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HIDA 2019 Medicare Report

HIDA 2019 Medicare Report

In the 2018 midterm elections, healthcare remained a top issue for voters. Many Senate and House elections hinged on candidates’ views regarding Medicare, the future of the program, and possible future expansions. Thispolicy platform carried over into the midterm elections, where Democratic nominees in both traditionally blue andred states advocated for this single payer system — with varying degrees of success and to a diverse voting bloc.

With a new Democratic majority in the House and new senators from both parties, it remains to be seen howCongress will approach any possible tweaks to Medicare moving forward. While 2019 has the makings of an activelegislative calendar, it also precedes a presidential election. This means it is more likely that Congress will makesmall adjustments in the healthcare space as well as Medicare rates as needed, while large pieces of legislationimpacting the industry are expected to be utilized as campaign platforms for the 2020 election.
However, the annual Medicare payment regulatory process is completed, and the Centers for Medicare andMedicaid Services (CMS) has finalized payment updates across all markets—this year most healthcare providerswill receive small payment increases. The majority of changes, such as de-duplication and elimination of qualitymeasures throughout the different programs, reflect CMS’s desire to focus on patient-centered outcome measureswhile taking into account opportunities to reduce reporting burdens on providers. In total, CMS plans to remove44 measures across the physician, acute, and post-acute markets over the next few years.

Some of the key highlights of these final rules include:
• Inpatient Prospective Payment System (IPPS): 1.85 percent increase in payment rates for hospitals
• Ambulatory Surgical Center (ASC): 2.1 percent increase
• Outpatient Prospective Payment System (OPPS): 1.35 percent increase
• Physician: The final conversion factor is $36.04 (compared to $35.99 last year)
• Laboratory: CMS is amending the applicable laboratory definition to include hospital laboratories that bill for
their non-patient laboratory services (on the CMS 1450 14X TOB bill)
• Skilled Nursing Facilities (SNF): 2.4 percent increase
• Home Health Agencies (HHA): 2.2 percent increase
• Hospice: 1.8 percent increase

Despite numerous attempts, the 115th Congress was unable to “repeal and replace” the Affordable Care Act(ACA). While this election cycle ushered in a new Congress with a substantially large number of new members,future reforms of the ACA remain possible but unlikely during the 116th Congress. HIDA anticipates that therewill be more focus on regulatory than legislative reform in the healthcare space in 2019. The changes totelehealth, Medicare Advantage plans, and prescription drugs coupled with the CMS’s desire to de-duplicate andreduce burdens on providers will likely take front stage as primary priorities moving forward.

The HIDA Government Affairs Medicare360 Report, published annually, outlines key trends, in addition to otherissues, and provides policy outlooks for all markets as well as detailed analyses of reimbursement and qualityprograms.


Executive Summary
Table of Contents
Cross Market Initiatives: ACOs & Bundling
Market by Market – What Lies Ahead
THE ACUTE CARE MARKET
2019 Policy Outlook & Analysis
Hospital Inpatient Quality Reporting
Hospital Outpatient Quality Reporting
Ambulatory Surgical Centers Quality Reporting
THE PHYSICIAN MARKET
2019 Policy Outlook & Analysis
Physician Quality Reporting
THE LABORATORY DIAGNOSTICS MARKET
2019 Policy Outlook & Analysis
THE POST ACUTE MARKET
2019 Policy Outlook & Analysis
Nursing Home Quality Reporting Initiative
Home Health Agencies Quality Reporting Initiative
Quality Reporting Initiative: Hospice
APPENDIX
Reimbursement Changes by Market – Final Rule Summaries
Hospital Inpatient
Hospital Outpatient and Ambulatory Surgery Centers
Physician
Skilled Nursing Facility
Home Health Agencies
IRF and Hospice
Glossary of Key Healthcare Terms
Glossary of Key Healthcare Acronyms
Medicare Primer: Parts A-D

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