MedPAC Declines to Recommend to Congress Additional Pay Bumps for Doctors, Hospitals

A top Medicare advisory board did not recommend any new payment hikes for acute care hospitals or doctors for 2023, stating that targeted relief funding has helped blunt the impact of the COVID-19 pandemic. The Medicare Payment Advisory Commission (MedPAC), which makes recommendations to Congress and the federal government on Medicare issues, voted on the payment changes to Congress during its Thursday meeting. The panel decided against recommending any pay hikes.

Regulators Eyeing Medicare Hospice Spending

As hospice utilization and associated costs continue to rise, federal regulators are looking more closely at providers and the services they provide. The U.S. Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health & Human Services Officer of the Inspector General (OIG) are zeroing in on longer lengths of stay, billing for services deemed unrelated to the terminal diagnosis and use of general inpatient care, among other concerns.

MedPAC Likely to Support Pay Increase for Hospitals in 2023

Hospitals, dialysis facilities and long-term care hospitals could see Medicare reimbursement bumps in fiscal 2023 under draft recommendations from the Medicare Payment Advisory Commission. Skilled nursing, home health and inpatient rehabilitation facilities could see 5% base pay decreases. Physicians, ambulatory surgical centers and hospices may see no change in pay from 2022. Post-acute care providers and stakeholders that could be facing pay freezes said they’re disappointed in MedPAC’s draft proposals. MedPAC’s own commissioners agreed with most recommendations staff presented. However, several members had concerns about leaving physician pay flat in 2023. Recommendations will come to an official vote at next month’s meeting.

Senate Votes to Avert Medicare Cuts to Providers

The Senate on Thursday evening voted 59-34 to avert looming Medicare cuts to providers, sending the legislation to President Biden’s desk for signature. The highly-anticipated vote comes weeks before the cuts were set to take effect, putting providers on edge as lawmakers hammered out a final deal. The bill, which passed the House earlier this week, will delay 2% cuts to Medicare rates through March 2022 and punt a separate round of 4% Medicare cuts totaling about $36 billion to 2023.

House Votes to Avert Looming Medicare Cuts

Providers are poised to get relief from pending Medicare cuts under legislation the U.S. House of Representatives passed Tuesday night on a party line vote, 222-212. It now heads to the Senate where it is expected to pass as soon as this week. The bill falls short of what providers advocated but hospitals are relieved that Congress is taking steps to block tens of millions of dollars in reimbursment reductions slated to take effect next year, American Hospital Association President and CEO Rick Pollack said. The legislation, released by the House Rules Committee Tuesday, would delay 2% cuts to Medicare rates through March 2022 and punt a separate round of 4% Medicare cuts totaling about $36 billion to 2023.

AMA: Medicare Spending on Physician Services Declined $13.9B in 2020

A new report from the American Medical Association (AMA) documents unprecedented changes in Medicare spending as people decided to delay or forgo health care services during the onset of the COVID-19 pandemic. The new AMA report, “Impacts of the COVID-19 Pandemic on 2020 Medicare Physicians Spending” (PDF) analyzed Medicare claims data exclusive to physician services and found spending fell an estimated $13.9 billion (14%) below expected levels in 2020. Despite a mid-year rebound after sharp declines early in the year, Medicare spending on physician services during 2020 never recovered to its pre-pandemic trend.

HHS: Telehealth Use in Medicare Increased 63-Fold Last Year with Behavioral Health Increasing the Most

The number of beneficiaries in traditional Medicare using telehealth exploded 63-fold in 2020 from 840,000 in 2019 to nearly 52.7 million, a new study found. The study, released Friday (PDF) by the Department of Health and Human Services (HHS), comes as advocates are pressing to make key flexibilities the federal government enabled at the start of the pandemic to be permanent. Even as telehealth use increased, there was still a decrease in Part B visits to doctors’ offices. Although telehealth use increased among all providers, the biggest users of the technology during the pandemic turned out to be behavioral health specialties.

Federal Spending Deal Leaves Looming Medicare Cuts in Place

Congressional leaders have struck a deal to avert a government shutdown, but they didn’t include a major priority for healthcare providers: preventing significant Medicare reimbursement cuts that are slated to take effect next month. Medicare providers stand to lose about $36 billion in reimbursements stemming from a 4% cut set to take effect in January, according to the nonpartisan Congressional Budget Office. The continuing resolution lawmakers will consider also does not address the 2% Medicare cuts dictated by the 2011 budget sequestration law that Congress postponed last year as part of the government’s response to the COVID-19 pandemic. Lawmakers on Thursday didn’t detail concrete next steps but indicated the issues will be resolved before Congress concludes its business for the year.

Implications of the 2022 Fee Schedule

Under the CY 2022 Final Rule, CMS finalized a reduction in the physician fee schedule conversion factor of 3.75% by decreasing the conversion factor from $34.89 to $33.59. In isolation, the theoretical effect to provider reimbursement due to the conversion factor adjustment will result in a 3.75% decrease in revenue for multi-specialty groups. In combination with other looming factors, providers are potentially facing up to a 10% cut to Medicare reimbursement beginning CY 2022. VMG has analyzed the expected changes detailed in the CY 2022 Final Rule. The following table summarizes VMG’s analysis on the estimated impact of the 2022 finalized changes to overall WRVUs and reimbursement for key medical and surgical specialties from 2020 levels.

Medicare’s Telehealth Decision Will Lead to Sweeping Changes for All of Behavioral Health

Recently announced changes to Medicare telebehavioral health coverage will impact the entire industry whether providers contract with the program or not. The move from the Centers for Medicare & Medicaid Services (CMS) marks an acceleration of telehealth on top of staking out a point-of-no-return for the industry’s progression toward digital adoption.