Healthcare Reimbursement

This document summarizes key provisions of the FY 2019 IPPS/LTCH final rule, published by CMS.

Nov. 5—Medicare pay cuts included in a new payment rule will affect the federal discount drug program and off-campus provider-based departments (PBDs).

Nov. 2—Leading physician advocacy groups are celebrating some provisions in the final rule issued by Medicare this week. But other components could cause problems.

A significant uptick in payer contractual allowances and discounts in the first quarter of 2018 indicate that hospitals should remain focused on payer mix and payer category shifts.

Nov. 1—Primary care will draw the attention of the Trump administration next week, amid the expectation that upcoming payment models will focus on that segment.

Oct. 30—Physicians across the country are concerned about rapid changes in alternative payment models (APMs) and want the process to slow down, according to a recent study. Meanwhile, Trump administration officials say physicians should prepare for accelerated changes.

Moving to a value-based payment model involves change and requires a strategy focused on both managing costs and enabling growth of the enterprise.

Consumers have come to expect price transparency in health care, which has greatly increased the strategic and operational importance of providers’ charge master descriptions and other pricing frameworks.

Rising premiums and reduced choice among insurance options are two challenges facing health insurance purchasers under the Affordable Care Act in 2019; nonetheless, public support for the act continues to be strong enough to block efforts to repeal the act.

Oct. 26—Hospitals would face uncertain financial impacts under a Medicare drug payment pilot announced this week.