House/Senate Hearings Focus on Medicare Reforms

At a House Energy and Commerce Health Subcommittee hearing, “A 21st Century Medicare: Bipartisan Proposals to Redesign the Program’s Outdated Benefit Structure,” witnesses said that the program lacks catastrophic cost protections while permitting comprehensive Medigap coverage that serves to dissuade Medicare beneficiaries from being cost conscious. They suggest reforms that strike a better balance between better financial protection and preserving incentives to consume care wisely. While some suggest combining the Medicare Part A and B deductibles, it was said that such a unified deductible could increase costs for 71% of beneficiaries, including those without a hospital inpatient stay. At a Senate Finance Committee hearing, “Health Care Quality: The Path Forward,” Chairman Max Baucus (D-MT) questioned whether Medicare needs to use 1,100 different quality measures to assess provider performance. Witnesses said that the current system for measuring quality is inadequate and fails to align the measures among different medical practices, lacks clear goals and could be improved by focusing more on patient-reported experience and treatment outcomes. Senator Orrin Hatch (R-UT) said the collection of data to assess quality needs to be as streamlined as much as possible and should be an outgrowth of routine clinician workflow. Witnesses said a consensus is needed to make the improvements necessary and that reform of the Medicare physician payment SGR system would offer a vehicle for the needed changes.

Senate Oversight of RAC and Medicare Drug Abuse

At another Senate Finance Committee hearing, the Medicare Recovery Audit Contractor program (RAC) came under fire for overburdening hospitals and physicians. The Senate Committee on Homeland Security & Governmental Affairs held a hearing focused on “Curbing Prescription Drug Abuse in Medicare”. The HHS Office of the Inspector General presented findings of a review which summarizes that prescription drug abuse is an epidemic being subsidized by taxpayers and that Medicare Part D paid more than $5 million for prescriptions not ordered by authorized prescribers. Witnesses from the OIG and DEA agreed that the Part D program needs more oversight to protect patient safety and address fraud and abuse. Members were in agreement that the OIG recommendations to prevent abuse should be quickly implemented.

Medicare HHA Payments to Decrease in CY 2014

CMS issued a proposed rule under which Medicare payments to home health agencies (HHA) would decrease by 1.5%, about $290 million, in CY 2014. The rule also makes changes to the quality reporting system. Comments are due by August 26.

Dual-Eligible Grants

CMS announced $12 million in grants under which states may participate in a new ombudsmen program to help enrollees who are to receive care in 2014 through the CMS Financial Alignment Initiative (which will test new methods to deliver care and cut expenditures for Medicare/Medicaid dual-eligibles).

CMS Rule to Coordinate Hospice/LTC

CMS issued a final rule which intends to improve the coordination between hospices and long-term care hospitals to eliminate duplication and conflicting services beginning August 26th. The rule revises the qualification requirements for skilled nursing facilities and nursing facilities and requires long-term care (LTC) facilities to develop a written agreement with a hospice if a resident elects to receive hospice care.

Physician Compare Website Updated

CMS announced that it has redesigned its Physician Compare website to make it easier for patients to find the information they are seeking, including information on the specialties offered by doctors and group practices; whether a physician is using electronic health records; what, if any, board certifications the doctor has; and whether the physician is affiliated with hospitals and other health care professionals.

Health Legislation Recently Introduced

S. RES. 182 (DENTAL HYGIENE), congratulating the American Dental Hygienists’ Association on the 100th anniversary of the profession of dental hygiene and commending its work to improve the oral health of the people of the United States; CARDIN; considered and agreed to, June 21.

S. 1220 (MEDICARE), to amend Title XVIII of the Social Security Act to preserve access to rehabilitation innovation centers under Medicare; KIRK; to the Committee on Finance, June 25.

S. 1223 (DISEASE RESEARCH), to amend the Public Health Service Act to expand and intensify programs of the National Institutes of Health and the Centers for Disease Control and Prevention with respect to translational research and related activities concerning cavernous angioma, and for other purposes; UDALL of New Mexico; to the Committee on Health, Education, Labor, and Pensions, June 26.

S. 1228 (MEDICARE), to establish a program to provide incentive payments to participating Medicare beneficiaries who voluntarily establish and maintain better health; WYDEN; to the Committee on Finance, June 26.

H.R. 2476 (TAXATION), to amend the Internal Revenue Code of 1986 to allow a $1,000 refundable credit for individuals who are bona fide volunteer members of volunteer firefighting and emergency medical service organizations; HANNA; to the Committee on Ways and Means, June 24.

H.R. 2477 (MEDICARE), to amend Title XVIII of the Social Security Act to provide for coverage of cancer care planning and coordination under Medicare; CAPPS; jointly, to the committees on Energy and Commerce and Ways and Means, June 25.

H.R. 2480 (PATIENT HANDLING), to direct the secretary of labor to issue an occupational safety and health standard to reduce injuries to patients, nurses, and all other health care workers by establishing a safe patient handling, mobility, and injury prevention standard, and for other purposes; CONYERS; jointly, to the committees on Education and the Workforce, Energy and Commerce, and Ways and Means, June 25.

H.R. 2484 (PHYSICIANS), to provide incentives to physicians to practice in rural and medically underserved communities, and for other purposes; BERA; to the Committee on the Judiciary, June 25.

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