GAO Finds that Better Data and Greater Transparency Could Improve Payment Accuracy

The Government Accountability Office (GAO) has released a report recommending that the Centers for Medicare and Medicaid Services (CMS) should better document its process for establishing relative values and inform the public of potentially misvalued services identified by the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC). The GAO also recommends that CMS should develop a plan for using funds appropriated for the collection and use of information on physicians’ services in the determination of relative values.

Ways and Means Begins Series of Hearings on Medicare Payment

The House Ways and Means Health Subcommittee held the first in a series of hearings on reforming the Medicare reimbursement system. The hearing, titled “Improving Competition in Medicare: Removing the Moratoria and Expanding Access,” featured a panel of witnesses representing the American Enterprise Institute, Methodist McKinney Hospital, the American Association for Homecare, and the American Hospital Association. Subcommittee Chairman Kevin Brady (R-Texas) has said he ultimately hopes to introduce legislation later this year to improve the payment system for hospitals and post-acute care, and has expressed an interest in making the inpatient and outpatient payment systems compatible. Future hearings to be conducted through July will consider physician shortages, rural health care disparities, and hospital payments. Also on Rep. Brady’s agenda are the medical device tax, examining the two-midnight rule and recovery audit contractors (RACs), and identifying additional options for seniors in the Medicare program, such as a cap to protect them from high out of pocket costs and the premium support model put forth by Rep. Paul Ryan (R-Wis.).

Lawmakers Propose Changes to Medicare Advantage

Policymakers on the House Ways and Means and Energy and Commerce Committees have introduced a series of bills aimed at reforming the Medicare Advantage (MA) program. In H.R. 2506, Rep. Vern Buchanan (R-Fla.), Rep. Charlie Rangel (D-N.Y.), and Rep. Marsha Blackburn (R-Tenn.) propose to delay the Administration’s ability to terminate MA contracts for plans that don’t achieve high enough star ratings. Rep. Mike Kelly (R-Pa.), Rep. Ron Kind (D-Wis.), and Rep. Gus Bilirakis (R-Fla.) introduced H.R. 2505, which would require plans to report annual enrollment data. H.R. 2507, a proposal from Rep. Kevin Brady (R-Texas), Rep. Mike Thompson (D-Calif.), and Rep. Joe Pitts (R-Pa.) would expand an annual regulatory schedule for the program’s payment rates. Finally, Rep. Brady, Rep. Keith Rothfus (R-Pa.), Rep. Susan Brooks (R-Ind.), and Rep. Kurt Schrader (D-Ore.) propose changes to the open enrollment period for the program in H.R. 2488.

NIH Congressional Caucus Created

Sen. Dick Durbin (D-Ill.) and Sen. Lindsey Graham (R-S.C.) launched the Senate National Institutes of Health (NIH) Caucus last week. Director of the NIH Francis Collins was present at the ceremony, and expressed excitement that 2015 might be the year that the decline in NIH funding could be reversed. The agency has lost 25 percent of its purchasing power since 2003. The Caucus will focus on the NIH’s ability to fund biomedical research. Caucus membership includes Sens. Tammy Baldwin (D-Wis.), Richard Blumenthal (D-Conn.), Bob Casey (D-Pa.), Ben Cardin (D-Md.), Joe Donnelly (D-Ind.), Ed Markey (D-Mass.), Gary Peters (D-Mich.), Al Franken (D-Minn.), Tim Kaine (D-Va.), Amy Klobuchar (D-Minn.), Roger Wicker (R-Miss.), and Jerry Moran (R-Kan.).

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