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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


AAMC Submits Comments to HHS ASPE on Social Risk Factors

November 16, 2018

The AAMC Nov. 16 submitted comments to the Department of Health and Human Services (HHS) Assistant Secretary for Planning and Evaluation (ASPE) in response to a request for information on provider and health plan approaches to improve care for Medicare beneficiaries with social risk factors (SRF).


MedPAC Discusses Modernizing the Medicare-Dependent Hospital Program and Integrating Dual-Eligible Special Needs Plans

November 9, 2018

The Medicare Payment Advisory Commission (MedPAC) met Nov. 12 to discuss several issues, including potential policies for modernizing the Medicare-Dependent Hospital (MDH) program and integrating Medicare and Medicaid for dual-eligible special needs plans (D-SNPs).


HHS OIG Issues Report on CMS’s Policies and Procedures on Medicare GME Reimbursement Compliance

November 9, 2018

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) Nov. 1 issued a report on whether the Centers for Medicare and Medicaid Services (CMS) adequately ensures that hospitals comply with Medicare graduate medical education (GME) requirements.


CMS Releases CY 2019 OPPS Final Rule

November 9, 2018

The Centers for Medicare and Medicaid Services (CMS) Nov. 2 released the calendar year (CY) 2019 Medicare Outpatient Prospective Payment System (OPPS) final rule. Among other policy issues, the final rule addresses site-neutral payment reductions for off-campus outpatient clinics, expands payment reductions for certain drugs acquired under the 340B program, and makes changes to the Medicare hospital quality reporting program. The AAMC previously submitted comments on the proposed rule [see Washington Highlights, Sept. 28]. 


CMS Releases Medicare Physician Fee Schedule and Quality Payment Program Final Rule

November 9, 2018

The Centers for Medicare and Medicaid Services (CMS) Nov. 1 released a final rule on the Physician Fee Schedule and Quality Payment Program, delaying changes to payment for evaluation and management (E&M) codes until 2021 and finalizing some documentation changes. AAMC President and CEO Darrell G. Kirch, MD, issued a statement applauding CMS for the documentation changes. He said, “These will significantly reduce burden for physicians and other health care professionals, allowing them more time to focus on patients.”


On Government Affairs



Testimony and Correspondence





External Resources