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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 teaching 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 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). 

HHS OIG Issues Report on Vulnerabilities in the Hospital Wage Index System for Medicare Payments

November 30, 2018

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) Nov. 28 issued a report on perceived vulnerabilities in the hospital wage index system for Medicare payments.

CMS Proposes Changes to Medicare Advantage and Part D Formulary Requirements

November 30, 2018

The Centers for Medicare and Medicaid Services (CMS) Nov. 26 released a proposed rule that would establish exceptions to formulary requirements for protected drug categories and classes under Medicare Advantage (MA) and Medicare Part D, as well as expand the use of step therapy and prior authorization. CMS also proposed requiring the inclusion of drug pricing information in the Part D Explanation of Benefits that beneficiaries receive.

AAMC Submits Comments to CMS on Hospital Outcome Measurement for Patients with Social Risk Factors

November 30, 2018

The AAMC Nov. 29 submitted comments to the Centers for Medicare and Medicaid Services (CMS) in response to the agency’s request for information regarding Hospital Outcome Measurement for Patients with Social Risk Factors. 

On Patient Care

Testimony and Correspondence