A cynic might say if there's a can sitting on a road, someone will kick it rather than pick it up. That seems to be the case with the doc fix bill passed March 26 by the U.S. House of Representatives, which the Senate decided can wait until it returns from spring break. In the meantime, the Centers for Medicare & Medicaid Services will once again suspend payment to physicians until the Senate acts in order to avert cuts of 21% to physician Medicare payments.
The House bill, the Sustainable Growth Rate (SGR) Repeal and Medicare Provider Payment Modernization Act of 2015 (H.R. 2), would prod providers away from fee-for-service care (Medical Device Daily, March 27), long an objective of policymakers in Washington. Roughly $140 billion of the $200 billion-plus price tag of H.R. will show up on the federal government's balance sheet as red ink, a dilemma many in Congress seem willing to face given the expectation that the economy will continue to clamber out of the recession.
The Senate will next have a chance to vote on H.R. 2 April 13.
NICE to recommend 3M's Tegaderm
The UK's National Institute for Health and Care Excellence announced March 27 that it will recommend coverage of the Tegaderm CHG IV securement dressing by 3M (St. Paul, Minnesota) as a means of fixation for central line catheters. The agency said its draft guidance recommends that the Tegaderm CHG "should be considered for use in critically ill patients who need a central venous or arterial catheter in intensive care or high dependency units."
The draft guidance notes that 3M has claimed that the Tegaderm CHG offers a 60% reduction in the incidence of catheter-related bloodstream infection in critical care patients with intravascular catheters, along with " reduced risk of death from this type of infection."
Carole Longson, director of the NICE office for health technology evaluation, said the 3M offering "enables the catheter insertion site to be seen clearly, and also provides antiseptic coverage." She added that the impact of the device's use on bloodstream infections "could save an estimated £73 per patient . . . instead of using a standard transparent semipermeable dressing." Hospitals and other clinics with very low rates of infection are " likely to incur the cost of the dressing," Longson said.
MedPAC urges no 2016 ASC update
The Medicare Payment Advisory Commission (MedPAC) has issued its March report to Congress with another round of recommendations for the Medicare program, including a recommendation that operators of ambulatory surgical centers receive no payment update in 2016, a recommendation that may not sit well with all stakeholders.
MedPAC stated that beneficiary access to ASCs is "adequate," noting that the number of Medicare-certified ASCs rose by 1.1% in 2013. The per-beneficiary volume of ASC services is said to have increased by 0.5%, an uptick MedPAC suggested may have been higher but for the fact that the higher payment rates for hospital outpatient departments compared to ASCs "may help explain why several hospitals have recently expanded their outpatient surgical capacity."
The report observes that ASCs commenced with quality measure reports in October 2012, but that insufficient data are available to assess the quality of care or changes to same. Per-beneficiary payment to ASCs rose 2% in 2013, and MedPAC urged the Centers for Medicare & Medicaid Services to "begin collecting cost data from ASCs without further delay."
William Prentice, CEO of the Ambulatory Surgery Center Association (Alexandria, Virginia), said in a statement e-mailed to Medical Device Daily, that the Centers for Medicare & Medicaid Services, "should focus on ending the growing disparity in ASC and HOPD payment rates that continues to occur each year as CMS continues to use different measures of inflation to update payment rates for the two sites of service."
"A decision to fix this payment policy would help prevent the reverse migration of procedures from the lower cost ASC setting into the higher cost HOPD setting and help ensure that ASCs can continue saving the Medicare program and its beneficiaries billions of dollars each year," Prentice concluded.
Operators of outpatient dialysis clinics won't be happy with the report, either, given that MedPAC urged that Congress eliminate the update for 2016. The report states that payment for outpatient dialysis rose 3% between 2012 and 2013 to $11 billion, but that the use of many injectables, including erythropoiesis-stimulating agents, declined between 2011 and 2012, albeit at a slower pace than the prior year.
MedPAC acknowledged that rates of mortality and hospitalization fell between 2010 and 2013, adding that treatment costs rose by 1% between 2012 and 2013 while Medicare payment rates rose by 1.5%. The authors state further, "we estimate that the aggregate Medicare margin was 4.3% in 2013, and the projected Medicare margin is 2.4% in 2015."
Operators of skilled nursing facilities will be less than thrilled with the MedPAC recommendation that no payment updates be offered in 2016, and that rates be cut 4% the following year.
MedPAC stated that Medicare fee-for-service spending on SNF services reached nearly $29 billion in 2013 and that highly efficient operators enjoyed "very high Medicare margins" in excess of 20%, which the report said suggests opportunities for greater efficiencies across industry. Access was characterized as "adequate for most beneficiaries," with 75% of beneficiaries living in counties with at least five SNFs and only 1% in counties with none.
The report points to MedPAC's previous recommendation of restructuring the payment base "to strike a better balance" between payments for therapeutic services and administration of pharmaceutical agents, and the latest data prompted the commission to discuss an immediate rebasing of payment rates, an option MedPAC said it would explore "over the coming year."
MedPAC characterized rates for inpatient rehabilitation facilities as "generally positive," citing a close match of supply and demand. The number of such facilities was more or less stable between 2012 and 2013, but average occupancy "has hovered around 63% for the past several years," the report states, thus "indicating that capacity is more than adequate to handle current demand" for these services.