Federal Officials To Adjust Hospitals’ Penalties For High Readmissions Of Some Patients
The new formula will provide some relief to hospitals that have large numbers of "dual eligible" patients, or those that are covered by both Medicare and Medicaid, because they tend to be poorer and sicker than the general population. Also, Iowa Sen. Chuck Grassley is pushing federal officials to get tougher with Medicare Advantage plans.
Dual-Eligibles: The Next Target In Hospital Readmissions Penalties
The CMS is proposing to adjust penalties in its Hospital Readmissions Reduction Program according to a hospital's proportion of dual-eligible patients, garnering praise from industry stakeholders even though they say the move is an incremental change. The proposed rule, released Friday, would take effect in fiscal 2019. ... The change stems from the 21st Century Cures Act, which was enacted in December 2016. The law required Medicare to take patient background into account when calculating payment reductions to hospitals under the Hospital Readmission Reduction Program, and to adjust those penalties based on the proportion of patients who were dually eligible for Medicare and Medicaid. Such patients are disproportionately expensive for hospitals. (Whitman, 4/18)
Kaiser Health News:
Sen. Grassley Demands Scrutiny Of Medicare Advantage Plans
Sen. Chuck Grassley (R-Iowa) wants federal health officials to tighten scrutiny of private Medicare Advantage health plans amid ongoing concern that insurers overbill the government by billions of dollars every year. Grassley, the influential chairman of the Senate Judiciary Committee, has asked Centers for Medicare and Medicaid Services (CMS) officials to explain why they failed to collect nearly $125 million in potential overcharges identified at five Medicare Advantage plans audited in a single year. (Schulte, 4/18)