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NAMDRC

The National Association for Medical Direction of Respiratory Care

The Washington Watchline

CMS Implements The Appropriate Use Criteria Program

It has been estimated that improper Medicare payments cost taxpayers and beneficiaries about $50 billion a year. Congress and the Department of Health and Human Services have been taking steps to reduce the burden of wasteful spending in Medicare. As part of this effort, CMS has advanced the implementation the Appropriate Use Criteria Program (required by the Protecting Access to Medicare Act of 2014) in the 2018 proposed Physician Fee Schedule (2018 PFS).

The Proposed Medicare Physician Fee Schedule for 2018

On July 13, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) for 2018. Physician compensation for services to Medicare beneficiaries is based on national relative values (RVUs) that have been established by combining values for physician work, practice expense, and malpractice insurance expense.

MedPAC Criticizes the CMS Physician Compensation Rules

In addition to promoting innovative treatments for patients with pulmonary disease, sleep disorders and the critically ill, one of NAMDRC’s primary issues is fair physician compensation consistent with their training, expertise and contribution to patient care. The attempt by Congress to transition from the flawed policy of the Sustainable Growth Rate to a “value based system” under the Medicare Administration has resulted in a complex methodology for compensating physicians caring for Medicare beneficiaries.

The Big Data Revolution in Intensive Care

In many areas of science, government and business, analyzing very large amounts of information, “Big Data”, has become a major driver of innovation and success. A talk at the 2017 NAMDRC Annual Meeting has raised our awareness of impending changes in patient evaluation and intervention strategy in the intensive care unit. The talk, Big Data Approaches for Critical Care Medicine, was delivered by John R. Hotchkiss, MD, Associate Professor of Medicine at the University of Pittsburgh School of Medicine.

The 2018 Medicare Inpatient Prospective Payment System

On April 14, 2017 the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update the 2018 Medicare Inpatient Prospective Payment System (IPPS) payment policies and rates. The proposed rule, which would apply to approximately 3,330 acute care hospitals and approximately 430 LTCHs, would affect discharges occurring on or after October 1, 2017.

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