Friday, March 7, 2014

Does the OIG's "Extend The DRG" report make no sense, or did I miss something?

In February 2014, the OIG published a report whose whose title seems to clearly predict its content:  "Medicare and Beneficiaries Could Realize Substantial Savings if the DRG Window were Expanded."  (For a brief summary of the 32-page document, see this blog.)

What happens now? 
The report notes that a pre-admission bundling policy currently exists for hospital services within a three day window and provided by the same hospital.  For three days before a DRG inpatient admission, services of the very same hospital are considered bundled (these might typically be emergency room services or pre-surgical laboratory tests).  No post-discharge services are overtly bundled, but a quirk for clinical laboratories called the "date of service rule" blocks additional payment for tests performed on samples taken while the beneficiary was an inpatient.

Is the FDA too slack or too tight?

Is the FDA too lenient or too strict?  Controlling safety or stifling innovation?

This question never goes away.   A few years ago there was a flurry of activity, both inside and outside the FDA, on the condition of, and prospects for reform of, the 510(k) device regulation pathway.   The IOM held a 2010 workshop,  followed by a 2011 report offering a "35 year perspective," and then the FDA held a public meeting (with a 134 page transcript) on the latter IOM report.

Prior Authorization - Medicare - And the President's FY2015 Budget

The 2015 Budget for HHS
The President's FY2015 budget for the Department of Health & Human Services - including the FDA and Medicare as well as the NIH - was released on March 4, 2014.  It's likely that only in Washington would a 146-page document be titled, "Budget in Brief."    The budget has risen from $886M in 2013 to a projected $958M in 2014 and $1.01M in 2015.  Most of this rise is due to the increasing populations in Medicare and Medicaid.

CMS and Prior Authorization - Current Policy Ideas
A particularly interesting item in the HHS policy roadmap - picked up in the trade journal GRAY SHEET (subscription) - is new authority for "Prior Authorization" for all Medicare services, at the discretion of the Secretary.   Prior authorization has most recently been required for electric wheelchairs in the durable medical equipment benefit; see the CMS webpage for this, and a CMS one-pager PDF.