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GME | Hospital Quality and Payment

The Medicare program, run by the Centers for Medicare and Medicaid Services (CMS), provides health insurance to the aged, disabled, and individuals who have end stage renal disease (ESRD).  Medicare, however, also plays a special role funding Graduate Medical Education (GME) at teaching hospitals. 

Medicare Disproportionate Share (DSH) payments compensate certain hospitals for the higher operating costs they incur in treating a large share of low-income patients, which teaching hospitals do. These hospitals often face substantial financial pressure, as they may provide significant amounts of care to the poor and lack the revenue needed to underwrite the costs associated with the provision of services.

Other areas of Medicare of interest to teaching hospitals and physicians include:

  • the Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS);
  • the Medicare Physician Fee Schedule (PFS);
  • the Center for Medicare and Medicaid Innovation (CMMI); and
  • the Medicare Payment Advisory Commission (MedPAC).

Payments: DSH | Geographic Variations | Coverage and Delivery Reform

News and Updates

AAMC Submits Comments to CMS on CY 2019 Medicare Physician Fee Schedule and Quality Payment Program Proposed Rule

September 14, 2018

The AAMC Sept. 10 submitted comments to the Centers for Medicare and Medicaid Services (CMS), responding to the agency’s proposed rule changes in the Medicare Physician Fee Schedule and Quality Payment Program to take effect in calendar year (CY) 2019. CMS proposed major changes to payment and documentation for outpatient evaluation and management (E/M) services. It also proposed that Medicare cover newly-established interprofessional internet consultation codes and recommended changes and updates to the quality payment program (QPP). 

MedPAC Discusses Payment Policy Context, Beneficiary Enrollment, Redesigning Hospital Quality Programs, and Other Topics

September 7, 2018

The Medicare Payment Advisory Commission (MedPAC) met Sept. 6-7 to discuss several Medicare payment issues, including the broader context of Medicare payment policy, understanding beneficiary enrollment, redesigning hospital quality measurement and incentives among other topics.

Congressional Leaders Send Letters on 340B Program

September 7, 2018

Leaders of the Senate Health, Education, Labor, and Pensions (HELP) Committee and House Energy and Commerce Committee sent an Aug. 27 bipartisan, bicameral letter to Health Resources and Services Administration (HRSA) Office of Pharmacy Affairs Director Capt. Krista Pedley, PharmD, MS, on the 340B Drug Pricing Program.

AAMC Refiles Lawsuit Challenging CMS’s Authority to Reduce Payment for Certain 340B Drugs

September 7, 2018

The AAMC, American Hospital Association, America’s Essential Hospitals, and three hospitals – Henry Ford Health System, Eastern Maine Healthcare Systems, and Park Ridge Health – Sept. 5 refiled the 340B lawsuit that had been rejected by an appeals court in July as the plaintiff hospitals had not yet filed claims or gone through the administrative appeals for reduced payment for separately payable drugs purchased under 340B in the fiscal year 2018 Outpatient Prospective Payment final rule [see Washington Highlights, July 20]. The new lawsuit argues that the reduction in 340B payments violate the Administrative Procedures Act.

HHS OIG Issues Request for Information Regarding the Anti-Kickback Statute and Beneficiary Inducements Civil Monetary Penalty

August 30, 2018

Department of Health and Human Services (HHS) Office of the Inspector General (OIG) Aug. 27 released a Request for Information (RFI) regarding the anti-kickback statute and beneficiary inducements civil monetary penalty (CMP) seeking input from the public on addressing regulatory provisions in Medicare and state health programs that may act as barriers to coordinated or value-based care.

On Government Affairs

Testimony and Correspondence

External Resources