New Report from Bloomberg Government Questions CMS’s Projected Savings
According to a new report from Bloomberg Government, the Centers for Medicare and Medicaid Services might be overstating the savings it projects to derive from its national competitive bidding program. The report titled “Assessing Year One of Medicare’s Competitive Bidding Program,” is a 26-page study done by Bloomberg Analyst Brian Rye. The various criticisms of NCB made by auction experts and HME industry representatives were reviewed by Rye. In addition, he described the reduction of 85% in HME providers allowed to bill Medicare in Round one.
Bloomberg’s report also raised the question why the total impact of the program was not being measured where the program’s full cost savings are concerned. Rye noted that to completely assess whether the program is resulting in any kind of activity that causes other types of Medicare expenditures, it would more effective if CMS would offer an analysis of Part A and other Part B claims from the nine areas affected by the bidding program.
HME News in Brief
In a letter to the Senate Finance Committee, AAHomecare stated that CMS’s current anti-fraud strategies are confusing and subjective. This is in response to the Committee’s plan to continue gathering input from industry stakeholders and providers about anti-fraud efforts as it intends to release a summary document with proposed best practices and ideas in fall.
PECOS Improved for Better Access
CMS announced in a bulletin that it has improved PECOS to increase access to information. Included in the improvements are: The layouts of the homepage and log-in screen which have been redesigned to include helpful links to tutorials, the ordering and referring list and the revalidation notice sent list.
OIG Favors Rebate Programs
A recently released report by the Office of Inspector General (OIG) had stated that by using manufacturer rebates for test strips, Indiana Medicaid had saved 50%. It showed a maximum Medicaid reimbursement rate of $36.72, with overall savings of $1.2 million from January 1 through June 30, 2011.
Industry Stakeholders Offer suggestions the Senate Finance Committee
In response to the U.S. Senate Committee on Finance’s solicitation to the health care community requesting recommendations on ways to curb fraud, waste and abuse in the Medicare system, VGM and several independent providers created a white paper outlining problems, and offering solutions to the Medicare auditing system. The group mentioned the four main problems in the auditing system, namely:
1) lack of oversight;
2) lack of regulations and standardization;
3) lack of transparency; and
4) lack of accountability and enforcement.
Legal argument containing anecdotal evidence to advocate for 15 specific changes to the auditing system was found in the 31-page white paper. Included are the requirement for auditors to abide by Medicare’s regulatory guidelines and the creation of benchmarks to establish the beginning and end of prepayment audit.
The white paper submission will be reviewed by the Senate Finance Committee who intends to prepare a report later this year.
More Organizations Show Interest in Medicare Shared Savings Initiatives
Eighty-nine new Accountable Care Organizations (ACOs) began serving 1.2 million people with Medicare in 40 states and Washington on July 1, according to the federal Department of Health and Human Services (HHS).These organizations, which are formed by groups of health care providers that have agreed to work together to coordinate caring for Medicare beneficiaries, share savings coming from the efficient management of patients. The 89 newly added ACOs bring the total to 154 organizations participating in Medicare shared savings initiatives.
HHS reported that more than 2.4 million beneficiaries receive care from providers taking part in the shared savings initiatives. Most of these ACOs have nationwide operations and almost half are physician-driven serving lesser than 10,000 beneficiaries, which shows that smaller organizations favor operating as ACOs.
Rejecting Medicaid Expansion could Affect Health Outcomes
The president and CEO of the National Association of Public Hospitals and Health Systems (NAPH), Bruce Siegel, has released a statement expressing concerns over the rejection of Medicaid expansion in some states. This means that as many as 4 million people who would have been eligible for Medicaid could become uninsured in states that have decided against the expansion. Siegel notes that the consequences of these rejections, which leave so many people uninsured, can greatly harm entire communities and affect even those with insurance.
NAPH emphasized the importance of insurance coverage in improving health outcomes and quality of life as evidenced by a randomized study in Oregon which showed adults without insurance being diagnosed with later stage cancer and dying from trauma or other serious acute conditions. Furthermore, the same study also found that higher numbers of uninsured can reduce the availability and quality of local health care services for everyone.