these cuts by waiving the requirement that changes to Medicare must be budget-neutral. That would allow CMS a one-time reprieve from balancing its budget, and it would give the medical profession an opportunity to recover and rebuild.
Will Medicare be cut during a recession?
The fact that Medicare is the largest single federal domestic program means that further cuts in Medicare payment are a virtual certainty when, not if, the federal budget deficit is driven higher by recessions.
This is the year to reform Medicare pay, boost telehealth
The AMA scored some wins for doctors in 2021, but big challenges lie ahead this year. Learn about efforts to fix outdated physician pay models.
AMA statement on continuing freeze of Medicare physician payment
The AMA disagreed with the MedPAC’s recommendation to continue the freeze in Medicare physician fee payments because it threatens patient access to quality care.
Jan. 7, 2022: Advocacy Update spotlight on federal advocacy agenda for 2022
The AMA outlines its federal advocacy agenda for 2022. Learn more in this Advocacy Update spotlight.
AMA fights against Medicare cuts, defending practices & access to care
Learn how AMA fights against Medicare cuts and defends physician practices and patients’ access to care.
Todd Askew shares what physicians need to know about advocacy in 2022
AMA's Moving Medicine series features physician voices and achievements. Learn more in this discussion with Todd Askew about what physicians need to know about advocacy in 2022.
AMA in the News: December 2021
Read media highlights mentioning the American Medical Association for December 2021.
More work remains to resolve Medicare payment situation
Congress took welcome action this month to avert Medicare payment cuts, but additional steps must be taken to provide permanent reform.
What services are being cut under Medicare?
That's because the Centers for Medicare & Medicaid Services (CMS) recently proposed cuts to certain Medicare services, including breast cancer screening, radiation oncology and physical therapy, along with other medical specialties.
Will there be a public health emergency in 2021?
Should these proposed changes become a reality, January 2021 will invite a public health emergency that could have been easily avoided — one that will unnecessarily harm doctors and patients. LendingTree.
Is Medicare a long delay?
Millions will wake up to a Medicare system that operates with long delays for previously routine services; conditions that are normally treatable with early detection will thrive undetected. Read More. This is unconscionable, and it's worse because there's an easy fix.
Is a doctor's office a charity?
The issue, of course, is that doctors' offices aren't charities — they're businesses. They depend on reimbursements from Medicare and insurance companies to stay afloat, particularly from people who come in for follow-up screenings and non-critical issues — the exact patients who they haven't been able to see lately.
Can CMS suspend Medicare cuts?
Congress can direct the CMS to suspend these cuts by waiving the requirement that changes to Medicare must be budget-neutral. That would allow CMS a one-time reprieve from balancing its budget, and it would give the medical profession an opportunity to recover and rebuild.
Why is Medicare important?
The Medicare Payment Advisory Commission, which reports to Congress, said in a 2019 report that “it is important to drive quality improvement by tying infection rates to payment.”. But the commission criticized the program’s use of a “tournament” model comparing hospitals to one another.
When are penalties based on patients who stayed in hospitals?
The penalties, based on patients who stayed in the hospitals anytime between mid-2017 and 2019 , before the pandemic, are not related to covid-19. They were levied under a program created by the Affordable Care Act that uses the threat of losing Medicare money to motivate hospitals to protect patients from harm.
How many hospitals have been penalized for infection?
The federal government has penalized 774 hospitals for having the highest rates of patient infections or other potentially avoidable medical complications. Those hospitals, which include some of the nation’s marquee medical centers, will lose 1% of their Medicare payments over 12 months.
Why do hospitals have to pay penalties?
Some hospitals insist they received penalties because they were more thorough than others in finding and reporting infections and other complications to the federal Centers for Medicare & Medicaid Services and the CDC.
What is the law that punishes the quarter of hospitals with the highest rates of patient safety issues?
Under the law, Medicare each year must punish the quarter of general care hospitals with the highest rates of patient safety issues. The government assesses the rates of infections, blood clots, sepsis cases, bedsores, hip fractures and other complications that occur in hospitals and might have been prevented.
When is Medicare penalty based on?
The total penalty amount is based on how much Medicare pays each hospital during the federal fiscal year — from last October through September. Hospitals can be punished even if they have improved over past years — and some have.
Is it unbending to penalize one quarter of hospitals?
At times, the difference in infection and complication rates between the hospitals that get punished and those that escape punishment is negligible, but the requirement to penalize one-quarter of hospitals is unbending under the law.
How long does it take for a hospital to terminate Medicare?
Weekly enforcement notices for four weeks beginning three weeks after the second letter. Termination from Medicare and Medicaid 30 days after the final enforcement notice.
When will hospitals begin reporting to CMS?
On Oct. 21, CMS will begin publicly reporting on each hospital’s compliance and, for noncompliant hospitals, which elements they are not reporting.
How much has HHS increased reporting?
Since HHS asked hospitals to begin reporting some of the data, weekly reporting has increased from 86% to 98% of all hospitals. Daily reporting has increased from 61% to 86%, said Deborah Birx, MD, White House coronavirus response coordinator.
How do hospitals report data?
Details of the reporting process. Hospitals can report the data using any of three options: Through their states. Directly to HHS through teletracking. Through their health IT vendors, which will send the data to HHS.
How many data elements are required for a hospital?
Hospitals are required to report 31 data elements daily and six elements weekly, according to an Oct. 6 FAQ from the U.S. Department of Health and Human Services (HHS). The reporting requirements broadly apply to all types of hospitals, or more than 6,000 facilities.
Is CMS overkill?
Hospital advocates condemned the approach as “overkill.”. "It is both inappropriate and frankly overkill for CMS to tie compliance with reporting to Medicare conditions of participation,” Chip Kahn, president and CEO of the Federation of American Hospitals, said in a written statement.
Can hospitals appeal termination?
Hospitals can appeal any termination. CMS plans to offer technical assistance, including a “hotline” that hospitals can call for details about their noncompliance or to address reporting issues, such as HHS not receiving submitted data. HHS also plans to release more details through sub-regulatory guidance.
