FutureFocus May 16, 2018: Patient’s Right to Freedom of Choice: Key Findings

Lisa Remington

In this week’s FutureFocus, we continue our discussions on patient's rights and their preferences to where they want to be cared for. A review of 57 studies provide key findings. The focus on palliative care consultations comes to the forefront in a study of 130,000 adults with serious illness. The study analyzed adults receiving palliative care consultants, and those that did not and the impact to hospital savings. A new rule protecting DME, expanding telehealth and focusing on improved care was announced giving emphasis to rural healthcare.

Lisa Remington, President, Remington Health Strategy Group

An interagency effort seeking to improve access and quality of care for rural Americans was unveiled last week by the Centers for Medicare & Medicaid Services. CMS’ first Rural Health Strategy is intended to provide a proactive approach on healthcare issues to ensure that the nearly one in five individuals who live in rural America have access to high quality, affordable healthcare.

 Based on input from rural providers and beneficiaries, the Strategy focuses on five objectives to achieve CMS’ vision for rural health:

  • Apply a rural lens to CMS programs and policies;
  • Improve access to care through provider engagement and support;
  • Advance telehealth and telemedicine;
  • Empower patients in rural communities to make decisions about their healthcare; and,
  • Leverage partnerships to achieve the goals of the CMS Rural Health Strategy.

Approximately 60 million people live in rural areas, in communities with disproportionally higher poverty rates, having more chronic conditions, being uninsured or underinsured, as well as experiencing a fragmented healthcare delivery system with a shrinking workforce.

Before the May 8 announcement, work on the Strategy is already underway, CMS noted. For example, to strengthen access to care, especially for those living in rural communities, CMS is transforming access to telehealth by paying for additional services and making it easier for providers to bill Medicare.

CMS will also continue to collaborate with agencies across the Department of Health and Human Services including the Office of Rural Health Policy at the Health Resources and Services Administration.

New Rule Will Protect Access To DME and Enteral Nutrition Through 2018

Issued in tandem with the Rural Health Strategy: An interim final rule with comment period (IFC) to increase the fee schedule rates from June 1, 2018, through December 31, 2018, for certain durable medical equipment (DME) items and services and enteral nutrition furnished in rural and non-contiguous areas (Alaska, Hawaii, and U.S. territories) of the country not subject to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP). 

Stakeholders have raised concerns about significant financial challenges the current adjusted DME fee schedule rates pose for suppliers, including many small businesses, and that the number of suppliers in certain areas continues to decline.

“This action will help Medicare beneficiaries in rural areas continue to access life-sustaining durable medical equipment, like oxygen equipment,” said CMS’ Verma."

In 2016 and 2017, information from the DMEPOS CBP was used to adjust Medicare payments for certain DME and enteral nutrition in certain areas of the county where the CBP did not occur (“non-bid areas”). The CBP has not been implemented in rural areas comprising about half the volume of the volume of items and services furnished in non-bid areas subject to the adjustments.  Beginning January 1, 2017, the fully adjusted fee schedule rates were on average 50 percent lower than the unadjusted rates in these non-bid areas based on the average reduction in payment for all of the items and services subject to the adjustments, weighted by volume, according to CMS. 

In 2016, prior to the fully adjusted fee schedule rates going into effect, blended rates of 50 percent of the amount based on the competitive bid rates and 50 percent of the traditional fee schedule amounts were implemented for the transitional year period. CMS’ action (May 11 Federal Register) resumes these blended rates from June 1, 2018, to December 31, 2018, in rural and non-contiguous areas not subject to the CBP.

By: Ronald M. Schwartz, Writer, The Remington Report