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Data Sharing Slows Hospitals on Stage 2 Attestation
Problems sharing digital health data with other providers and patients have limited the number of hospitals that have successfully attested to Stage 2 of the federal electronic health record (EHR) incentive program, new research indicates.

Seventy-eight hospitals have attested to Stage 2 of meaningful use for the 2014 reporting year, according to data released in August, representing a jump of 68 from the previous month. Such attestation is required to receive bonus payments and avoid FY15 penalties under the Medicare EHR incentive program authorized in 2009. The program requires hospitals that have attested to Stage 1 for at least two years to then attest to the more advanced requirements of Stage 2. Failure to demonstrate meaningful use for 90 consecutive days during the fiscal year could result in a 1 percent reduction in hospitals' Medicare payments.

The new research indicates that aspects of the 16 core objectives related to data sharing—with both other providers and patients—may be the biggest factors preventing hospitals from attesting to Stage 2 of meaningful use.

Medicare Inpatient Hospital Rates Tick Up
The final FY15 Inpatient Prospective Payment System (IPPS) rate increase of 1.4 percent, released in August, was slightly larger than the 1.3 percent proposed by the Centers for Medicare & Medicaid Services (CMS) in April.

Hospitals that submit data on quality measures and meaningfully use electronic health records would avoid a combined 0.5 percent reduction in the 2.9 percent market-basket update. Additionally, all IPPS hospitals face a 0.5 percent productivity cut and a 0.2 percent cut mandated by the Affordable Care Act (ACA). An additional 0.8 percent cut was required by the American Taxpayer Relief Act of 2012 to reclaim supposed overpayments stemming from documentation and coding changes in FY10-12.

Also among the payment changes is an ACA-mandated 1.3 percent reduction in Medicare disproportionate share hospital (DSH) payments. The reduction was an increase over the 0.9 percent cut originally proposed.

Washington Update

Federal appeals courts reached opposite conclusions in late July on whether subsidies are legal for health insurance policies purchased through 34 of the new government-run marketplaces. A panel of the District of Columbia Circuit Court of Appeals concluded that the language of the ACA clearly limited federal subsidies to marketplaces established by states, which operate only 16. On the same day, a three-judge panel of the U.S. Court of Appeals for the Fourth Circuit in Richmond ruled unanimously that the language of the law was too vague to draw definitive conclusions and upheld the subsidies. The ACA marketplaces paid $16 billion in premium and cost-sharing subsidies for 5 million enrollees in the first year of operation, according to the Congressional Budget Office. The White House said the premium tax credits will continue until the appeals are completed.

President Barack Obama signed legislation in August to expand treatment options for veterans. The $16.3 billion measure aims to increase veterans’ access to healthcare services following the discovery that Department of Veterans Affairs (VA) facilities used a variety of misleading tactics to obscure wait times for care. The law includes $10 billion to provide access to care at non-VA providers when delays hamper veterans’ care. Veterans who live more than 40 miles from a VA facility or who have to wait more than 30 days for a medical appointment can seek outside care. The law requires negotiated payment rates—up to Medicare rates—and implementation of prompt-payment systems for non-VA providers. The law also exempts non-VA providers from federal contractor or subcontractor obligations for its duration. 

A new "collaboration" with states announced by CMS Services will provide $100 million in federal expertise to help Medicaid programs improve healthcare delivery while reducing costs. The Medicaid Innovation Accelerator Program funding will pay for federal technical support to help states’ efforts to improve their Medicaid programs and will seek to "jump-start innovation" by providing federal tools and resources. Federal support will focus on data analytics, quality measurement and rapid-cycle evaluation capabilities, and effective and timely dissemination of best practices and learning among states.

The penalties for a lack of qualifying health insurance this year will be capped at $2,448 for individuals and $12,240 for families of five or more people, according to parameters specified in July by the IRS. The ACA’s individual mandate established a tax penalty of 1 percent of annual household income for individuals making at least $19,650 and $95 for those making less (those making less than $10,150 would not be penalized). The newly released caps mean the tax penalty would be under 1 percent for individuals making more than $244,800 this year. The Obama administration also signaled that it intends to continue with the rollout next year of the long-delayed employer mandate.


HFMA Comments to CMS on the 2015 Medicare OPPS Proposed Rule
HFMA voices concerns on key payment policy issues in the 2015 Medicare outpatient PPS proposed rule. Read HFMA's comment letter.

HFMA Fact Sheet: CY15 Medicare Physician Fee Schedule Proposed Rule
CMS released a proposed rule with comment period in July that would revise payment polices under the Medicare Physician Fee Schedule and makes other policy changes related to Medicare Part B payment. Read HFMA's fact sheet.

Spanish Guide on Healthcare Pricing for Consumers
HFMA has published a Spanish version of its "Understanding Healthcare Prices: A Consumer Guide."


Publication Date: Monday, September 15, 2014