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The Paradigm Shift for Hospice Providers Begins

A number of key trends are impacting the future of hospice providers. Four key trends contribute to the paradigm shift: Principal diagnoses are changing. Expenditures are expected to increase by 8% annually. Expanded role of physician assistants …. now has a “twist.” A Meaningful...

MarketScan: Payors Expanding Into Palliative Care

Payors and Alternative Payment Models (APMs) are turning to palliative care programs as a way to offer value-based end-of-life care. Learn how changes affect the future.  By: Lisa Remington, President Remington Health Strategy Group, Publisher, The Remington Report The palliative...

Readmission Analysis By Payor: Seven and Thirty Day By Diagnosis

In 2014, 14 percent of inpatient stays were readmitted within 30-days. More than one-third of these readmissions occurred within 7-days, reflecting a 7-day readmission rate of 5 percent.  By: Lisa Remington, President Remington Health Strategy Group, Publisher, The Remington...

What Does A Unified PAC Payment System Look Like?

Some operational and administrative requirements are relatively similar across PAC settings. Exploring similarities flushes out what is presently aligned for the model to work, and identifies where there are gaps that need more oversight or policy changes. By: Lisa Remington, President...

Episode-Based Vs. Stay Based Payments: Discussions for Future Payments

The Medicare Payment Advisory Commission (MedPAC) is discussing how to proceed on creating a unified prospective payment system to improve the accuracy of Medicare fee-for-service payments for post-acute care settings (HHA, SNF, IRF, and LTCH). By: Lisa Remington, President, Remington Health...

2019 Guidelines for Home and Community-Based Services

CMS issued new guidance to clarify where Medicaid beneficiaries can receive home- and community-based services as defined in a 2014 regulation.  The guidelines in the HCBS final rule establishes new reimbursement criteria. By: Lisa Remington, President Remington Health Strategy Group...

How ACOs Manage High-Risk, High-Need Patients

A study in The American Journal of Accountable Care analyzed the clinical and administrative workforces of 17 ACOs. An aspect of the analysis looked at the resources needed to reduce the overall cost of care by improving care for high-risk patients. The study provides a window into how ACOs...

16 Things To Know About Stark Laws

The Stark Law is a set of United States federal laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient to an entity providing designated health services ("DHS") if the physician (or an immediate family member) has a...

Readmission Data For All Cause 7-Day and 30-Day

Is 30-days the right interval for your organization to be measuring readmissions? 30-day risk-standardized, all-cause, unplanned readmission rates is widely used to measure hospital penalties. Yet, many question if this is the correct interval by condition. For both 7-day and 30-day...

Which Patient Populations Cause The Highest Readmissions?

In the third year of the Hospital Re­ad­mission Reduction Program (HRRP) (FY 2015), the proportion of hospitals receiving a penalty increased to 78 percent – up from 64 percent and 66 percent in 2013 and 2014 respectively. This increase is not surprising given that for 2015 penalties, CMS...

The Five Barriers to Accessing Palliative Care

Barriers to palliative care access in the United States occurs in five domains: By: Lisa Remington, President, Remington Health Strategy Group, and Publisher, The Remington Report Lack of AwarenessThe misperception among doctors and other health professionals that palliative care is...

22 Key Facts About Physician CCM Billing

Frequently Asked Questions about Physician Billing for Chronic Care Management Services.  This document answers frequently asked questions about billing chronic care management (CCM) services to the Physician Fee Schedule (PFS) under CPT codes 99487, 99489 and 99490. January 18...

ACOs: Three Approaches To Improve End-of-Life Care

The ACO model has the right incentives to reduce variation, spur innovation, and improve quality in end-of-life (EOL) care. It also gives providers and delivery systems the flexibility to expand access to palliative care outside of the Medicare hospice benefit by encouraging ACO providers to...

Home-Based Palliative Care Models

Palliative care focuses on relieving patients’ stress, pain and other symptoms as their health declines, and it helps them maintain their quality of life. It’s for people with serious illnesses, such as cancer, dementia and heart failure. The idea is for patients to get palliative care and then...

The ACO Medicare-Medicaid Model For Managing High-Risk Patients

Some of the highest-need, highest risk Medicare beneficiaries are those enrolled in both Medicare and Medicaid.  In current Medicare ACO initiatives, beneficiaries who are Medicare-Medicaid enrollees may be attributed to ACOs. The Medicare ACO, however, does not have financial...

Patient Activation Measures For High-Risk Patients

Patient "activation scores" can identify those who might benefit from help making behavioral changes.  After reviewing medical records for approximately 98,000 adults, researchers found that patients who did not feel competent to manage their own health or navigate the health care system were...

Primary Care Is Driving Care Coordination: Market Changes Ahead

Market conditions are sending strong signals about changing responsibilities and payments physicians will have for managing patients beyond the four walls of their offices. We explore three key game changing trends.
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Physician Practice Transformation: A Primer on MIPS and APMs

The Medi­care Access and CHIP Reauthori­zation Act (MACRA) went into law over a year ago. CMS released the first major regulation under MACRA, set­ting forth the new rules under this game-changing law. For now, only physician offices – not hospitals – are governed by MACRA rules. CMS...

End-of-Life Medicare Spending And The Cost Of Care Insights

Of the 2.6 million people who died in the U.S. in 2014, 2.1 million, or eight out of 10, were people on Medicare, making Medicare the largest insurer of medical care provided at the end of life. Spending on Medicare beneficiaries in their last year of life accounts for about 25% of total...

Readmission Insights Tied To Patient’s Socio-Demographic Status

Many post-acute care organizations are asking CMS to account for differences in patient populations. CMS is shaping a framework intended to allow better comparisons of post-acute care provided in four different settings. A roughly $60 billion annual expense for Medicare, the field involves the work...

Care Coordination High Priority For Bundled Payment Models

The Centers for Medicare & Medicaid Services recently proposed a new payment model that would bundle payment to acute care hospitals for heart attack and cardiac bypass surgery services. In 2014, more than 200,000 Medicare beneficiaries were hospitalized for heart attack treatment or underwent...

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MarketScan
Capitalizing on the Rising Value of the Home Health Care Industry
 
 

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