2018 Medicare 360: Reimbursement Analysis

  • ID: 4516883
  • Report
  • 76 Pages
  • Health Industry Distributors Association (HIDA)
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Understanding your customers’ reimbursement outlook is critical. The 2018 Medicare Reimbursement Report compiles all the information you need, packed with insights on Medicare’s payment adjustments, quality programs, as well as key trends and issues. The report provides a policy outlook for all markets as well as detailed analyses and primer for the Medicare program as a whole.

Although the majority of healthcare providers will receive small payment increases from Medicare in 2018, they continue to face an uncertain reimbursement future. The Centers for Medicare & Medicaid Services (CMS) is accelerating efforts to tie Medicare payment to quality and outcomes across all provider settings, which will lead to continued shifts in payment models. Specific provider segments including labs and physicians have even more uncertainty as congressionally-mandated payment changes have started to be implemented.

CMS has finalized payment updates to all markets, and the changes between final and proposed rules indicate a desire to alleviate administrative burdens and lower costs. However, not everyone is satisfied with the outcomes as each market has its own unique challenges. For instance, CMS’s changes to the clinical laboratory fee schedule would save the government payer around $670 million, despite vocal concern from the lab industry that the agency is using incomplete data.

Key payment changes for 2018 include:

  • IPPS: Revised Hospital Readmission Reduction Program to include the number of dual eligibles as well as comparing hospitals within their own cohort
  • SNF: Formalized policies for the first year of the value-based purchasing program
  • OPPS: Will see an overall impact of 1.4% payment increase for providers except for services that are also performed in a physician office, which will be cut significantly
  • Labs: 75% of codes will receive negative payment adjustment - with 58% receiving the maximum cut of 10% - while 10% of codes will see a payment increase
  • ASC: Payments are projected to increase approximately 3% (MRP-adjusted CPI-U update factor of 1.2%)
  • Home Health Agencies: Will receive a -0.4% payment reduction totalling around $80 million
  • Physician: Medicare reimbursement is slated for a +0.41% update.

While policymakers continue to push initiatives that hold providers accountable on quality and cost, the tumultuous effort to "repeal and replace" the Affordable Care Act (ACA) further indicated a clear desire by the new Republican administration and Congress to move away from a healthcare status quo, and institute wholesale changes. After initially failing, the House did pass a plan to repeal the ACA. However, the Senate was not able to pass similar legislation despite repeated attempts and various versions.

This prompted President Trump to sign an executive order that expanded access to more loosely regulated health plans among other contentious provisions. With other legislative priorities pressing, Congress chose to put their health reform efforts on hold for 2017, but may look to resume them in 2018. Regardless, cost and quality initiatives are very bipartisan concepts and will remain in some form, irrespective of how Congress chooses to handle any future ACA repeal efforts.

The Government Affairs Medicare 360 Report, published annually, outlines these key trends and issues. This report provides a policy outlook for all markets as well as detailed analyses of reimbursement and quality programs.

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  • Executive Summary
  • Table of Contents
  • A Medicare Primer: Parts A-D
  • Cross-Market Trends

Market by Market - What Lies Ahead


  • 2018 Policy Outlook & Analysis
  • Hospital Inpatient Quality Reporting
  • Hospital Outpatient Quality Reporting
  • Ambulatory Surgical Centers Quality Reporting


  • 2018 Policy Outlook & Analysis
  • Physician Quality Reporting


  • 2018 Policy Outlook & Analysis


  • 2018 Policy Outlook & Analysis
  • Nursing Home Quality Reporting Initiative
  • Home Health Agencies Quality Reporting Initiative
  • Quality Reporting Initiative: Hospice


  • Reimbursement Changes by Market - Final Rule Summaries
    • Hospital Inpatient
    • Hospital Outpatient and Ambulatory Surgery Centers
    • Physician
    • Skilled Nursing Facility
    • Home Health Agencies
    • IRF and Hospice
  • Glossary of Key Healthcare Terms
  • Glossary of Key Healthcare Acronyms
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