Congress Passes Paent Access and Medicare Protecon Act On December 18, Congress unanimously passed the Paent Access and Medicare Protecon Act (S. 2425), legislaon supported by the stakeholders across the cancer care community. On December 28, the President signed the legislaon into law. The legislaon provides payment stability to freestanding radiaon therapy centers by freezing Medicare payment rates for the sector in 2017 and 2018 as it transions to a new, episodic alternave payment model in 2019. The legislaon also requires the Secretary of Health and Human Services (HHS) to submit to Congress a report on the development of an episodic alternave payment model for payment under the Medicare program within 18 months. To view the legislave language, click here. Congress Passes Omnibus Spending Bill On December 18, Congress passed a $1.15 trillion omnibus appropriaons bill and tax extenders package. The legislaon (H.R. 2029) was signed into law by President Barack Obama the same day. The omnibus bill passed in the Senate by a vote of 65-33 and the House by a vote of 316-113. Health-related provisions in the measure include: IPAB operaonal funding was cut by $15B (although the panel has never actually been established) Breast cancer screening recommendaons issued by the USPTF were blocked for 2 years AHRQ funding was cut by $30M (earlier House version had zeroed out agency funding) Funding for NIH was increased by $2B Funds for 9-1-1 emergency responder health care benefits were reauthorized and expanded Addional funds were provided for opioid prescripon drug overdose prevenon $20M was provided for the Naonal Diabetes Prevenon Program Other Medicare provisions include: Secon 502 Part B Services Reduces payments for the "technical" (versus "professional") component of film X-rays on film (versus digital) starng in 2017, by 20 percent. (The RUC is transioning valuaon of X-rays from film to digital technology, but medicine generally opposes Congressional interference in valuaon.) These reducons would be exempt from the budget-neutrality calculaon. Reduces payments for the "technical component" of "computed radiography" by 7 percent in 2018-2022 and by 10 percent starng in 2023. "Computed radiography" is defined as cassee-based imaging that uses an imaging plate. JANUARY 2016
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Congress Passes Patient Access and Medicare Protection Act
On December 18, Congress unanimously passed the Patient Access and Medicare Protection Act (S. 2425), legislation supported by the stakeholders across the cancer care community. On December 28, the President signed the legislation into law.
The legislation provides payment stability to freestanding radiation therapy centers by freezing Medicare payment rates for the sector in 2017 and 2018 as it transitions to a new, episodic alternative payment model in 2019. The legislation also requires the Secretary of Health and Human Services (HHS) to submit to Congress a report on the development of an episodic alternative payment model for payment under the Medicare program within 18 months.
To view the legislative language, click here.
Congress Passes Omnibus Spending Bill
On December 18, Congress passed a $1.15 trillion omnibus appropriations bill and tax extenders package. The legislation (H.R. 2029) was signed into law by President Barack Obama the same day. The omnibus bill passed in the Senate by a vote of 65-33 and the House by a vote of 316-113.
Health-related provisions in the measure include:
IPAB operational funding was cut by $15B (although the panel has never actually been established)
Breast cancer screening recommendations issued by the USPTF were blocked for 2 years
AHRQ funding was cut by $30M (earlier House version had zeroed out agency funding)
Funding for NIH was increased by $2B
Funds for 9-1-1 emergency responder health care benefits were reauthorized and expanded
Additional funds were provided for opioid prescription drug overdose prevention
$20M was provided for the National Diabetes Prevention Program Other Medicare provisions include:
Section 502 Part B Services
Reduces payments for the "technical" (versus "professional") component of film X-rays on film (versus digital) starting in 2017, by 20 percent. (The RUC is transitioning valuation of X-rays from film to digital technology, but medicine generally opposes Congressional interference in valuation.) These reductions would be exempt from the budget-neutrality calculation.
Reduces payments for the "technical component" of "computed radiography" by 7 percent in 2018-2022 and by 10 percent starting in 2023. "Computed radiography" is defined as cassette-based imaging that uses an imaging plate.
The Secretary could adopt new code modifiers to implement the preceding two reductions.
Reduces the current 25 percent discount that is applied to the "professional component" (i.e., the radiologists’ services) when there are multiple imaging services, to just 5 percent, starting in 2017. This would be exempt from budget-neutrality calculations.
Hospital Outpatient Departments (HOPDs)
Reduces payment for film (versus digital) X-rays by 20 percent starting in 2017.
Phases in reductions for "computed radiography" at the same levels as Part B services—7 percent in 2018-2022 and 10 percent starting in 2023.
These two adjustments would be exempt from budget neutrality and could be implemented with the use of code modifiers.
Section 503
Limits the federal share of Medicaid payments for durable medical equipment (DME) to what Medicare would pay, but allows states to make additional payments.
Section 504
Requires Medicare, starting in 2017, to pay for the home use of negative pressure wound therapy devices, which can rapidly speed up healing when used appropriately. It also calls for a GAO study & report on the value of these and other "disposable" medical devices.
The fiscal 2016 omnibus package would increase the deficit by $58 billion over 10 years, according to the Congressional Budget Office and Joint Committee on Taxation.
To view the legislative text of H.R. 2029, click here
To view the CBO score, click here.
