The Medicare Payment Advisory Commission in its June report to Congress made a series of recommendations to reform Medicares payment system and make providers more accountable for the quality of care they provide. The commission made specific recommendations in three areas: primary care, care provided around a hospitalization and skilled-nursing facility payments. To improve care coordination and efficiency, the panel recommended reducing payments to hospitals with relatively high readmission rates for select conditions, and suggested that the CMS conduct a voluntary pilot program to test bundled payment for all services around a hospitalization for select conditions. In addition, it said HHS should confidentially report to hospitals and physicians information about resource use around a hospitalizationsuch as inpatient staysand readmission rates. After two years of confidential disclosure, this information should be reported publicly. To boost primary care, MedPAC said Congress should increase fee-schedule payments for primary-care physicians and create a medical-home pilot program in Medicare.
The Medical Group Management Association urged the CMS to review the Stark law rules on physician self-referral before the agency implements additional changes. In its comments about the CMS proposed inpatient prospective payment system rule, the Englewood, Colo.-based MGMAwhich represents medical group practicessaid the rules named after Rep. Pete Stark (D-Calif.) have become so complex that even routine business and clinical arrangements now require development and review by high-priced lawyers and consultants, which, in turn, adds to the cost of practice and leaves groups uncertain about their compliance status. Less than five months from the effective date of the long-awaited Phase III Stark rules, groups are now confronted with another set of complex proposalssome with specific regulatory language proposed for amendment and some simply preamble musings on what options for change may be under considerationdealing with just a few aspects of this hydra-headed monster, MGMA President and Chief Executive Officer William Jessee wrote in a letter to acting CMS Administrator Kerry Weems.
Seventeen hospitals in Arizona filed a motion backing the state in a lawsuit against a county healthcare district over the release of Medicaid disproportionate-share hospital, or DSH, funding, saying that the district is holding up some $26 million in federal funds to hospitals across the state. The state of Arizona sued Maricopa Integrated Health System, a Phoenix-based healthcare district, on June 6 over the districts refusal to certify federal funding by a June 1 deadline. Under the states Medicaid waiver, the district must certify its share of DSH funding in order for the state to draw down Medicaid funding and distribute DSH money to hospitals. It is our understanding that the feds wont release DSH funding to the state until all the paperwork is filed, said Greg Harris, a partner with Lewis and Roca, which is representing the hospitals. The Maricopa system is refusing to certify the funding because it believes it should get more DSH dollars, according to the lawsuit. The district did not return calls by deadline.
Genesis HealthCare Corp.through its parent company, private-equity firm Formation Capitalagreed to buy bankrupt nursing home chain Haven Healthcare, Connecticut Attorney General Richard Blumenthal said. Formation will pay approximately $84 million for 24 out of 25 Haven Healthcare nursing homes in Connecticut and four other New England states, he said. The pending deal is the result of a months-long search and negotiations to prevent the nursing homes from folding, he added in a news release. The deal requires court approval; a hearing is scheduled for June 26. Haven operated 15 nursing homes in Connecticut before it collapsed late last year, according to Blumenthal. The corporation allegedly mismanaged millions of dollars and diverted public funds intended for patient services to improper investments in a recording company and personal real estate, Blumenthal said. He vowed to aggressively continue the investigation into Havens corporate leadership. The court-appointed restructuring officer for Haven, Benjamin Jones, declined to comment.
Express Scripts, a St. Louis-based pharmacy-benefits management company signed an agreement to acquire the pharmacy services division of Medical Services Co., Jacksonville, Fla., for an undisclosed amount, according to news releases from both companies. Under the terms of the deal, Express Scripts will acquire all of Medical Services PBM business, which is exclusively focused on the workers compensation market, following regulatory clearances. Medical Services will retain its four ancillary businesses in the areas of durable medical equipment, home-health nursing services, imaging services, and translation and transportation services. The deal comes on the heels of an announcement earlier in the week that Express Scripts agreed to sell its infusion pharmacy business to OptionCare, a home infusion services company owned by Deerfield, Ill.-based Walgreen Co. Both moves are part of a strategy for Express Scripts to focus exclusively on PBM operations.
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