This Quarter in Health Reform: Fall 2014 Roundup

December 19, 2014 | By CAPC Staff

Greetings, dear readers, and holiday cheer! We’ve reached once again the best time of the year: Friday.

You know, ‘round this time of year, I like to play fun games of “did you know.”

“Did you know,” I ask colleagues, “that Christmas is next week?” “Did you know,” I probe further, “that that’s only 5 days from now?”  “Did you know,” I portend “that 2-day shipping to California costs $47?!”

It’s a fun game. For instance:

  1. Did you know that CMS released the measures to be considered by the Measures Application Partnership (MAP) a few weeks ago? For those of you who don’t refer to this time of year as “MAP season,” each year CMS considers new measures to include into its various quality reporting and incentive programs. However, before making any decisions, it needs to get input from a consensus-based entity.  That entity is the NQF’s MAP.  MAP reviews these measures in December and January and makes its recommendations at the end of January. This year, CMS actually included a few measures related to palliative care, including “Hospice and Palliative Care—Treatment Preferences” (for PPS-Exempt Cancer Hospitals), “Adult Kidney Disease: Referral to Hospice” (for the Medicare Shared Savings Program),  and “ICU Length of Stay and ICU mortality” (for the hospital inpatient reporting program).  CAPC supports, at a minimum, the first measure, and will take the opportunity to comment on the MAP reports at the end of January.
  1. Did you know that you might just be on the verge of being $42.60 richer? The Medicare Physician Fee Schedule was released last month, and it includes new codes for complex care management of patients with two or more conditions. Practices that meet certain criteria will be able to bill for non-face-to-face care management monthly. This, in tandem with the transitional care management codes that started in 2013, has contributed to making geriatrics and family practice two of the top four “winners” of the physician fee schedule. The gold-star winner? Chiropractic.  I am sure physicians everywhere greet this news enthusiastically.  Also included in the final rule were comments that Medicare may look at including codes for advance care planning in the future. If you have any thoughts about this, Medicare invites you to comment on the final rule by December 30.
  1. Did you know that California passed a law that has a good shot at improving access to palliative care for all people enrolled in Medi-Cal Managed Care? The law, passed in September, requires the Department of Health Care Services to create standards for palliative care “to ensure delivery of palliative care services” through Medi-Cal managed care. Pallimed has a great post that will tell you more.
  1. Did you know that I just deleted about 1,400 words on King v. Burwell? This case, for which the Supreme Court granted cert in November, challenges the IRS’s policy of providing subsidies to low-income individuals who purchase insurance on both federally- and state-run exchanges. The ACA, by its plain language, provides for subsidies to purchase insurance on state-run exchanges only. The Court will likely decide the case in June, and at that time, the subsidies for over 4 million enrollees could stop.  This could have broad impact on individuals, hospitals and payers, though where the dust would actually settle is hard to say, as I suspect at least some states might open their own exchanges to preserve their citizens’ access to subsidies.  Regardless, this is an important lawsuit, and we will likely be seeing a lot of forecasting in the coming months.
  1. Did you know that one of my favorite parts of the holidays is the end-of year listicles? Here are my top 3:
    1. Top Healthcare Stories of 2014. Much to Aunt Myrna’s surprise, the riveting account of her bunion surgery is not included.
    2. Top 5 Health Plan Developments of 2014. I particularly applaud this listicle’s use of verbs.
    3. 5 Big Hospital CFO Concerns for 2015. [Spoiler Alert] They involve money.

And finally, did you know that the most honorable of mentions goes to Assemblyman Richard Gottfried, who is, I am sure, on the eve of pushing through a sweeping law establishing a single-payer healthcare system in New York State? This dazzling achievement, dulled only by the fact that it will never come to pass, shines brightly against Vermont’s dark abandonment of same. Way to keep the fire alive, New York.

And that’s it, my good friends; it’s time I depart, to type and to write and to fill up flip charts. But before I leave thee, good tidings I send: to all a good lunch, and a lovely weekend.

Happy holidays!

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