Susan Morse

The insurer said its new subsidiary will work with health systems to create necessary core capabilities for alternative payment models or to hone those already in place for more effective physician alignment and clinical integration. 

Obama wrote that Congress should revisit the idea of building a more affordable public healthcare plan for citizens living in regions with few other options to save the federal government money and improve care. 

The Kaiser Family Foundation investigated the potential impact of capping Medicaid payment rates and found that states and health systems may end up stuck with the bill when beneficiaries cannot pay. 

New measures could save hospitals up to $284 million annually, officials say.

The first rebid for durable medical equipment such as orthotics and prosthetics reduced the Centers for Medicare and Medicaid Services budget by $580 million. The second phase cut it by $3.6 billion. 

The U.S. House Ways and Means Committee has passed the "Helping Hospitals Improve Patient Care Act," a bill that, among other things, aims to provide financial relief to hospitals that were in the process of building off-campus outpatient centers in 2015 when reimbursement policy changed. Ways and Means Health Subcommittee Chairman Pat Tiberi, R-Ohio, and Ranking Member Jim McDermott, D-Washington, introduced the bipartisan legislation last week. It has received support from the American Hospital Association, the Federation of American Hospitals and the Association of American Medical Colleges. One of the bill's main features is turning back the clock - for some facilities - on a policy of the Bipartisan Budget Act of 2015 that lowered the rate at which Medicare reimbursed off-campus doctors' offices owned by hospitals. Prior to the budget act, clinics off-campus were reimbursed at the same rate as hospitals. The reasoning was that hospitals incurred higher expenses. Also, supporters believed the budget act policy would reduce hospitals' incentive to acquire physician offices. The ACA and other hospital groups criticized the policy, saying it would block access to healthcare for patients who used off-campus, outpatient clinics. The Helping Hospitals Improve Patient Care Act, or H.R. 5273, pays off-campus hospital outpatient departments the higher Medicare Hospital Outpatient Department rate for those facilities that were in the process of mid-build from Nov. 2, 2015 to Dec. 31,2016, or 60 days after enactment of the budget act, whichever is later. Newer facilities are capped at the lower physician fee schedule rate. "For those select HOPDs that would qualify, this legislation is a significant relief, and we are supportive of the legislation on their behalf," said American Hospital Association Executive Vice President Tom Nickels. "AHA also supports provisions in the bill that would adjust the Hospital Readmissions Reduction Program to account for socioeconomic status, and extend the Rural Community Hospital Demonstration Program for five years." The legislation also gives improved consideration of socioeconomic status in the Hospital Readmissions Reduction Program, that levies fines over excessive readmissions. It also delays CMS's authority to terminate contracts for Medicare Advantage plans failing to achieve minimum quality ratings as it conducts research and reports on socioeconomic status and quality ratings. Finally, the bill allows hospitals providing cancer care to continue to be paid at cancer hospital rates at new off-campus locations; extends a program dealing with the reimbursement of small rural hospitals for five more years; and exempts physicians who treat patients in ambulatory service centers from the Electronic Health Records Incentive Program and the Merit-Based Incentive Payment System. Ways and Means Committee Chairman Kevin Brady, R-Texas, said  the bill, "provides some necessary regulatory relief to providers and makes it easier for beneficiaries to enroll in Medicare." Twitter: @SusanJMorse Follow Healthcare Finance on Twitter and LinkedIn.

The Democratic presidential candidate’s campaign proposal would make uninsured Americans eligible for Medicare at age 50 or 55. Whether that will be financially advantageous is a matter of some debate. 

Marc Harrison, MD, will replace current CEO Charles Sorenson, who intends to stay on and work with Intermountain’s Healthcare Leadership Institute. 

Under the new Accountable Care Organization, Cigna will reward doctors for healthier populations and reduced expenses. 

