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Intelligence Resource Center
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IMPACT ACT – Four Proposed Measures for CY 2018
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...
Medicare Reforms To Support Home Health, Care Coordination And Technology For Chronically Ill Patients
On June 15, the Leonard D. Schaeffer initiative for Innovation in Health Policy featured Senator Ron Wyden and health policy experts from across the political spectrum...
ACO Results Show Complex Care Management Lowered Spending Per Beneficiary
A new study by Dartmouth Institute For Policy and Clinical Practice finds coordinated care for patients with complex needs a big winner for ACOs. Currently there are...
Legislation To Improve Hospice and Palliative Care and Change Homebound Requirements
At a hearing of the Senate Special Committee on Aging, Senator Sheldon Whitehouse unveiled a bill to improve care for Medicare beneficiaries with advanced illnesses like...
Five Characteristics Of Home Healthcare Fraud – OIG
Attorney General Loretta E. Lynch and Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell announced an unprecedented nationwide sweep led by...
Fiscal Year Work Plan – Mid-Year Update 2016 Home Care
The OIG annually prepares a summary of the most significant management and performance challenges facing HHS, the associated recommendations for improvement, and the...
MedPAC: Unified Post-Acute Payment Within Reach
“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...
Reform Recommendations For The Future Of Medicare
The House Ways and Means Committee has approved an amended version of H.R. 5273, the Helping Hospitals Improve Patient Care Act of 2016. The provisions address Medicare...
New Unified Program Integrity Contractor Program (UPICs) Detects Fraud and Abuse
The federal government will soon unveil a new contractor program aimed at fraud in both the Medicare and Medicaid programs, according to an official with CMS. The new...
MACPAC Report To Congress On Medicaid
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...
Palliative Care Oncology Guidelines
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...
Palliative And Hospice Care Insights
Despite recommendations to the contrary, only about half of elderly patients with advanced cancer receive palliative care, according to new findings. Many of the...
Hospice Merger and Acquisition Insights
Despite the strong M&A volume, the hospice industry remains highly fragmented with the market’s two largest players, VITAS (owned by Chemed Corp.) and Gentiva...
Prior Authorization’ Becomes ‘Pre-Claim Review
After the Centers for Medicare & Medicaid Services (CMS) sought public comments February 5 for a proposed prior authorization demonstration for Medicare home health...
MedPAC Disagrees With CMS’ Approach To A Unified Post-Acute Payment System
The Medicare Payment Advisory Commission (MedPAC) made know its concerns about proposals in the draft fiscal 2017 payment rules as CMS proposes separate Medicare...
MedPAC Suggests Adjusting Overall Readmission Penalties
The Medicare Payment Advisory Commission (MedPAC) in a letter to Congress wants to change how penalties are assessed on hospitals for excessive readmission rates. The...
Medicare Advantage vs. Medicare-Fee-For Service Longitudinal Site Of Death Study
A recent study found that people who are continuously enrolled in Medicare Advantage (MA) are less likely to die in a hospital than people continuously enrolled in...
$89 Billion In Improper Medicare, Medicaid Payments
“Just last year, HHS estimated approximately $89 billion dollars in improper payments through Medicare and Medicaid,” said Rep. Tim Murphy (R-PA)....
CMS Initiative To Decrease 30-Day Hospital Readmissions 12% By 2019
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...
116 House Members Urge HHS To Withdraw Home Health Prior Authorization Proposal
Up to 116 members of the U.S. House of Representatives urged the Department of Health and Human Services to withdraw its proposed demonstration for prior authorization...
ACO Factoids
Of the 220 Medicare ACOs that were eligible for renewal, 147 renewed in the MSSP, eight transitioned to the Next Generation ACO program, and an additional 10 combined or...
Antibiotics Resistance: New Stewardship Required
“The medicine cabinet is empty for some patients. It is the end of the road for antibiotics unless we act urgently.” That comment from Centers for Disease...
DOL Issues “Overtime” Rule Effective December 2016
Home health and hospice providers, like other businesses seeking similar relief, were unable to gain an extension from the Department of Labor (DOL) new...
Medicare Advantage Fewer Readmissions
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...
Top 10 DRGs By Number of 30-Day Readmissions
Data analytics drives value-based partnerships. One component of the Triple Aim is reducing the cost of care. Below are the top DRGs with the highest number of 30-day...
Readmissions By Diagnosis and Payer
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...
Which Health Care Innovation Awards Show Promising Results
CMS shares the second annual independent evaluation reports of round one of the Health Care Innovation Awards. The Health Care Innovation Awards is a Centers for...
Trends in Medicare Advantage Plans
The number and share of Medicare beneficiaries enrolled in Medicare Advantage has steadily climbed over the past decade, and this trend in enrollment growth is...
Hospital Star Ratings – Only 168 Receive 5 Stars
CMS released ratings on close to 4,000 Medicare-eligible hospitals, and the vast majority scored either three of four stars. Only 168 hospitals in the United States...
House, Senate Bills Take Aim At DME Competitive Bidding
Legislation to delay a new round of cuts to rural and non-bid area suppliers and provide additional fixes to the Medicare competitive bidding program for home medical...

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