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Resources to Drive Performance and Profitability:

Behavioral Health Population Health Study

Study estimates a total annual value opportunity of $31 billion in the Medicare market through integration of Mental Health/substance use and medical treatments. “Literature suggests that an estimated 5%-10% of these total health expenditures for those with behavioral conditions may be...

Home Health Agency “Introductory” Visits To Patients

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services, the primary enforcer of fraud and abuse prohibitions, posted Advisory Opinion No. 15-12 on August 13, 2015, which makes it clear that agencies may provide “introductory” or coordination visits to patients in...

Community-Based Services: Paramedics New Role

Community paramedicine (CP) is a new and evolving model of community-based health care in which paramedics function outside their customary emergency response and transport roles in ways that facilitate more appropriate use of emergency care resources and/or enhance access to primary care for...

New Discharge Planning Framework Under The IMPACT Act

CMS’s proposed rules revise the discharge planning requirements that hospitals, including long-term care hospitals and inpatient rehabilitation facilities, critical access hospitals, and home health agencies, must meet in order to participate in the Medicare and Medicaid programs. As called for in...

Home Health Agency Value-Based (HHVPB) Model Background

Beginning January 1, 2016, CMS will implement the HHVBP model among all HHAs in nine states representing each geographic area in the nation. All Medicare-certified home health agencies (HHAs) that provide services in Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa...

IMPACT Act – Cross-Setting Standardization For Skin Integrity

The IMPACT Act requires collection of data across eight domains. In keeping with the requirements of the IMPACT Act, measures for the other domains will be addressed through future rulemaking. CMS received feedback on four future, cross-setting measure constructs to potentially meet requirements of...

IMPACT Act – Cross-Setting Quality Measure For Medication Reconciliation

CMS has contracted with Abt Associates and RTI International to develop a cross-setting Post-Acute Care measure for the quality measure domain – medication reconciliation. In this measure, medication reconciliation and drug regimen review are defined as: Medication Reconciliation – the process of...

IMPACT Act –Preventable Readmission Measures For Post-Acute Providers

CMS has contracted with RTI International and Abt Associates to develop potentially preventable readmission measures, in alignment with the Improving Post-Acute Care Transformation Act of 2014 (known as the IMPACT Act) and the Protecting Access to Medicare Act of 2014 (known as PAMA). “The...

Physician Market Scan: Advanced Primary Care Tests Population-Based Care

Under development from CMS is the advanced Primary Care initiative to test innovations in advanced primary care, particularly mechanisms to encourage more comprehensiveness in primary care delivery; to improve the care of complex patients; to facilitate robust connections to the medical...

MEDICAID ACO Market Scan

Colorado The longest-standing Medicaid program is in Colorado, where the statewide Accountable Care Collaborative launched in 2011. The Colorado program’s Regional Care Collaborative Organizations (RCCOs) are not at financial risk for improving quality and lowering costs (they only share in...

ACO Investment Model

The ACO Investment Model is an initiative developed by the Center for Medicare & Medicaid Innovation (Innovation Center) for organizations participating as ACOs in the Medicare Shared Savings Program (Shared Savings Program). The ACO Investment Model is a new model of pre-paid shared savings...

Payor and Physician Models For Chronic Care Management

Fragmentation of the care delivery system is widely recognized as a cause of missed opportunities to treat both acute and chronic conditions. Coordination of care among physicians and other practitioners is seen as an essential part of improved quality. Anthem is partnering with well-established...

Payor Merger and Acquisition National Landscape

Several factors are driving merger and acquisitions in the payor’s national market. First, they appear to be diversifying their product mix to create synergies and mitigate risk by expanding their offerings across market segments and experimenting with new distribution channels in public and...

Readmissions For Surgical Site Infections After Discharge Increasing

Nearly one in five patients who are readmitted to a hospital after having emergency general surgery are there because they developed a surgical site infection, a new study suggests.  “Reducing readmissions is a noble cost-saving goal with benefits not only to the hospitals, but also to the...

The IMPACT Act Unifies Payment System For Post-Acute Providers

Congressional approval of H.R. 4994, the IMPACT Act in October 2014, mandates the development and implementation of a standardized post-acute care assessment tool, and paves the way for effective payment reforms for Post-Acute Providers. “Historically paid under separate reimbursement systems, the...

What Is The Definition Of Patient Centered-Care?

A panel of eldercare experts, organized by the American Geriatrics Society, released its definition for person-centered care. The updated definition stresses the importance of individuals’ values, and a collaboration between the patient, their family and the provider. A panel of eldercare experts...

The IMPACT Act Standardized Patient Assessment Data

Section 2(a) of the Improving Medicare Post-Acute Care Transformation Act of 2014 (the IMPACT Act) requires post-acute providers to submit standardized patient assessment data, as well as standardized data on quality measures and resource use and other measures. A standard acute care instrument...

Comprehensive Care For Joint Replacement Model Background

The Comprehensive Care for Joint Replacement (CJR) Model – set to begin on April 1, 2016 – will test bundled payment and quality measurement for hip and knee replacements and/or major leg procedures to encourage hospitals, physicians, and post-acute care (PAC) providers to work together to improve...

The IMPACT Act Quality Measure Domains

HHAs, Skilled Nursing Facilities (SNFs), Inpatient Rehabilitation Facilities (IRFs), and Long-Term Care Hospitals (LTCHs) have different quality measure domains. All four settings must report standardized data using the assessment instruments  on at least five of the following eight quality...

The IMPACT Act New Discharge Planning Rules Impacts Post-Acute Providers

Under the proposed rule, hospitals and critical access hospitals would be required to develop a discharge plan within 24 hours of admission or registration and complete a discharge plan before the patient is discharged home or transferred to another facility. The IMPACT Act requires hospitals...

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March/April 2019 Remington Report
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