- The Center for Medicare and Medicaid Services ("CMS") last Thursday issued its final rule revising Medicare's outpatient hospital prospective payment system for the 2008 calendar year. "CMS estimates hospitals will receive an overall average increase of 3.8 percent in Medicare payments for outpatient services in CY 2008." CMS is linking Medicare reimbursement to quality measure reporting by hospitals.
In CY 2008, CMS is requiring that hospitals report seven consensus quality measures, including five emergency department acute myocardial infarction transfer measures and two surgical care improvement measures. Hospitals that are paid under the Inpatient Prospective Payment System are required to report the applicable hospital outpatient quality measures in order to receive the full OPPS market basket update in CY 2009; otherwise, their CY 2009 update will be reduced by 2.0 percentage points.
- CMS also announced its final rule on Medicare Part B payments to physicians. CMS explains that a statutory formula mandates a 10.1% reduction in those payments for the 2008 calendar year, unless Congress changes the formula which is likely in my opinion. CMS currently is paying physicians who participate in the voluntary Physician Quality Reporting Initiative (PQRI) Medicare payment incentives of up to 1.5 percent of their total allowed charges, subject to a cap. "The 2008 rule also adopts recommendations of the American Medical Association’s Relative Value Update Committee to increase the payments for the work involved in providing anesthesia services by 32 percent. In addition, the value of the work component of certain physician visits to patients’ homes will increase."
- The Philadelphia Inquirer is reporting the the Medicare Part D prescription drug program is one the factors causing a substantial reduction in prescription drug imports from Canada.