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Resources to Drive Performance and Profitability:

The top six types of providers who provided home-based medical care (non-podiatry) in both 2012 and 2013 were physicians in internal medicine, family practice, geriatric medicine, or general practice; nurse practitioners; and physician assistants – providers we termed primary care providers.
MACRA is a transformative law that builds a new, fast-speed highway to take the health care system away from the fee-for-service system and toward new risk-bearing, coordinated care models. “Once the program is up and running, physicians can pick one of two routes that will determine how they...
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 published a rule on Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models...
Older adults are at increased risk for adverse events after surgical procedures. Loss of independence (LOI), defined as a decline in function or mobility, increased care needs at home, or discharge to a non-home destination, is an important patient-centered outcome measure. “Readmission...
An estimated 29 percent of Medicare beneficiaries experienced adverse or temporary harm events during their rehabilitation hospital stays, resulting in temporary harm; prolonged stays or transfers to other hospitals; permanent harm; life-sustaining intervention; or death, according to a new report...
CMS wants to cut the number 30-day hospital readmissions by 12% and achieve a 20% reduction in overall patient harm by 2019 over the next three years under a hospital improvement plan. Proposals for the new Hospital Improvement and Innovation Networks, will work with hospitals, patients and other...
CMS is proposing to adopt four measures for the CY 2018 payment determination to meet the requirements of the Improving Medicare Post-Acute Care Transformation Act of 2014 IMPACT Act. Three of these measures are resource-based and calculated using Medicare claims. The fourth measure is...
“The PPS prototype that the Commission developed accurately predicts resource needs for nearly all patient groups, indicating that it can be used to set fair and accurate payments,” MedPAC adds in a News Release with the June 15 report which addresses issues affecting the Medicare program as well...
The Medicaid and CHIP Payment and Access Commission (MACPAC) released its June report to Congress, which looks at Medicaid spending and financing at the request of congressional committees with interest in Medicaid. The report findings state Medicaid spending on long-term care is disproportionate...
For the second performance year, Independence at Home participants saved Medicare more than $10 million – an average of $1,010 per beneficiary – while delivering higher quality patient care in the home, according to a new analysis by the Centers for Medicare & Medicaid Services (CMS). Under...
A new guidance statement to define high-quality primary palliative care delivery in medical oncology has been developed by the American Society of Clinical Oncology (ASCO) and the American Academy of Hospice and Palliative Medicine (AAHPM). The two organizations have partnered to develop these...
Despite recommendations to the contrary, only about half of elderly patients with advanced cancer receive palliative care, according to new findings. Many of the patients who do receive it late in the course of their disease, as opposed to immediately after diagnosis, which is recommended in...
Greater use of Medicare Advantage (MA) over traditional fee-for-service Medicare (TM) in certain populations, and even across small areas, has been associated with fewer overall hospitalizations and avoidable hospitalizations. Proponents attribute these associations to successful care management...
Trends in the 30-day all-cause readmission rate following index admissions for four high-volume conditions, by expected payer of the index stay, in 2009 and 2013 are discussed.    All-cause rate of readmission, by principal diagnosis and expected payer of the index stay, 2009-2013 In...
CMS will collaborate with a broad group of stakeholder organizations and persons to develop measures that are important to both patients and clinicians and that represent important performance gaps in the targeted quality domains. MACRA identifies five quality domains: clinical...

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