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The Daily Scan

Last Updated: 1:00 PM EST


  • Yesterday, CMS finalized proposals that address provider burnout and provide clinicians immediate relief from excessive paperwork tied to outdated billing practices. The final 2019 Physician Fee Schedule (PFS) and the Quality Payment Program (QPP) rule also modernizes Medicare payment policies to promote access to virtual care, saving Medicare beneficiaries time and money while improving their access to high-quality services, no matter where they live. It makes changes to ease health information exchange through improved interoperability and updates QPP measures to focus on those that are most meaningful to positive outcomes. The rule also updates some policies under Medicare’s accountable care organization (ACO) program that streamline quality measures to reduce burden and encourage better health outcomes, although broader reforms to Medicare’s ACO program were proposed in a separate rule. This rule is projected to save clinicians $87 million in reduced administrative costs in 2019 and $843 million over the next decade. Coding requirements for physician services known as “evaluation and management” (E&M) visits have not been updated in 20 years. This final rule addresses longstanding issues and also responds to concerns raised by commenters on the proposed rule. (Press Release: CMS.gov, Final Rule: FederalRegister.gov)

  • Yesterday, the Centers for Medicare & Medicaid Services (CMS) finalized changes to the Medicare payment rules for Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) and the End-Stage Renal Disease (ESRD) programs. The policies aim to increase access to items and services for patients, drive competition and increase affordability. “The rule finalized today makes innovative changes to the Medicare payment rules for the durable medical equipment and end-stage renal disease programs. It also helps to ensure continued access to durable medical equipment and makes significant improvements to our competitive bidding system.” said CMS Administrator Seema Verma. “Based on many comments we received on our DME proposal from suppliers, manufacturers and their associations -- all of whom supported our proposals -- we are implementing market-oriented reforms to Medicare’s DMEPOS Competitive Bidding Program that also reduce burden on suppliers by simplifying the bidding process.” (Press Release: CMS.gov, Final Rule: FederalRegister.gov)

  • Yesterday, a federal judge set a 2022 deadline for the U.S. Department of Health and Human Services to work through its backlog of Medicare reimbursement appeals from hospitals, saying new funding provided by Congress made doing so possible. U.S. District Judge James Boasberg in Washington, D.C. said that Congress’s recent decision to grant the department’s funding requests to address the backlog was a “deus ex machina” that would allow him to finally resolve a 2014 case by the American Hospital Association. (Reuters.com)

  • Today, the CMS released a final rule that strengthens the Medicare program by providing seniors more choices and lower cost options in making the best decisions on their care. The policies adopted in the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule with comment period will help lay the foundation for a patient-driven healthcare system. To increase the sustainability of the Medicare program and improve the quality of care for patients, CMS is finalizing its proposed method to control unnecessary volume increases for certain clinical visits by utilizing site-neutral payments for these visits. This change will be phased in over two years. Clinic visits are the most common service billed under the OPPS. Currently, CMS and beneficiaries often pay more for the same type of clinic visit in the hospital outpatient setting than in the physician office setting. This policy would result in lower co-payments for beneficiaries and savings for the Medicare program in an estimated amount of $380 million for 2019. For example, for a clinic visit furnished in an excepted off-campus PBD, average beneficiary cost sharing is currently $23. Under this final rule, that cost sharing would be reduced to $16 (based on a two year phase-in), saving beneficiaries an average of $7 each time they visit an off-campus department in CY 2019. (Press Release: CMS.gov, Final Rule: FederalRegister.gov)

Private Sector

  • The pharmaceutical giant Merck & Co. Inc. is ending a long-term agreement to supply a lifesaving vaccine for children in West Africa. At the same time, the company has started sending the vaccine to China, where it will likely be sold for a much higher price. The vaccine is for a deadly form of diarrhea, called rotavirus, which kills about 200,000 young children and babies each year.

Merck's decision means it will fall short of its commitment to supply its rotavirus vaccine, RotaTeq, to four low-income countries in 2018 and 2019, according to Gavi, the Vaccine Alliance. By 2020, the company will completely stop delivering its vaccine. "This was difficult decision for us, which did not come lightly," Merck wrote to NPR in an email. "We would like to express our deepest regret to all of the parties involved and have offered to assist and work with UNICEF, Gavi and affected countries through the transition to alternative images [versions] of rotavirus vaccines," the email added.

Merck said in the email that "supply constraints" were preventing it from fulfilling its agreement to the West African countries. (NPR.org)

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