Timely analysis from our multidisciplinary team.
November 14, 2019
McDermottPlus is pleased to present The Health Policy Breakroom, a podcast dedicated to health policy updates. Our inaugural episode provides an overview of the 2020 PFS, OPPS and ASC Final Rules recently released by CMS.
February 12, 2020
On February 10, 2020, the White House released its $4.8 trillion FY 2021 budget proposal. In the area of healthcare, the president requested $94.5 billion in discretionary budget authority for the US Department of Health and Human Services (HHS), which represents a 10% decrease from the 2020 enacted level.
February 11, 2020
On February 5, 2020, CMS issued two documents impacting the Medicare Advantage program: (1) the Medicare and Medicaid Programs: Contract Year 2021 and 2022 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly Proposed Rule; and (2) the…
February 07, 2020
The House Ways and Means and Education and Labor committees released information on their surprise billing proposals, and President Trump delivered the State of the Union on the eve of the Senate’s vote to acquit him in the impeachment trial.
January 31, 2020
The House of Representatives returned from recess to continue work on legislation to address surprise medical bills and high drug costs, while the Administration unveiled a proposal to let states opt for Medicaid block grants. The Senate remained busy with impeachment proceedings.
January 17, 2020
The House of Representatives voted to formally present the articles of impeachment against President Trump to the Senate, kicking off the trial phase of the impeachment process. The Senate trial is expected to tie-up and stall legislation in the upper chamber for several weeks, and perhaps longer. House lawmakers, meanwhile, continued to grapple with surprise…
January 13, 2020
The year 2020 is expected to be another active year for the healthcare industry. In this report, we have narrowed a vast health policy landscape to our top 10 issues of significance for 2020, and offer our consultants’ insights into what 2020 might have in store.
December 20, 2019
The 2019 legislative session has come to an end. Lawmakers reached a deal to fund the government through fiscal year (FY) 2020, the House of Representatives impeached President Trump, and a federal appeals court issued a highly anticipated ruling with implications for the Affordable Care Act (ACA).
November 26, 2019
Primary Care First, a new care delivery and payment model from the CMS Innovation Center is another approach to advancing primary care. PCF eligibility and care delivery design mirror the CPC+ model in several ways, but is distinct in others. The model leverages both population-based and flat fee visit payments to promote access and better…
November 21, 2019
Mara McDermott and Jessica Roth join Emma Zimmerman to discuss changes in the 2020 Hospital Outpatient Prospective Payment System final rule related to prior authorization and the landscape of utilization management policy more broadly.
November 20, 2019
Healthcare remains a pressing concern for voters heading into the 2020 presidential election. Many of the Democratic candidates have put forward detailed policy proposals for expanding healthcare access and affordability. The table below offers a broad overview of the healthcare plans proposed by the major contenders in the 2020 Democratic Primary, focusing on coverage, affordability,…
November 06, 2019
On November 1, 2019, CMS released the CY 2020 Revisions to Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies, which includes changes related to Medicare physician payment and the Quality Payment Program effective for services on January 1, 2020.
October 11, 2019
There are 20 scheduled joint legislative days left until the current continuing resolution funding the government ends on November 21, 2019, followed by an additional eight scheduled joint legislative days until the end of the year. These are significant dates for several important healthcare programs and their funding.
September 20, 2019
On September 19, 2019, the Speaker of the US House of Representatives released a proposal to contain federal and individual spending on prescription drugs, joining Administration and Senate efforts to address prescription drug pricing. This article contemplates the likelihood of a drug pricing package and how it could come together.
August 06, 2019
On July 29, 2019, CMS released the CY 2020 Revisions to Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies, which includes proposals related to Medicare physician payment and the Quality Payment Program. The proposed regulations will be published in the Federal Register on August 14, 2019. Comments are…
July 26, 2019
This Week’s Dose: The Senate Finance Committee finally released its drug pricing package and moved quickly to a markup. The bill passed out of committee, but work will continue before the full Senate votes. We’ll be watching closely as things develop.
July 25, 2019
There has been a surge of congressional activity relating to the various surprise billing proposals. What started out as an issue for a small Senate working group last year has turned into a major health priority for both parties in both chambers.
July 24, 2019
On July 10, 2019, the CMS published the Medicare Program; Specialty Care Models to Improve Quality of Care and Reduce Expenditures proposed rule. This proposed rule implements a new mandatory Radiation Oncology Model and furthers the administration’s goal of transitioning providers to performance-based arrangements in traditional Medicare.
