Home From The Editor Payment changes on the horizon?

Payment changes on the horizon?

August 2018

Published in the August 2018 issue of Today’s Hospitalist

AS WE FINISH UP this issue, we’re seeing some exciting news about potential reforms in Medicare reimbursement.

Last month, the Centers for Medicare and Medicaid Services (CMS) proposed some major changes to its fee schedule. The one that got my attention? Medicare is proposing to combine levels 2 through 5 of its outpatient E/M codes into one group that would have a single payment rate and minimal documentation requirements.

That’s big news because doctors spend way too much time documenting the difference among the five levels of E/M codes to avoid being audited or having their payments denied. The CMS estimates that this change to E/M services alone would save clinicians about 51 hours per year.

The announcement wasn’t the only recent news about possible changes in Medicare payment and policy. As our cover story explains, the agency may be about to start discussing whether—and how—to reimburse hospitals that move inpatients to the home setting as part of hospital at home.

The concept of hospital at home isn’t exactly new. In fact, decades of evidence and dozens of trials have shown that the model can offer not only better outcomes for patients, but for health systems as well. The most obvious gains come in reduced LOS, fewer 30-day readmissions, and less ED visits and SNF stays. What the CMS may now start to consider is adopting a hospital at home payment bundle that would include a 30-day post-acute care period.

Will hospital at home finally be available in prime time, with reimbursement? Like the changes to E/M codes, the idea of a bundled payment for hospital at home right now is only a proposal. But it’s one that has many physicians, including hospitalists, energized nonetheless.

Edward Doyle
Editor & Publisher
edoyle@todayshospitalist.com

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