Themes from American Health Law Association’s 2023 Institute on Medicare and Medicaid Payment Issues

I am fresh back from Baltimore, Maryland, where I was on the faculty of AHLA’s annual Institute on Medicare and Medicaid Payment Issues. I have been on the faculty of this program for a dozen years, and am always thrilled to hear the latest in healthcare payment and reimbursement changes and trends. This year I spoke on Medicare policies on hospital co-location, and presented along with the person who oversaw development of the government policy, David Wright, Director of the Quality, Safety & Oversight Group of the Centers for Medicare & Medicaid Services.

The big themes from this year’s conference were:

1) Physician shortages are driving legal changes and focuses all over.


  • The addition of residency slots to allow more physicians to be trained simultaneously;
  • Increasing flexibilities around the delivery of services via telemedicine, a holdover that will survive the pandemic; and
  • There were two sessions regarding the use of non-physician advanced practice professionals and the application of the so-called “incident to” rules in this context and also billing for services performed by residents. There was explicit acknowledgement in one of those sessions that with healthcare staffing shortages, it will be necessary to provide care by relying on teams of practitioners who are not physicians to supplement physician care.

2) Medicaid payment and supplemental payments are growing in significance and creativity. The Medicaid program is evolving in recognition that healthcare is difficult to provide in a vacuum.

  • A much larger percentage of Medicaid sessions were offered at this year’s conference which has historically had a greater focus on Medicare.
  • CMS is encouraging states to exercise authority to utilize certain Medicaid waivers (and Medicare in accountable care situations) to pay for certain health-related social needs such as housing, food and utilities to see if addressing these has an impact on reducing healthcare costs. California is among them.

3) Value-based care in the Medicare program is trending and will evolve into the face of the Medicare program, reducing fee-for-service care for many beneficiaries.

  • CMS has set a goal of having all Medicare fee-for-service beneficiaries in a care relationship with accountability for quality and total cost of care by 2030.
  • Evolving value-based care models are accounting for health equity.

4) The federal COVID-19 Public Health Emergency is ending on May 11, 2023, but some of the “temporary flexibilities” will stay in place.

Those items include:

  • Flexibilities to provide certain hospital at home services under the Medicare program will be extended; hospitals can continue to apply for approval to provide services in this way through the end of 2024;
  • There will be permanent additional telehealth flexibilities under the Medicare program; and
  • Payment for vaccines, testing, and treatment for COVID-19 will continue to be available under the Medicare and Medicaid programs.

On a lighter note: This conference is always a great chance for me to connect with my friends in the health law bar across the country. You might be surprised at what we healthcare geeks like to do for entertainment. Last year, there was great discussion of the Theranos debacle and the heroics of a certain surveyor from the Centers of Medicare & Medicaid Services in bringing down the enterprise. I went home and binge-watched Netflix’s The Dropout with Amanda Seyfried after last year’s conference. This year I learned of a podcast called Dr. Death from Wondery about more egregious cases of malpractice. I am looking forward to tuning in during my commutes.