|
Type
|
Proposed Cut |
10 Yr Projected Savings (Billions)
|
|
Bad Debts
|
Reduce Medicare Bad Debt reimbursements from 70% to 25% of bad debt over 3 years starting in 2013 (55%, 40%, 25%). |
$20
|
|
IME
|
Reduce IME adjustment by 10% starting in 2013. |
$9
|
|
Add-on for Hospital/Physicians
|
Reduce the add-on payment for hospitals & physicians in low-population States starting in 2013. |
$2
|
|
CAH
|
Reduce the 101% cost reimbursement for CAHs to 100%; and eliminate CAH status for hospitals less than 10 miles from nearest hospital (assume start 2013). |
$4
|
|
Post Acute Care Services LTCH, SNF, IP Rehab, & HH
|
Based on MedPAC recommendation, will gradually realign payments (Ron Knapp definition “Reduce”) through adjustments to payment rates beginning in 2014 through 2021. |
$32
|
|
IP Rehab & SNF Common Services
|
For common procedures (e.g. hip or knee replacement), will reduce the difference in payment for treatment of specified conditions to encourage care in the most clinically appropriate setting starting 2013. |
$4
|
|
IP Rehab
|
Modify current compliance threshold of 60% (IP Rehab must demonstrate a compliance threshold which specifies a minimum % of patients with designated medical conditions that require intensive Rehab services) to previous threshold of 75% beginning in 2013. |
$3
|
|
SNF
|
To reduce the incidence of preventable readmissions, proposing to reduce payments by up to 3% beginning in 2015 for SNFs with high rates of care-sensitive, preventable hospital readmissions. |
$2
|
|
Part D Drugs
|
Will allow Medicare to benefit from the same rebates that Medicaid receives for brand name and generic drugs provided to beneficiaries who receive the Medicare Low-Income Subsidy beginning in 2013. |
$135
|
|
Fraud & Abuse Medicare Advantage
|
Recover payments made to Medicare Advantage plans that reflect mistaken overpayments made for beneficiaries. Recovery to be based on extrapolation of CMS audits. |
$2.3
|
|
Fraud & Abuse Improper Payments
|
A series of enforcements are proposed to reduce the level of improper Medicare payments. This includes increased scrutiny of providers using high-risk banking arrangements, civil monetary penalties for providers who do not update enrollment information, creation of a Medicare claims ordering system to validate physician orders for certain high risk services, etc. |
$1
|
|
EHR
|
Proposes to use the penalties imposed for hospitals & physicians who do not implement electronic health records systems (penalties begin in 2015) for deficit reduction beginning in 2021. |
$0.5
|
|
Imaging Services
|
Spending for imaging services has grown dramatically in recent years. This proposal will implement in 2013 a payment adjustment (reduction) for advanced imaging equipment to account for higher levels of utilization of certain types of equipment. |
$0.4
|
|
Imaging Services Prior Authorization
|
Proposes to adopt prior authorization for the most expensive imaging services beginning in 2013. |
$0.9
|
|
Part B & D Premiums
|
Proposes to increase income-related premiums starting in 2017 under Medicare Part B & D by 15% and maintain the income thresholds associated with income-related premiums until 25% of beneficiaries under Parts B & D are subject to these premiums. |
$20
|
|
Part B Deductibles
|
For new beneficiaries, proposed increase in Part B deductible of $25 to be applied to 2017, 2019, & 2021. Existing beneficiaries will not subject to this change. |
$1
|
|
Home Health Co-Pay
|
For new beneficiaries, proposed implementation of a $100 co-pay per episode (minimum 5 visits in episode) beginning in 2017. Existing beneficiaries will not be subject to this change. |
$0.4
|
|
Part B Premium Medigap Coverge
|
For new beneficiaries starting in 2017, proposes a Part B premium surcharge equivalent to about 15% of the average Medigap premium (or about 30% of Part B premium) for those that purchase Medigap policies with particularly low cost-sharing requirements. |
$2.5
|
|
Independent Payment Advisory Board (IPAB)
|
Proposes to provide IPAB with additional tools like the ability to consider value-based benefit design and enforcement mechanisms such as automatic sequester as a backstop for IPAB, the Congress, and the Secretary of HHS. Reduces the target rate growth from GDP plus 1% to GDP plus .5% |
|
| |
Total Projected Medicare Savings |
$240B
|