Senate Passes Reconciliation Bill
On December 3, the U.S. Senate passed a budget reconciliation package by a vote of 52-47, which includes a number of changes to the Affordable Care Act. The final Senate package includes measures to:
Defund the Prevention and Public Health Fund;
Give the Community Health Center Program $235 million more for a total $3.8 billion;
Remove the HHS secretary's authority to run a federal exchange as of Jan. 1, 2018;
Make the ACA's section on territory health care ineffective;
Block the HHS secretary from collecting fees and making payments under the reinsurance, risk corridor and risk adjustment programs;
Address substance abuse-related public health crises and mental health needs;
Wind down the premium tax credits, cost-sharing subsidies and small business tax credits as of Dec. 31, 2017;
End the individual and employer mandate penalties retroactively effective as of Dec. 31, 2014;
Restrict federal funds to states that pay providers offering abortion services; roll back Medicaid expansion;
Repeal disproportionate share hospital payment reductions; end the tax on over-the-counter medications for Archer MSAs, flexible spending arrangements and health reimbursement arrangements as of Dec. 31;
Lower the tax on health savings accounts to 10 percent, Archer MSAs to 15 percent and chronic care tax to 7.5 percent on Dec. 31;
Block limits on contributions to flexible spending accounts; and
Repeal the tax on prescription medicines, medical device excise tax and health insurance tax. The Senate also passed amendments to permanently repeal the 40 percent "Cadillac Tax" on high-cost healthcare plans and change the rules on income levels needed for seniors to deduct from the medical expenses.
The Congressional Budget Office (CBO) and Joint Committee on Taxation estimate that the reconciliation package will reduce the federal deficit by $282 billion by FY 2025.
To view the legislative text, click here.
For a section-by-section summary, click here.
To view the CBO score, click here.
MedPAC Discusses Physician Payment Adequacy
On December 10, the Medicare Payment Advisory Commission (MedPAC) met to discuss Medicare policy issues and develop and approve reports and recommendations to the U.S. Congress.
Issues addressed at the December meeting included a presentation by Medicare staff entitled, "Assessing payment adequacy and updating payments: physician and other health professional services; ambulatory surgical center services."
Within the presentation, MedPAC staff address the shift from services performed in freestanding offices to hospitals. While their findings were specific to imaging, they note that:
Trend toward billing for some services in hospitals instead of freestanding offices
Increases overall program spending and beneficiary cost sharing
Volume growth sensitive to shifts in site of care The Commission will continue to work on addressing disparities in reimbursement related to the fee schedule and work on the development of Alternative Payment Models and the Merit-Based Incentive Payment System.
To view the presentation to MedPAC, click here.
GAO Releases Report on Hospital Physician Consolidation
The Government Accountability Office (GAO) released a report in December, "Increasing Hospital Physician Consolidation Highlights Need for Payment Reform," which concludes that vertically consolidated hospitals and physician practices are resulting in increased Medicare costs.
This report examines both trends in vertical consolidation between hospitals and physicians and the extent to which higher levels of vertical consolidation were associated with more evaluation & management office visits being performed in HOPDs from 2007 to 2013.
The report finds that the number of vertically consolidated hospitals and physicians increased from 2007 through 2013. During this time, the number of vertically consolidated hospitals increased from approximately 1,400 to 1,700 and the number of vertically consolidated physicians nearly doubled from 96,000 to 182,000. The GAO state that regardless what has driven hospitals and physicians to vertically consolidate, paying more for the same service when performed in an HOPD rather than a physician office provides an incentive to shift services that were once performed in physician offices to HOPDs after consolidation has occurred.
The GAO encourages Congress to consider directing the Secretary of HHS to equalize payment rates between settings for office visits—and other services that the Secretary deems appropriate—to return the associated savings to the Medicare program and to prevent the shift of services from physician offices to HOPDs, which increases costs for the Medicare program and beneficiaries.
To access the full report, click here.
Chronic Care Work Group Releases Policy Options
The Senate Finance Committee (SFC) Chronic Care Working Group released a policy options paper on December 18 outlining various recommendations submitted by healthcare stakeholders on how best to improve care to Americans living with chronic conditions.
In July, the Chronic Conditions Working Group accepted 530 stakeholder comments in response to a request by the Committee for ideas to improve the way care is delivered to Medicare beneficiaries with chronic diseases.
In releasing a new policy options document, the Chronic Care Working Group underscored its commitment to moving forward with a bipartisan process, which includes the consideration of comments generated in response to the new document. In an email to stakeholders on December 18, the Working Group leaders reiterated their desire to develop policy options based on data-driven Congressional and stakeholder input that aids in the development of a bipartisan legislative product that can be introduced next year.
To view the SFC Bipartisan Chronic Care Working Group Policy Options Document, click here.
CMS Releases 2014 National Health Expenditures
On December 2, 2015, the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary released its 2014 National Health Expenditures report. According to the report, U.S. health care spending grew 5.3 percent in 2014, reaching $3.0 trillion or $9,523 per person. As a share of the nation's Gross Domestic Product, health spending accounted for 17.5 percent.
Specific to Medicare spending, the report found:
Medicare represented 20 percent of national health spending in 2014.
Medicare spending grew 5.5 percent to $618.7 billion, a faster increase than the 3.0 percent growth in 2013.
The 2014 rate of growth was driven by increased spending growth for retail prescription drugs and in Medicare Advantage.
The report concludes that the acceleration in spending growth from 2013 was primarily driven by millions of new people with health insurance coverage a result of the Affordable Care Act, and by rapid rising prescription drug costs.
Overall, health care spending grew 1.2 percentage points faster than the overall economy in 2014.
To read the CMS press statement, click here.
To access the full report, click here.
To view the Health Affairs article, click here.
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