July 19, 2019
This Week’s Dose: The Energy and Commerce Committee held a marathon mark-up of 25 bills, including 10 health care related bills. The No Surprises Act received an amendment that adds arbitration to the payment dispute process. The House voted to repeal the Cadillac tax. And, we finally have a Congressional Budget Office (CBO) score for…
July 12, 2019
This Week’s Dose: Congress is back for the final legislative session before the August recess, and it’s all about what can get done ahead of the break. House and Senate committees have already advanced a cost containment legislation that includes surprise billing and prescription drug cost provisions, among many other things. We still await any…
July 11, 2019
The question is not if, but how: How will lawmakers tackle surprise billing? What started out as question for a small Senate working group in 2018 has turned into one of the major health priorities of both parties.
June 28, 2019
This Week’s Dose: Lots of movement in Congress ahead of the Fourth of July recess with the House and Senate both advancing a number of health care bills. President Trump also signed an executive order this week, continuing the Administration’s focus on health care transparency.
June 21, 2019
This Week’s Dose: Three weeks down, one week to go in this work period. The Senate Health, Education, Labor and Pensions (HELP) Committee is moving forward with its cost containment legislation, and the House passed the first batch of health care extenders.
June 14, 2019
This Week’s Dose: The focus was back on surprise billing this week with the third hearing of the year. We also saw hearings on Medicare for All and vertical consolidation in the health care industry, and the House advanced an appropriations package.
May 29, 2019
Since mid-2018, the Centers for Medicare and Medicaid Services has been implementing sections of the American Patients First Blueprint, President Trump’s plan to lower drug prices and reduce patient out-of-pocket spending.
May 10, 2019
This Week’s Dose: Another busy week for prescription drug pricing. Two more hearings took place on the subject, and a handful of bills passed out of the House. Now we watch the Senate to see how it packages and advances prescription drug bills that have moved through the House.
May 03, 2019
This Week’s Dose: Lots of activity surrounding single-payer this week with a hearing, the introduction of two Medicare expansion bills and a report from the Congressional Budget Office (CBO). Hearings and markups of drug pricing bills continue as well. This legislative session is off to a busy start.
April 26, 2019
This Week’s Dose: When Congress is away, the agencies will play. The Administration made some major announcements and dropped several new important rules this week, giving stakeholders plenty to talk about (and work on) while Congress is in recess.
March 13, 2019
On March 11, 2019, the White House released its FY 2020 budget proposal. In the area of health care, the president has requested $87.1 billion in discretionary budget authority for HHS, which represents a 12 percent decrease from the 2019 estimated level. Read on for key HHS proposal highlights.
March 06, 2019
On February 27, 2019, Representative Pramila Jayapal (D-WA) and more than 100 co-sponsors in the House of Representatives introduced the Medicare for All Act (HR 1384). The bill, like its predecessors, creates a single payer, government-funded health care program. The new program would cover enumerated medical benefits, prescription drugs, vision, dental, mental health and substance…
February 20, 2019
CMS released its latest payment innovation model, “Emergency Triage, Treat and Transport”, which will incentivize reducing costs for the emergency transport and care of Medicare fee-for-service beneficiaries by allowing ambulance suppliers to be paid by Medicare for transport not only to emergency departments but also to alternative sites, such as urgent care centers or primary…
February 08, 2019
This Week’s Dose: The State of the Union briefly highlighted a few Administration health initiatives. The House continues its focus on the Affordable Care Act (ACA). The Senate is pressuring CEOs from the largest drug manufacturers to testify.
January 31, 2019
This Week’s Diagnosis: Government reopens…for at least three weeks. Congress is full steam ahead, kicking off the 116th with health care hearings on drug pricing and pre-existing conditions. The US Department of Health and Human Services focuses on 2019 priorities.
January 11, 2019
This Week’s Diagnosis: Welcome back – sort of. The partial federal government shutdown drags on. We are on day 21 with no end in sight, which has shifted the focus of the new Congress away from overarching health priorities and toward continued efforts to reopen the government.
January 08, 2019
On December 31, 2018 CMS published the Medicare Shared Savings Program; Accountable Care Organizations—Pathways to Success and Extreme and Uncontrollable Circumstances Policies for Performance Year 2017 final rule.
December 14, 2018
This Week’s Diagnosis: President Trump clashed with House Democratic Leader Nancy Pelosi (D-CA) and Senate Minority Leader Chuck Schumer (D-NY) in a meeting this week about how to keep the government’s lights on. The President threatened to shut down the government on December 21, when the current short-term funding agreement expires, if his request for…
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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