Aug 6, 2019

Medicare sets higher hospital pay for 2020

Photo: ATU Images/Getty Images

The federal government approved a 3% all-in pay bump for Medicare’s inpatient services in 2020, equating to $3.8 billion in additional funding to hospitals.

The bottom line: Even though the final raise is down from the proposed regulation (which would’ve raised Medicare inpatient spending by $4.7 billion), this is one of the most generous rules hospitals have seen in years, as mandated cuts from the Affordable Care Act are phasing out.

Yes, but: Some hospitals will benefit more than others, especially when it comes to specific payment policies.

  • Medicare will continue to make “add-on” payments for CAR-T therapy, but decided against creating a new diagnosis code for the cancer treatment — something hospitals and drug companies have vigorously lobbied for.
  • Hospitals in higher-wage cities get paid more than facilities in rural areas, and Medicare is finalizing changes that would attempt to lessen the growing discrepancies.
  • Some hospitals in high-wage areas have been known to game this system.

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Hospitals winning big state battles

Illustration: Aïda Amer/Axios

Several states have made ambitious attempts to address health care costs, only to be thwarted by the hospital industry.

Why it matters: States' failures provide a warning to Washington: Even policies with bipartisan support — like ending surprise medical bills — could die at the hand of the all-powerful hospital lobby.

Go deeperArrowAug 15, 2019

Hospital care is getting more expensive for Americans

Data: United Health Group; Chart: Axios Visuals

Hospital prices for inpatient services increased more than the prices paid to doctors providing these services between 2013 and 2017, according to a new data brief by United Health Group.

By the numbers: Hospital prices for inpatient services increased by 19% over this time period, or by 4.5% per year. Physician prices for inpatient services increased by 10%, or 2.5% per year.

Go deeperArrowAug 12, 2019

Medicare will now cover a costly cell therapy for cancer patients

A lab tech handles a CliniMACS Prodigy automated device used for cell processing. Chimeric antigen receptor (CAR) T-cell therapy has been hailed as a major advance in clinical cancer care. Photo: GERARD JULIEN/AFP/Getty Images

The Centers for Medicare & Medicaid Services announced yesterday that Medicare will cover the innovative but expensive cancer treatment CAR-T, providing "consistent and predictable patient access nationwide," CMS administrator Seema Verma said.

By the numbers: The treatment, which is customized for each individual patient, costs $375,000 or $475,000, depending on the type of cancer, the Washington Post notes. The overall cost can rise by hundreds of thousands of dollars when hospital stays are factored in.

Go deeperArrowAug 8, 2019