KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Detailing Medicare’s 2013 Doc Pay Schedules: Home Health Flat, Primary Care Up

Under Medicare's 2013 payment schedule, released late last week, home health agency payments will remain flat while primary care physicians can expect up to a 7 percent boost in payments.

Modern Healthcare: Medicare Home Health Payments To Remain Flat
Home health agencies can expect Medicare payments to drop by 0.01 percent next year, decreasing total payments in this segment by about $10 million from 2012 payments, the CMS announced Friday. The so-called market basket -- which adjusts for inflation -- called for a 1.3 percent payment increase to home health providers next year. Then the CMS applied an updated wage index that resulted in a 0.37 percent decrease, as well as a 1.32 percent decrease in the case-mix adjustment and an update to the fixed-dollar loss ratio used in outlier payments that led to an increase of 0.38 percent. Taken together, these adjustments result in a total decrease of 0.01 percent for 2013 payments, a CMS spokeswoman explained in an e-mail (Zigmond, 11/2).

Medpage Today: Medicare Sets 2013 Physician Fee Schedule
Family physicians will receive up to a 7 percent boost in Medicare payments in 2013, and other primary care providers will receive 3 percent to 5 percent more, under a final rule announced Thursday by the Centers for Medicare and Medicaid Services (CMS). Much of the increase in the physician fee schedule reimbursement will come from new added payments for coordinating a patient's care in the 30 days following a hospital or skilled nursing facility stay. Under the rule, providers will for the first time receive a separate payment to help a patient transition back to the community following a discharge. The American Medical Association (AMA) said it was pleased that the transition payments -- which were suggested by a work group that the association participated in -- had been adopted (Pittman, 11/1).

News outlets also look at one health plan's efforts to improve its Medicare rating and some of the unexpected beneficiaries of Medicare.

Health News Florida: $34M In Doctor Bonuses Led To Ratings Boost, Humana Says
Humana Gold Plus took a big leap in Medicare's quality ratings in just one year by paying bonuses to groups of doctors who produced results, the company said. The company paid $34 million in bonuses to more than 900 Florida primary-care physician practices that did the right things at the right time, documented what they did and got better outcomes for patients, spokesman Mitch Lubitz said. Health News Florida reported on Thursday that Humana Gold Plus, Florida's largest Medicare Advantage plan, was the only statewide plan to reach the level of 4.5 stars in a 5-star scale (Gentry, 11/2).

Marketplace: Medicare's Unexpected Beneficiaries
When you think of Medicare’s beneficiaries, you probably think of senior citizens. They account for more than 80 percent of the 49 million Americans on Medicare. Medicare beneficiaries also include younger Americans with disabilities and terminal kidney disease. But Medicare has helped millions of other Americans: the children and grandchildren of elderly parents. … Democratic Congressman John Dingell helped vote Medicare into law in 1965, and he remembers what elderly care used to be like, in the days before Medicare: "Well, it was pretty grim. Senior citizens were depending either on charity or on their kids in most instances." Back then, insurers wouldn't offer coverage to seniors because they were seen as too high a risk (Gura, 11/2).

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