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Second Opinion

Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.

Medicare

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


Two House Committees Advance Opioid Legislation

May 18, 2018

Two separate committees in the House of Representatives – the Ways and Means Committee and the Energy and Commerce Committee – advanced separate opioid packages. The action by the House Energy and Commerce Committee follows a May 9 markup of 26 pieces of legislation, and an April 24 markup of 57 pieces of legislation [see, Washington Highlights, April 27, May 11]. The House Ways and Means Committee had not previously considered any related opioids bills.


White House Releases Drug Pricing Plan and RFI

May 18, 2018

President Trump May 11 released the outline of his Administration’s plan to lower prescription drug prices, titled “American Patients First: The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs.”  The Department of Health and Human Services (HHS) May 14 issued a Request for Information (RFI) on the blueprint seeking suggestions to improve the affordability and accessibility of prescription drugs. Responses are due by July 16, 2018.


AAMC Submits Letter to Bipartisan Group of Senators on Price Transparency

May 18, 2018

The AAMC May 14 sent a letter detailing the Association’s priorities on price transparency efforts. The letter was sent to Senators Bill Cassidy, MD (R-La.), Chuck Grassley (R-Iowa), Todd Young (R-Ind.), Michael Bennet (D-Colo.), Tom Carper (D-Del.) and Claire McCaskill (D-Mo.) in response to a request for information sent earlier this spring.


Bipartisan GME Legislation Introduced to Support the Opioid Workforce

May 18, 2018

Representatives Joseph Crowley (D-N.Y) and Ryan Costello (R-Penn.) and Senators Bill Nelson (D-Fla.) and Dean Heller (R-Nev.) May 15 introduced the Opioid Workforce Act of 2018 (H.R. 5818, S. 2843), legislation that increases by 1,000 the number of Medicare supported residency positions available to teaching hospitals that have or are in the process of establishing approved residency programs in addiction medicine, addiction psychiatry, or pain management.


Court Hears Oral Arguments in 340B Case

May 11, 2018

A three-judge panel of the D.C. Circuit May 4 heard arguments in the case challenging Medicare payment cuts to many hospitals in the 340B Drug Pricing Program.


On Government Affairs



Testimony and Correspondence





External Resources