Medicare Compliance & Reimbursement

Big changes could be in store for hospital, physician reimbursement At its most recent open meeting the Medicare Payment Advisory Commission (MedPAC) considered issuing single payments to be shared by both the hospital and doctors involved in providing inpatient treatment, reports CQ HealthBeat. The plan would be difficult to administer but it would eliminate the inefficiencies in care and deliver major savings, MedPAC hopes. MedPAC chairman Glenn Hackbarth praised the idea but said the commission hasn't decided to send a final recommendation to Congress on the proposal. While MedPAC hopes the proposal will provide cost-effective health care, confusion prevails over the division of payment. Hospitals and physicians will be anxious to know how the proposal compares to what they get paid now. MedPAC hopes the proposal would reduce treatment costs, as doctors and hospitals would work together to make health care delivery more efficient, leaving more money for them to share. MedPAC staff also suggested making health care delivery more efficient by avoiding wasteful tests and other procedures. Among the draft recommendations discussed at the meeting was a proposal that the Centers for Medicare and Medicaid Services (CMS) should monitor hospital resource utilization. Under the "virtual bundling" model, inefficient hospitals and health providers would be penalized and the excess reimbursement would be transferred to hospitals that deliver high quality with fewer resources. The second draft recommendation states that CMS should create a voluntary pilot program to explore issues related to actual bundled payments for hospitalization services. MedPAC commissioners also discussed establishing an independent board to oversee research and funding for the program.