Friday, February 27, 2015

CMS pitches 1.1% boost to Medicare Advantage payments

Bob Herman reports in a Modern Healthcare post dated 2-20-15:

The CMS has proposed increasing health insurers' Medicare Advantage payment rates by 1.05% for 2016, a move that kicks off a 45-day dogfight in Washington before the rates are cemented.

The base rate was an 0.95% average decrease, but "when combined with expected growth in plan risk scores due to coding," Advantage plans will actually receive the 1.05% hike in revenue next year, according to a release from the CMS posted late Friday afternoon. Risk scores relate to how Medicare pays for the health status of beneficiaries. CMS pays more for patients who have more health conditions and less for those who are healthier.

Comments on the proposed rates are due by March 6. Final rates will be released April 6.


An increase of a hair over 1% in payment rate falls far short of fair compensation for managing the influx of complex medical cases.

Read More in the current issue of FHI's Week in Review.

Monday, February 16, 2015

Medicare moves toward value-based oncology payments

What Happened

In a Modern Healthcare article posted February 12, 2015,Sabriya Rice reports:

The CMS Innovation Center plans to test a new oncology payment model intended to address the spiraling costs of cancer care and improve quality for beneficiaries. 

As part of a broader federal push to reward hospitals and doctors for value rather than the volume of services they provide, the CMS is inviting oncology practices and solo practitioners to join a five-year test set to begin in the spring of 2016.

Read More (complimentary registration/log in may be required)>>

Why It Matters

Although many practitioners are unimpressed by the push toward value-based care, the train has left the station. See related article entitled Quality-based health care is based on false assumptions by Thomas D. Guastavino, MD and posted to KevinMD.

Read More from this week's issue of Week in Review HERE>>.