Federal Watch
March 29th, 2013
AGS is tracking developments of interest to geriatrics health professionals in order to provide weekly updates for our readers via our List Serv, americangeriatrics.org, our Facebook page, and our Twitter feed. This week, we discuss the recent release of the NCQA’s Patient Centered Specialty Practice Recognition program. We also share an interesting article about the extreme opposition to Medicare’s proposal of greater drug rebates. In addition, we discuss White House warnings that cutting Medicare will shift costs to the private sector. Lastly, we update you on a new rule allowing hospitals to claim Medicare Part B costs in settings where the original setting of care was incorrect.
Release of the NCQA Patient Centered Specialty Practice Recognition program
On March 25th, the NCQA Patient Centered Specialty Practice Recognition (PSCP) program was released. This new evaluation program includes principles of the patient-centered medical home to specialties besides primary care. PCSP is modeled on the most widely adopted medical home model in the country, NCQA’s Patient-Centered Medical Home Recognition program. On Thursday, March 21, 2013, NCQA held a press event announcing the release of this new program. Guest speakers of the event included Carol Greenlee, MD, FACP, Vice Chair of the CSS and John Cox, DO, a member of the CSS PCMH Workgroup. To see a recording of this webinar and accompanying slides, which include a description of the program's standards, please click here.
Extreme Opposition to Medicare’s proposal for Greater Drug Rebates
In President Obama’s February 19th State of the Union speech, one of the topics that he addressed was Medicare drug discounts. He proposed that drug companies provide dual-eligible Medicare beneficiaries the same drug discounts as individuals who are solely eligible for Medicaid. However, drug companies have criticized the plan stating that this would result in them cutting back on research. In addition, some Congressmen who are also in opposition of the plan, state that these higher markdowns would result in patients paying higher prices. Nonetheless, according to the Congressional Budget Office (CBO) if the plan was enacted it would result in savings of $112 billion over 10 years. To read the full Medicare Newsgroup article, click here.
White House warns cutting Medicare will shift costs
Obama Administration officials stated earlier this week, if the Nation’s budget deficit is addressed by cutting Medicare, it will not address the underlying issues, rather it will shift health care costs to the private sector. Health and Human Services Secretary Kathleen Sebelius said that Medicare and Medicaid are not the reason health costs are going up; rather costs in these programs are increasing at a slower pace than private-sector health care costs. She stated, "You don't do anything about the trajectory the U.S. is on ... unless you concentrate on the underlying costs." Sebelius also cites new numbers that indicate because of the Affordable Care Act, the Medicare spending rate is the lowest it has been in 50 years, and Medicaid spending went down 2% in 2012. Despite facts such as this, the law continues to face harsh criticism from groups determined to cancel funding for the act. To read the entire article, visit here.
Hospitals reject new Part B rebilling rule
Marilyn Tavenner, acting CMS Administrator issued a new rule last week that was created to address hospitals concerns about billing, and payment for Medicare Part A and B services. The new rule was published in the Federal Register, and directs Medicare judges to allow hospitals to claim Part B costs in situations where the original setting of care was incorrect. Thousands of claims that are pending in the appeals process are expected to be affected by Tavenner’s ruling. However there is dispute about this rule, Andrew Wachler, a healthcare attorney stated that this rule may make it more difficult for hospitals to be paid in wrong setting of care cases in the future. To read the entire article from Modern Healthcare click here.
Should you have any questions, please don’t hesitate to contact Ashley Fletcher, Senior Coordinator of Public Affairs & Advocacy, afletcher@americangeriatrics.org.
Modified On: March 29th, 2013
