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News to Note – July 2022

  • CMS has started the review process for the Important Message from Medicare (IMM) and the Medicare Outpatient Observation Notice (MOON). This is the required three-year review that every form undergoes. We don’t anticipate any major changes, but who knows. For now, you need to do nothing. It is not until the new forms are released that you’ll have to act and search filing cabinets for all the out-of-date forms and replace them.
  • The OIG released a report about the acquisition of physician practices by hospital systems that then increases Medicare spending because of the facility fee that can be charged with physician office visits. Of course, their conclusion is that the added spending is not justified and Medicare should work to equalize the payments. What they fail to mention is that the current Medicare and other insurer payment rates are so low, that many physicians find the only way to continue to practice medicine is to sell their practice to a hospital.
  • The Medicare Payment Advisory Committee (MedPAC) released a report to Congress summarizing their most recent recommendations which include reducing the payment differential between a surgery done at the outpatient hospital compared to an ambulatory surgery center (ASC). MedPAC carried out a complex data analysis and noted that for many surgeries, patients at the hospital actually had more comorbid conditions than those at the ASC which raised the risk and supported the added payment compared to the ASC. The also acknowledged that hospitals have many fixed costs that ASCs do not incur, so that also must be considered. Will CMS or Congress do anything with this information? Only time will tell.
  • MedPAC also suggested to CMS that Emergency Department (ED) visits, critical care visits, and trauma care facility charges be converted from standard APCs to comprehensive APCs. That would mean the hospital would get one single payment for the ED patient who is not subsequently admitted to the hospital. If the doctor orders no CT scans or three CT scans and an MRI, no labs or a whole panel of labs, the payment will be the same. Once again, their motivation is to save Medicare money but at what cost? How many trauma centers will become financially nonviable and result in limited access for patients?

**The news above in addition to many other points of interest for Physician Advisors and other leaders in health care can be heard weekly during Dr. Ronald Hirsch’s Monday Rounds segment on’s Monitor Monday webcast/podcast. Learn More

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