News and Updates
July 13, 2017
CMS looks to drop payment for off-campus services by half
The CMS wants to drop by half what Medicare pays when patients receive healthcare at medical facilities that are owned by hospitals but located off their campuses.
The Obama administration last year finalized a rule that paid hospital off-campus facilities the same as hospital-based outpatient departments if they started billing Medicare after Nov. 2, 2015.
The proposal, outlined in the proposed 2018 physician fee pay rule released Thursday, would drop that rate from 50% to 25% of what they would have been paid under outpatient rates.
"At a time when the nation is moving toward value-based payments, this proposal makes no sense. In essence, it removes all incentives to provide care out in the communities rather than at the hospital, and ultimately will lead to higher overall Medicare spending," said Blair Childs, senior vice president of public affairs for Premier, a consulting firm.
The prioir, more generous payment made to off-campus facilities has led to hospitals acquiring physician practices at a rapid clip. But hospitals say the facilities, while increasing their operating costs, allow them to provide greater access to healthcare, especially in underserved areas.
The Trump administration's proposed changes would save $25 million next year. Among the services affected would include pain management treatment, some x-rays and radiation therapies as well as some behavioral health services.
"The CMS proposal will result in an unsustainable payment rate that will further reduce access for people in chronically underserved communities, health care deserts, and the hospitals on which they rely," Dr. Bruce Siegel CEO of America's Essential Hospitals said in a statement.
Congress passed what's called the site-neutral policy after a 2013 Medicare Payment Advisory Commission report that found Medicare was paying 141% more for a echocardiogram in an outpatient setting than for the same procedure in a doctor's office.
Comments on the proposed rule are due by Sept. 11.
Source: Modern Healthcare
Senate Finance Committee Passes CHRONIC ACT, Bill Moves on to Full Senate
Two days after the May 16 Senate Finance Committee hearing, the Committee passed S. 870, the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017. RPA supports this legislation, which is among the telehealth bills that will add the patient's home and the dialysis facility to the list of Medicare-approved originating sites for telehealth, and allow the partial use of telehealth in providing monthly visits to home dialysis patients. While there currently is no House companion legislation, prompt passage of this bill in the Finance Committee increases the likelihood that telehealth provisions would be included in any broad Medicare legislative vehicle later this year. Follow @RPANephrology on Twitter for real-time updates.
Source: RPA Weekly Enews
RPA Endorses CONNECT Telehealth Legislation
On May 3, S. 1016 which will be known as the CONNECT Act, was introduced by Senator Brian Schatz (D-HI) in the U.S. Senate. In dialysis, the bill designates the ESRD patient's home and the dialysis facility as originating sites for telehealth services, and allows the delivery of two of the three required monthly visits to home dialysis patients in a three consecutive month period via telehealth, with the appropriate safeguard of mandating that the third visit is a face-to-face encounter between the nephrology practitioner and patient. RPA has endorsed the legislation and will be advocating for it among other legislative priorities during Capitol Hill Day on June 2. Register now to join your colleagues in Washington, DC.
Statewide Provider and Health Plan Claim Dispute Resolution Program
The Agency for Health Care Administration is contracted with MAXIMUS, an independent dispute resolution organization, to provide assistance to health care providers and health plans in resolving claim disputes. Claims submitted to managed care plans that have been denied in full or in part, or allegedly underpaid or overpaid may be eligible for dispute under the arbitration process.
To learn more about these available arbitration services, go to http://ahca.myflorida.com/medicaid/statewide mc/index.shtml or contact MAXIMUS directly at 1- 866-763-6395 (select 1 for English or 2 for Spanish), and then select Option 2. Ask for Florida Provider Appeals Process.
Contact MAXIMUS for application forms and instructions on how to file a claim dispute.
Gov. Scott Declares State of Emergency For Opioid Epidemic
Following the Centers for Disease Control and Prevention (CDC) declaring a national opioid epidemic, Governor Rick Scott signed Executive Order 17-146 directing a Public Health Emergency across the state. By signing the Emergency Order, it will allow the state to immediately draw down more than $27 million in federal grant funding from the United States Department of Health and Human Services (HHS) Opioid State Targeted Response Grant which was awarded to Florida on April 21 to provide prevention, treatment and recovery support services.
Without the order, it would have taken months for the state to distribute these funds to local communities. In addition to declaring a Public Health Emergency, Surgeon General Dr. Celeste Philip will issue a standing order for Naloxen, an emergency treatment for opioid overdose. This will ensure first responders have immediate access to this lifesaving drug to respond to opioid overdoses.
Read the release from the Office of the Governor
Important OSHA update
OSHA Delays Electronic Record-Keeping Rule Compliance Date
Back in August, we reported on the new OSHA rule, which would require certain employers to submit injury and illness data electronically. The new reporting requirement was scheduled to go into effect on July 1st of this year. However, OSHA just announced that the requirement has been delayed indefinitely. OSHA has not given the reason for the delay or provided any information about a future effective date. We will provide updates if and when they are available.
Source: Donald A. Berman, MD, President, OSHA Medical Courses