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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 Releases March 2019 Report to Congress, Recommends Payment Updates for Medicare’s Payment Systems

March 22, 2019

The Medicare Payment Advisory Commission (MedPAC) March 15 released its March 2019 Report to Congress. The report recommends payment updates for Medicare’s payment systems, including a 2% update for hospital inpatient and outpatient services.

MACPAC Releases March 2019 Report to Congress, Including Recommendation for DSH Allotments to States

March 22, 2019

The Medicaid and CHIP (Children’s Health Insurance Program) Payment and Access Commission (MACPAC) March 15 released its March 2019 Report to Congress on Medicaid and CHIP. The Commission made recommendations on restructuring disproportionate share hospital (DSH) allotment reductions in current law and upper payment limit (UPL) oversight. Additionally, MACPAC included its annual analysis of DSH allotments to states.

MedPAC Discusses Primary Care Physician Shortage, Growth in Spending on ED Services, and Clinician Payment

March 8, 2019

The Medicare Payment Advisory Commission (MedPAC) met March 7-8 to discuss Medicare’s role in the supply of primary care physicians, the growth of spending for emergency department (ED) services, and clinician payment. 

House, Senate Hold Hearings on Prescription Drug Prices

March 8, 2019

The Senate and House the week of March 4 each held hearings to examine prescription drug prices. The Senate Special Committee on Aging hosted the first two in a series of hearings on the topic, while the House Ways and Means Health Subcommittee continued its work to find solutions to help lower drug prices.

CMS Updates Hospital Quality Star Ratings, Invites Public Input on Future Improvements

March 1, 2019

The Centers for Medicare and Medicaid Services (CMS) Feb. 28 released updated Star Ratings as part of a broader refresh to the hospital quality data publicly available on the Hospital Compare website.

On Government Affairs

Testimony and Correspondence

External Resources