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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 | Physician 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 | HIT | Coverage and Delivery Reform


News and Updates


MedPAC Discusses Physician and Hospital Medicare Payment Adequacy

January 13, 2017

The Medicare Payment Advisory Commission (MedPAC) Jan. 12-13 held a meeting to discuss a range of Medicare issues, including payment adequacy of various payment systems, approaches to MACRA implementation, and Medicare Part B payment policy issues.


OIG Issues Report on Vulnerabilities of Two-Midnight Rule

January 6, 2017

The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) Dec. 16 issued a report on the issues following the Center for Medicare and Medicaid Service’s (CMS)’s implementation of the Two-Midnight rule policy.


ASPE Releases First of Two Reports on Social Risk Factors in Medicare’s Performance Programs

January 6, 2017

The Office of the Assistant Secretary for Planning and Evaluation (ASPE) Dec. 21 released the first of two reports to analyze the effect of social risk factors on Medicare quality-based payment programs and quality and resource use measures.


AAMC Comments on New Payment Rates for Nonexcepted HOPDs

January 6, 2017

The AAMC Dec. 29 submitted a comment letter on the Centers for Medicare and Medicaid Services (CMS)’s 2017 Outpatient Prospective Payment System (OPPS) Interim Final Rule with Comment (IFC).


AAMC Submits Comment Letter on Final Rule for MACRA Physician Payment System

January 6, 2017

The AAMC Dec. 19 submitted a comment letter in response to the Centers for Medicare and Medicaid Services’ (CMS) final rule with a comment period on the Medicare Access CHIP Reauthorization Act (MACRA) physician payment system.