Medicare & Medicaid
Medicare spends approximately $35 billion annually on care for beneficiaries with end-stage renal disease.
A joint contract between CMS, states and health plans would pay a capitated amount to provide integrated Medicare and Medicaid services.
The change would ramp up add-on payments to hospitals that implement new tech and increase the wage index for rural and other qualifying hospitals.
Pre-existing coverage remains protected, though a new type of high risk pool approach could better tailor coverage for these enrollees, Verma says.
Part D drug spending projections are lower than last year because of slower price growth and a continuing trend of higher manufacturer rebates.
The Primary Care First payment model will provide payment to practices through a simplified total monthly payment to allow clinicians to focus on caring for patients rather than their revenue cycle, CMS says.
SNFs will be scored on a measure of potentially preventable hospital readmissions and on two new quality measures for interoperability.
Rule proposes no changes to practice of silver loading as insurers start to set rates for 2020.
Large hospitals and teaching hospitals are the most likely to see reduced penalties; those in states with high Medicaid enrollment will fare better.
Primary care represents an estimated 2.12 to 4.88 percent of total medical and prescription spending in Medicare Parts A, B and D.