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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

MedPAC Recommends Changes to Physician Payments and Hospital Payment Updates

January 18, 2019

The Medicare Payment Advisory Commission (MedPAC) met Jan. 17-18 to approve recommendations on physician payments and hospital payment updates. The commission also discussed Medicare prescription drug pricing and performance in the Medicare Shared Savings Program (MSSP).

AAMC Submits Comments on NQF Measure Application Partnership Draft Report

January 11, 2019

The AAMC Jan. 10 submitted comments to the National Quality Forum (NQF) regarding the Measure Application Partnership’s (MAP) draft reports to the Centers for Medicare and Medicaid Services (CMS) on 2019 Considerations for Implementing Measures based upon CMS’s 2018 Measures under Consideration List for 2019 pre-rulemaking.

AAMC Submits Comments on International Pricing Index Model ANPRM

January 11, 2019

The AAMC Dec. 31, 2018, submitted comments on the Centers for Medicare and Medicaid Services’ (CMS) advance notice of proposed rulemaking (ANPRM) titled, “International Pricing Index Model (IPI Model) for Medicare Part B Drugs.” The AAMC supports efforts to address skyrocketing drug prices. However, the association’s comments express concern that the IPI Model, as outlined in the ANPRM, would result in increased regulatory and financial burden on hospitals. 

MedPAC Discusses Payment Adequacy and Updating Services and Redesigning the Hospital Quality Incentive Program

December 7, 2018

The Medicare Payment Advisory Commission (MedPAC) met Dec. 6-7 to discuss payment adequacy and updates to payments for professional, inpatient, and outpatient services, as well as redesigning Medicare’s hospital quality incentive program. The commission discussed several draft recommendations, which will be voted upon at the January 2019 meeting.

CMS Releases Price Comparison Tool for Certain Surgical Procedures

November 30, 2018

The Centers for Medicare and Medicaid Services (CMS) Nov. 27 released an online price comparison tool to allow beneficiaries to compare Medicare payments for certain procedures that are performed in both hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs). 

On Government Affairs

Testimony and Correspondence

External Resources