Implementation of MACRA will impact not only physicians, but also the hospitals with whom they partner, the American Hospital Association told Andy Slavitt, acting administrator of CMS, and the U.S. House Ways and Means Subcommittee on Health on Wednesday. Health Subcommittee members met with Slavitt Wednesday on the implementation of the Medicare Access and the CHIP Reauthorization Act of 2015. MACRA's Quality Payment Program, released by CMS on April 27, consolidates a patchwork of programs into two paths for physicians receiving Medicare payments: the Merit-based Incentive Payment Systems (MIPS); and an Advanced Alternative Payment Model (APM). The AHA said it applauds MACRA's streamlining of the physician reporting burden, but still has concerns, especially for smaller practices, and is disappointed the federal government is providing no financial incentives for upfront investments in technology to meet the demands of implementation. The estimated investment is $11.6 million for a small accountable care organization and $26.1 million for a medium ACO, the AHA said. [See also: A deep dive on the 'overwhelmingly complex' MACRA proposed rule.] "Hospitals that employ physicians directly may bear the cost of implementation of an ongoing compliance with the new physician performance reporting requirements under the Merit-based Incentive Payment Systems, as well as be at risk for any payment adjustments," the AHA said in a statement. "Moreover, hospitals may be called upon to participate in alternative payment models so that the physicians with whom they partner can qualify for bonus payments and exemption from MIPS reporting requirements that accompanies the APM 'track.'" House Ways and Means Subcommittee on Health Chairman Pat Tiberi, R-Ohio, asked Slavitt about concerns he's heard about the difficulty smaller practices may have coming into compliance, saying the rural provider, and one or two-person provider group "has a bunch of angst right now." Slavitt said the data shows that smaller and solo practices can succeed as well as physicians in larger-size groups as long as they report. It's up to CMS to make the reporting burden as easy as possible, Slavitt said. "Importantly we are looking for additional steps and ideas as people review the rules, but I will say that we are focusing on technical assistance, providing access to medical home models, opportunities to report in groups and using a reporting process that automatically feeds data, reduces the number of measures and overall lowers the burden for small practices," Slavitt said. Small physicians can report in groups and other physicians may not have to report at all because they're under a minimum threshold for the number of Medicare patients they see, Slavitt said. Slavitt said he's heard from physicians that they want to focus on care, not reporting. Congress has provided funding for MACRA technical assistance to small practices, rural practices and others, he said. MACRA replaces the sustainable growth rate and changes the way physicians and providers are paid, moving the healthcare system closer to CMS's goal of tying 50 percent of Medicare payments to alternative payment models by 2018. CMS is taking comment on the MACRA proposal for 60 days. "Success will come from adopting approaches that are practice-driven," Slavitt said. "It is our intent to align the MIPS and the Advanced APM components of the Quality Payment Program, allowing maximum flexibility for clinicians to switch between MIPS and participation in Advanced APMS based on what works best for them and their patients." To spur motivation, MACRA established an 11-member independent advisory committee, the Physician-Focused Payment Model Technical Advisory Committee, PTAC, that will meet quarterly to review payment models. [See also: A deep dive on the 'overwhelmingly complex' MACRA proposed rule.] The AHA has formed its own clinical advisory group to identify  important policy and operational implications of MIPS and APMS for hospitals. The AHA recommends hospital-based physicians be able to use their hospital's quality reporting and pay-for-performance program to measure performance in MIPS; employ risk adjustment rigorously, including for sociodemographics to ensure providers do not perform poorly simply because they care for more complex patients; and align EHR Incentive Program changes for physicians with those of eligible hospitals. The AHA applauded CMS's proposal to reduce the number of measures for quality reporting from nine to six, and also for its recent work with private insurers and physician groups to reach agreement on a common set of physician quality measures that can be used in both CMS and private payer pay-for-performance programs. "Physicians and hospitals alike spend significant resources reporting on multiple versions of measures assessing the same aspect of care to meet the differing requirements of CMS and individual private payers," the AHA said. The AHA is disappointed CMS has proposed a narrow definition of financial risk in advanced APMs for purposes of MACRA bonus payments, in not recognizing the upfront investment made by providers to implement alternative payment models. The AHA also said fraud and abuse laws need to be modified for a "legal safe zone" where physicians and hospitals can share information Twitter: @SusanJMorse