CMS will implement a new Rural Emergency Hospital provider type on Jan. 1. REHs will be able to provide certain outpatient hospital services including emergency department and observation services. CAHs and small rural acute care hospitals with no more than 50 beds are eligible to enroll as REHs under Medicare if they meet certain criteria. If you're considering converting a rural hospital or Critical Access Hospital to an REH, you can submit your application . You can also learn more about becoming an REH Medicare provider . REHs will be paid under the Medicare Outpatient Prospective Payment System payment rates, plus 5.0%. CMS will also include a fixed monthly payment, based on the excess of the total amount paid to all CAHs in 2019 over the estimated total amount that would have been paid to CAHs in 2019 if payment were made for inpatient, outpatient and skilled nursing facility services under the PPS. In the future, the monthly payment will be based on 2023 data, increase...

The good news: The Medicare Shared Savings Program (MSSP) has reported a fifth consecutive year of savings while delivering high-quality care for Medicare beneficiaries in accountable care organizations (ACOs). The tricky news: With participation dropping since performance year 2018, ACOs will need places to pivot as success becomes more dependent on risk progression, benchmarking and equity goals. The 2021 MSSP results CMS reported the following highlights from the 2021 MSSP performance year : 99% of participants met the quality targets required for shared savings; 58% earned shared savings; ACOs outperformed non-MSSP providers in metrics related to diabetes, blood pressure, select cancers, fall risk, flu vaccination, tobacco screening and smoking cessation, and screening/remission for depression. ACOs with specific characteristics saved more than their counterparts. This includes ACOs labeled low revenue and those dominated by primary care providers. For example, low-revenue ACOs sa...

As the final at-risk period for the Oncology Care Model was closing at the end of June, the Center for Medicare and Medicaid Innovation announced its new Enhancing Oncology Model (EOM). EOM aims to improve the coordination of oncology care, drive practice transformation and reduce Medicare fee-for-service spending through episode-based payment.  What is EOM? EOM is a voluntary, five-year model set to begin July 1, 2023. Patients undergoing chemotherapy for the treatment of cancer will trigger six-month episodes of care.  Eligible EOM participants include physician group practices with at least one Medicare-enrolled physician or a non-physician practitioner who furnishes evaluation and management services to Medicare beneficiaries receiving chemotherapy for cancer treatment.  EOM participants are required to implement eight participant redesign activities to drive care transformation in their practice. Examples include the provision of patient navigation, 24/7 access ...

DataGen’s 2022 Enacted Medicare Cuts Analysis shows how hospitals have been impacted by existing Medicare fee-for-service provider payment cuts enacted by Congress to achieve Medicare payment policy and/or long-term deficit reduction goals. This analysis is provided to DataGen clients for advocacy purposes only . The impacts shown in this analysis include the major legislative, regulatory and quality cuts enacted since 2010 and are described below.  Enacted legislative cuts analyzed: Medicare marketbasket, Medicare Disproportionate Share Hospital and quality adjustments authorized by the Affordable Care Act of 2010; note that for this analysis, quality adjustments are broken out into their own category;  the effect of the 2.0% across-the-board sequestration reduction to payments authorized by the Budget Control Act of 2011, and the 4.0% sequestration reduction resulting from the calendar year 2021 triggering of the Statutory Pay-As-You-Go Act of 2010 (PAYGO);  inpatient c...

The 340B Drug Pricing Program allows qualifying hospitals to offer affordable prescription drugs to financially vulnerable and fragile patients by purchasing outpatient drugs from manufacturers at a discounted rate. These hospitals then can reinvest the savings in their services. In 2018, CMS issued a final Outpatient Prospective Payment System rule that reduced by approximately 25% the reimbursement for certain drugs that hospitals acquired through the 340B Program and then continued those cuts in 2019 through 2022. HHS' 340B cuts are currently being challenged through a lawsuit with the U.S. Supreme Court.  This analysis includes the continued 3.19% budget-neutral adjustment and the 340B reduction (Average Sales Price minus 22.5%) that was identified in the Standard Analytic File with the “JG” modifier, resulting in a net impact. DataGen has analyzed the budget neutrality adjustment and 340B cuts utilizing the 2019 Standard Analytic File showing the potential impact to 340B hosp...

DataGen has completed its analysis of enacted Medicare cuts, the results of which are shared here. Please note that this analysis is intended for advocacy purposes only and should be used as an indication of the extent to which hospital providers nationwide have been impacted by existing Medicare provider payment cuts. These cuts were enacted by Congress to achieve Medicare payment policy and long-term deficit reduction goals. This DataGen impact analysis includes major cuts enacted since 2010. The enacted legislative cuts analyzed consist of: Medicare marketbasket, Medicare Disproportionate Share Hospital and quality adjustments authorized by the Affordable Care Act of 2010; note that for the purposes of this analysis, quality adjustments are broken out into their own category; the effect of the 2.0% across-the-board sequestration reduction to payments authorized by the Budget Control Act of 2011; inpatient coding adjustment reductions authorized by the American Taxpayer Relief Act of...