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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

CMS Issues Proposed Physician Fee Schedule (MPFS) and Quality Payment Program (QPP) Rule for 2019

July 13, 2018

The Centers for Medicare and Medicaid Services (CMS) proposed historic changes to the evaluation and management code documentation and payment in a proposed rule released July 12, 2018. This rule will update payment rates and policies for services provided by physicians and other clinicians to Medicare beneficiaries in 2019. The rule also proposes changes to the QPP, which consists of two participation pathways — merit-based incentive payment system (MIPS), which measures performance based on four categories, and advanced alternative payment models (APMs) in which clinicians may earn incentive payments based on sufficient participation in models. The AAMC will analyze the proposed rule in more detail in the coming weeks and will be submitting comments by the September 10, 2018, deadline.

NQF Launches 3-Year Extension to Social Risk Trial

June 29, 2018

The National Quality Forum (NQF) June 28 launched a three-year extension of its Social Risk Trial as part of NQF’s Health Equity Program. The initial trial began in 2015 and ended in August 2017. The extension will build upon the trial’s prior work examining the inclusion of social risk factors in risk adjustment models for quality measurement.  It also will help inform a decision on whether to change permanently NQF’s policy to allow social risk adjustment for outcome measures.

Energy and Commerce Committee Holds Mark-Up of Five Public Health Bills

June 29, 2018

The House Energy and Commerce Committee June 27 held a mark-up of five public health bills; the Title VIII Nursing Workforce Reauthorization Act of 2017 (H.R. 959), the Palliative Care and Hospice Education and Training Act (H.R. 1676), the Educating Medical Professionals and Optimizing Workforce Efficiency Readiness Act of 2017 (EMPOWER Act, H.R. 3728); the Children’s Hospital GME Support Reauthorization Act of 2018 (H.R. 5385), and a discussion draft of the Pandemic and All-Hazards Preparedness Reauthorization Act of 2018.

Senate HELP Committee Holds Hearing on the Rising Cost of Health Care

June 29, 2018

The Senate Health, Education, Labor and Pensions (HELP) committee June 27 held a hearing titled “How to Reduce Health Care Costs: Understanding the Cost of Health Care in America.” The hearing is a first in a planned series of hearings to examine health care costs, which will include a hearing on administrative costs, waste, how to improve transparency, and private sector solutions.

AAMC Submits Comment Letter on IPPS FY 2019 Proposed Rule

June 29, 2018

The AAMC June 25 submitted a comment letter on the Centers for Medicare and Medicaid Services (CMS) Inpatient Prospective Payment System (IPPS) fiscal year (FY) 2019 proposed rule. In addition to the standard payment update proposals, the proposed rule detailed changes to the Medicare cost report submission requirements, public listing of hospital standard charges, and payment for chimeric antigen receptor T-cell (CAR-T) therapies. Moreover, the proposed rule addressed several quality measurement issues, including removing quality measures, Value-Based Purchasing (VBP) Program scoring, Hospital-Acquired Condition Reduction Program (HACRP) scoring, and the Medicare and Medicaid Promoting Interoperability Programs.

On Government Affairs

Testimony and Correspondence

External Resources