Summaries of health policy coverage from major news organizations
HCFA Sets New Reimbursement Rate For Medicare+Choice Members With Congestive Heart Failure
HCFA announced last week new guidelines that will provide Medicare+Choice organizations extra risk adjustment payments for outpatient care of enrollees with congestive heart failure. The new guidelines, set to take effect in 2002, revise the current policy under which Medicare+Choice organizations receive payment adjustments based solely on inpatient data. Under the new system, Medicare+Choice organizations will be paid more to cover the high costs of providing outpatient care for congestive heart failure. According to the new policy, Medicare+Choice organizations may qualify for extra payments by meeting the following clinical quality indicators: at least 75% of designated congestive heart failure patients have received evaluation of left ventricular function and at least 80% of those enrollees with left ventricular systolic dysfunction have been prescribed an ACE inhibitor. The new guidelines also include rules for the 2001 National Quality Assessment and Performance Improvement Project, which aims to "reduce the number of deaths and improve the overall quality of life for" congestive heart failure patients. Dr. Robert Berenson, director of HCFA's Center for Health Plans and Providers, said, "The new guidelines will help Medicare+Choice organizations better serve their patients who have been diagnosed with congestive heart failure. We are pleased to be able to have partnered with Medicare+Choice organizations ... to reward participating ... organizations for their investment in quality management of this prevalent, chronic disease." Congestive heart failure is the leading cause of hospitalization among Medicare enrollees, as more than 80% of the 3 million Americans currently diagnosed with the condition are over age 65 (HCFA release, 11/22).
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