Timely analysis from our multidisciplinary team.
December 07, 2018
This Week’s Diagnosis: Memorial services for President George H.W. Bush were held this week in Washington, DC and Texas. No agreement has been reached on border wall funding, which means Members may be here through at least December 21.
November 09, 2018
This Week’s Diagnoses: Was the election only four days ago? Tuesday brought change to Congress. While a handful of races have yet to be called, Democrats will take charge of the House of Representatives, while Republicans will retain control of the Senate come January 2019. We have a full breakdown of what the election results…
November 09, 2018
Democrats will take control of the House of Representatives in January 2019. Republicans will retain control of the Senate, widening their margin slightly. Split control of Congress will have important consequences for healthcare policy. This article takes a closer look at how the election is likely to impact the health policy agenda.
November 06, 2018
On November 1, 2018, the Centers for Medicare & Medicaid Services released the CY 2019 Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Medicare Part B [CMS-1693F] Final Rule, which includes policies related to Medicare physician payment and the Quality Payment Program (QPP). The regulations will be published in the…
October 03, 2018
In recent years, a number of codes on the Medicare Physician Fee Schedule have experienced significant reductions in their payment rates due to changes to a single direct practice expense input. This analysis identifies over 366 additional codes vulnerable to potentially significant payment reductions because their rate is tied predominantly to a single input.
September 11, 2018
A recently released evaluation of the CMS Comprehensive Care for Joint Replacement Model found a statistically significant reduction in spending in both high cost and low cost areas during the first performance year. Here are our five key takeaways.
August 30, 2018
On August 17, 2018, CMS released proposed rule that would make sweeping changes to the Medicare Shared Savings Program, a federal program that incentivizes integrated health provider networks to form Accountable Care Organizations. Comments are due October 16, 2018. Our top 5 takeaways follow.
July 30, 2018
On July 25, 2018, CMS released proposed policy and payment updates affecting the Hospital Outpatient Prospective Payment System and the Ambulatory Surgical Center Payment System for calendar year 2019. Read our top 10 takeaways from the rule.
July 26, 2018
Beginning January 1, 2020, when submitting claims to Medicare for advanced diagnostic imaging services furnishing professionals and entities must certify that professionals ordering services consulted AUC applicable to the imaging modality
July 16, 2018
On July 12, 2018, CMS released the CY 2019 Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Medicare Part B, which includes proposals related to Medicare physician payment and the Quality Payment Program. Read our top 10 takeaways from the rule here.
July 12, 2018
This article—the latest in a McDermott+Consulting series investigating the president’s drug pricing plans—takes a closer look at Oklahoma’s recently approved State Plan Amendment that allows Oklahoma to negotiate value-based contracts with drug makers for individuals covered by the state’s Medicaid plan.
July 10, 2018
From January through June 2018, it seemed legislative efforts to address the national opioid epidemic were the primary focus of congressional work. No fewer than eight committees in both chambers held hearings and produced numerous bills in an attempt to help address the public health crisis. These bills are in various stages of the legislative…
July 05, 2018
The Medicare Advantage Qualifying Payment Arrangement Incentive demonstration would waive Merit-Based Incentive Payment System requirements for clinicians taking sufficient risk in contracts with Medicare Advantage plans. The agency seeks comments on the information collection burdens associated with this demonstration that is under consideration for formal approval. More information on the request for comments is available…
June 27, 2018
McDermottPlus’ PERVU Calculator replicates and verifies PERVUs published by CMS, which allows McDermottPlus to simulate the impact of alternate inputs on PERVUs and to assist with the development of comments in response to Proposed and Final MPFS Rulemaking.
June 25, 2018
The Centers for Medicare and Medicaid Services is scheduled to release the 2019 Quality Payment Program (QPP) proposed rule shortly. For the first time it is expected to be combined with the 2019 Medicare Physician Fee Schedule proposed rule, which generally is released on or around July 1. Our top five issues to watch in…
June 11, 2018
On June 7, 2018, the US Department of Health and Human Services (HHS) published a Request for Information (RFI) in the Federal Register regarding formation of a workgroup to encourage investment and innovation in health care. The RFI provides investors and innovative companies in health care with an opportunity to engage with the HHS to…
April 16, 2018
High-profile hires Mara McDermott, former vice president of federal affairs at a leading physician advocacy group, and Rachel Stauffer, former Hill staffer and HHS Office of the National Coordinator legislative affairs director, join the growing McDermottPlus team.
March 06, 2018
Since the run-up to the 2016 presidential election, Donald Trump has stated his interest in controlling and lowering the high cost of prescription drugs. Until recently his administration had released limited details on possible ways to do so.
November 14, 2016
It is vitally important for the health system board, as well as certain of its key committees, to receive an introductory briefing as soon as possible on the health policy implications of last week’s Presidential and Congressional elections, as they are currently understood.
October 05, 2016
The final lab payment amounts for several well-established tests fall well below current Medicare pricing. Stakeholders have until October 30, 2016, to request reconsideration of these rates.
April 15, 2015
With draconian 21% cuts to physician payments looming, the Senate took action late yesterday; approving H.R. 2 by an overwhelming majority (92-8), and permanently repealing the much-maligned Sustainable Growth Rate (SGR). While six amendments were considered, none survived, clearing the way for the President’s signature. President Obama has announced that he will sign the bill.
April 08, 2014
Tucked away in the recently enacted Medicare legislation is a little-noticed provision that should be drawing more attention. While this legislative change implements a seemingly benign new requirement applicable only to physicians ordering advanced diagnostic imaging services, it will likely set the stage for new controls on the use of a wide variety of services…
Jul 24
Join McDermottPlus as we analyze major proposals related to the implementation of the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs); and forecast what this means.
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