GAO Report Takes Aim at Medicare Auditors
The multiple auditors used by the Centers for Medicare and Medicaid Services (CMS) often duplicate efforts, creating confusion and extra paperwork for healthcare providers, according to a new report from the Government Accountability Office (GAO). In particular, recovery audit contractors, or RACs, have come under fire for requiring enormous resources from hospitals that RACs target for post-payment reviews.
“Among these numerous auditors, RACs are the only ones Medicare paid on a contingency fee basis,” noted the American Hospital Association in a recent statement to Congress. “RACs receive 9 to 12.5 percent of claims denied, which results in a high percentage of erroneous denials. Despite being charged with ensuring the accuracy of Medicare payments, and despite a purported expertise in identifying inaccuracies, RACs have a dismal track record for properly identifying errors in hospital claims.”
In fact, according to a report from the Department of Health and Human Services Inspector General, 72% of RAC inpatient denials that hospitals appealed were overturned in favor of the hospital, and some hospitals have reported appeal success rates above 95%. AHA has reported that its member hospitals routinely hire additional staff solely to manage RAC audits.
GAO recommended that CMS strengthen oversight of these auditors. “CMS neither has reliable data nor provides sufficient oversight and guidance to measure and fully prevent duplication,” the report notes.
NIH Issues Policy on Genomic Data Sharing
The National Institutes of Health (NIH) has issued a final genomic data sharing (GDS) policy, aimed at speeding the translation of data into clinical use and protecting the privacy of research participants. The GDS policy can be traced to the Human Genome Project, which required rapid and broad data release during mapping and sequencing of the human genome.
The new policy retains a two-tiered system for providing access to human data based on data sensitivity and privacy. Some data will still be available publicly without restrictions, while access to other data will be available only for research consistent with the consent of the original study. The new policy also encourages researchers to seek the broadest possible sharing permissions from participants for future research use of their data.
NIH also wants more timely data submission and access to promote broad data sharing. In general, researchers should make non-human genomic data publicly available no later than the date of initial publication. The new policy is available at a dedicated website, http://gds.nih.gov.
Federal Health Spending to Grow Rapidly Over the Next Decade
The latest report from the Congressional Budget Office (CBO) found overall mandatory spending on Social Security and federal healthcare programs will sharply increase over the next decade, “boosted by the aging of the population, the expansion of federal subsidies for health insurance, rising healthcare costs per beneficiary, and mounting interest costs on federal debt.”
Annual net outlays for the government’s major health care programs—including Medicare, Medicaid, the Children’s Health Insurance Program, and subsidies for health insurance purchased through exchanges—are projected to rise by more than 85% between 2014 and 2024. Similarly, spending for Social Security is projected to grow by 80% in this timeframe.
The CBO anticipates that spending for both Social Security and Medicare will remain fairly stable as a percentage of gross domestic product (GDP) for the first half of the next decade. However, spending for those programs rises relative to GDP in the second half of the period. By 2024, Social Security and net Medicare outlays reach 5.6% and 3.2% of GDP, respectively, compared with 4.9% and 2.9% in 2014.