Payment Reimbursement and Managed Care

HFMA Comments on CMS’s Proposed Inpatient Hospital PPS Rule for FY15

HFMA submitted a comment letter on key issues contained in CMS's Proposed Rule for FY2015 PPS for inpatient hospitals. Significant concerns relate to DSH, HACs, VBP, short stays, and other issues.

HFMA June 19, 2014

FY15 IPPS Proposed Rule Overview

This document summarizes important proposed updates to payment rates to IPPS hospitals for FY15.

HFMA May 30, 2014

HFMA Comments on Interim Final Rule on Third Party Payment of Qualified Health Plan Premiums

HFMA comments on CMS's IFR to codify the guidance related to third party premium payment for individuals enrolling in QHPs. However, the IFR does not resolve the ambiguity created by CMS’s conflicting statements on the issue.

HFMA May 12, 2014

Price Transparency Task Force

The American Hospital Association fully supports the recommendations of the HFMA Price Transparency Task Force. The AHA has long supported the need to provide patients with healthcare price and quality information and has worked with stakeholders, including HFMA, to provide useful information that will help patients make healthcare decisions.  We believe that it will take everyone—providers, insurers, employers and government—working together to provide patients with the information they need. Hospitals are committed to improving how consumers get information on the amount they will be expected to pay for care. This includes helping patients understand their hospital bills by finding better ways to explain them in user-friendly terms. Providing understandable and useful information about the price of hospital care is one of the ways America’s hospitals are working to improve the health of their communities. Rich Umbdenstock President and CEO American Hospital Association Ensuring consumers have the support and information they need to maximize the value of their healthcare dollars has been a longstanding priority for health plans. These recommendations build on health plans’ innovative tools that empower consumers in their decision-making. Increased transparency also shines a spotlight on the need for all stakeholders to address the underlying drivers of healthcare costs. Karen Ignagni President and CEO America's Health Insurance Plans Transparency in price information is a reflection of our commitment to respect the dignity of the persons we serve. Patients and their families deserve complete information about their care and price information is an important component of what they need to make decisions about that care. Sister Carol Keehan, DC President and CEO Catholic Health Association of the United States The American College of Physician Executives, representing more than 11,000 high-level physician leaders in all types of healthcare organizations across the U.S. and 46 countries, is pleased to offer its support for the policy recommendations included in this important new study on price transparency. The implementation of reform, including the Affordable Care Act, shined a bright light on this increasingly difficult issue, and the time for change is now. As patients assume greater responsibility for their healthcare needs, the demand for accurate, reliable information will continue to grow. The healthcare industry has an obligation to all citizens—the insured and the uninsured—to make the procurement of care as simple and accessible as possible. To continue along the current path would risk creating prolonged and greater mistrust of the medical community as a whole. As an organization dedicated to the lifelong development and support of physician leaders, ACPE is all too aware of the challenges involved in creating greater price transparency. We believe the recommendations included in this report are an important first step toward meaningful reform. ACPE stands ready to assist in any way necessary as you move forward. Peter Angood, MD, MD, FRCS(C), FACS, MCCM, President and CEO, ACPE Mark Werner, MD, CPE, FACPE, Chairman, ACPE Board of Directors Engaging patients in their healthcare decisions is a top priority for physicians. MGMA is pleased to be part of the Price Transparency Task Force and join with key stakeholders to determine ways that patients can better access price information to help guide healthcare decisions. Readily available price and quality information is crucial to helping patients make informed choices about their care Susan L. Turney, MD, MS, FACP, FACMPE President and CEO Medical Group Management Association As the U.S. healthcare industry continues to evolve into a more open and transparent care system, it has been rewarding to represent a major teaching safety net health system in the recent work related to pricing transparency. The HFMA Price Transparency Task Force has included representation from health systems, hospitals, insurance plans, and the consumer in its work to develop guidelines for all constituents affected by healthcare pricing. The discussions were thoughtful and energetic; the final product establishes the initial baselines to create transparency. I endorse the findings and recommendations in this report. Mary Lee DeCoster Vice President, Revenue Cycle Maricopa Integrated Health System Most Americans agree healthcare pricing is opaque. HFMA has provided a great service by convening diverse organizational stakeholders who comprised the task force that developed this report. It establishes a common language and puts forth sensible principles, both necessary to achieve price transparency. This HFMA report is likely to become a must-have resource for anyone mounting an effort to establish clear healthcare pricing. Mark Rukavina Community Health Advisors, LLC The ability for consumers, whether insured or not, to have easy access to meaningful information about the price of healthcare services and the total expected price of medical episodes or events, has become a national priority for good reasons. The share of medical expenses paid by individual consumers is at an all-time high and projected to increase. Consumers should be able to know the price of any service or product purchased before becoming liable to pay the bill. The HFMA has taken a bold and important step to lay out the fundamental principles that all industry stakeholders should abide by to get consumers the pricing information they need and deserve. HCI3 was privileged to be a part of the team that developed this report and supports its conclusions and calls to action. François de Brantes Executive Director Health Care Incentives Improvement Institute Price transparency is important to all of us as healthcare consumers and in our roles as providers or payers of care. It has been a pleasure to work with HFMA’s Price Transparency Task Force in developing practical solutions for improving price transparency. By following these recommendations, we can help demystify consumers’ financial responsibility for their care and equip them to make better-informed healthcare decisions. Robert Galvin, MD Chief Executive Officer, Equity Healthcare Operating Partner, The Blackstone Group

HFMA April 11, 2014

Examples of Price Transparency Tools

A number of health plans, provider organizations, state hospital associations, and other groups have already developed transparency tools.

HFMA April 11, 2014

Price Transparency in Health Care: Highlights from the Task Force Report

Convened by HFMA, a task force made up of health plans, providers, consumers, employer groups, physician groups, and others has released guiding principles and recommendations for improving price transparency in health care.

HFMA April 10, 2014

HFMA Comments on Medicare DSH Payment Reductions

With weeks remaining in the open enrollment period it appears highly unlikely that the CBO's May 2013 estimate of a reduction in the uninsured by 14 million individuals in 2014 will be achieved. 

HFMA March 13, 2014

CY14 Medicare Physician Fee Schedule Final Rule Fact Sheet

This fact sheet sumarrizes the payment changes applicable to physicians under the CY14 Medicare Physician Fee Schedule final rule released by CMS.

HFMA February 26, 2014

Comment Letter to CMS: FY14 IPPS Proposed Rule

Read HFMA's comments to Centers for Medicare & Medicaid Services regarding its FY2014 proposed rule for Hospital Inpatient Prospective Payment Systems.

HFMA February 6, 2014

HFMA Supports the Two-Midnight Rule Delay Act (H.R. 3698)

HFMA believes a workable approach is to delay enforcement of the two-midnight rule until October 1, 2014. During this delay, CMS will work with stakeholders to develop alternate policy solutions.

HFMA January 30, 2014
googletag.cmd.push( function () { googletag.display( 'hfma-gpt-leaderboard' ); } );