In this week’s FutureFocus, is important new information about how a unified Medicare PAC payment will work for home health agencies, skilled nursing facilities, inpatient rehabilitation facilities and long-term care hospitals. What does a unified PAC payment system look like? Discussions are flushing out the similarities and gaps among the four settings. New approaches could establish tiers based on levels of care. Policy considerations are being explored. Are possible timeframes nearing the future? This is a must read. Your future could be impacted sooner than once thought.
In this week’s FutureFocus, is a letter from the Medicare Payment Advisory Commission (MedPAC) to CMS Administrator, Seema Verma. The letter is commenting on the Centers for Medicare & Medicaid Services’ (CMS) proposed rule entitled “Medicare and Medicaid Programs; CY2019 home health prospective payment system rate update and 2020 case-mix adjustment methodology refinements; home health value-based purchasing model; home health quality reporting requirements; home infusion therapy requirements; and training requirements for surveyors of national accrediting organizations,” Federal Register, vol. 83, no. 134, p. 32340 (July 12, 2018). We provide the in-depth comments. This is a must read for all providers. Will MedPAC's comments influence the final rule?
In this week’s FutureFocus, we discuss the paradigm shift for hospice provders. There are a number of key trends impacting the future of hospice providers. Our analysis and insight will help the industry have a better understanding of how this change is taking place, how it shifts the industry and why it is important for all providers to understand the paradigm shift. A reminder: when there are major shifts to one healthcare provider, it means it also can impact your organization.
In this week’s FutureFocus, palliative care and hospice are in the spotlight. A bill called the Palliative Care & Hospice Education Training Act passed the House at the end of July. It establishes greater palliative care workforce training programs for doctors, nurses and other health professionals. In another story, the OIG is taking a closer look at hospice and finding vulnerabilities. We provide the report that has some eye-opening findings.
In this week’s FutureFocus, we discuss the Physician Self-Referral Law affecting all post-acute providers. Enacted in 1989, the Stark Law have turned into an outdated set of legal requirements inhibiting and blocking the ability to move into value-based care. This is important to learn about as it will change our future healthcare delivery system. We also take a look at anti-kickback issues in palliative care, and a report by the OIG examining home health agency low utilization claims and hospice benefit charges.
In this week’s FutureFocus, are new discussions and trending insights about how policy is supporting the use of telehealth for all providers. This is a big breakthrough for patient care management and oversight. Threaded into the new announcement about 2019/2020 Medicare reimbursement updates for home health agencies is a glimpse of the future of telehealth. Be sure to read how telehealth can broaden your organization’s internal and external growth and partnerships.
In this week's FutureFocus, are new discussions about discharge planning practices. The June MedPAC report urges CMS to provide more guidance. CMS’s current regulatory guidance, reflects “the prohibitions” of a law more than two decades old, the Balanced Budget Act (BBA) of 1997, which states “a hospital ‘may not specify or otherwise limit the PAC providers made available to beneficiaries. (Medicare Advantage allows plans to establish their own networks; these plans’ enrollees must select a provider that is in their plan’s network.)” The BBA also requires “that hospitals provide a list of HHAs or SNFs that are near the beneficiary’s residence for patients identified as needing these services.” We provide updates and insights.
We have been keeping you informed about patient choice and discharge planning options. This started back in October 2017 with MedPAC's recommendation for discharge planning options. It appears from a recent lawsuit, patient choice is also affecting physician referrals. We provide the details.
News permeated the industry as notice of the pre-claim review demonstration is restarting and expanding. The demonstration will impact 1.3 million claims each year. Of interest to our readers is the report issued by the congressional watchdog agency, the General Accounting Office (GAO). CMS wants to identify new opportunities for expanding prior authorizations for additional items and services with high unnecessary utilization and high improper payment rates. The CMS asked for public input on how it can ensure the new experiment doesn't harm access to care. Comments are due July 31.
In this week’s FutureFocus, we continue our discussions on Medicare Advantage Plans and new insights for PAC providers and patients. Our first article explores the differences in Medicare Advantage plans and fee-for-service and why Medicare Advantage plans should coordinate with PAC providers. Attorney Elizabeth Hogue explores the new Medicare Advantage Plans allowable supplemental benefits for home-based palliative care, in-home support services and caregivers. In our Washington Report, we look at the next overhaul of the private sector care program for the VA.
In this week’s FutureFocus, we continue our discussions on patient's rights and their preferences to where they want to be cared for. A review of 57 studies provide key findings. The focus on palliative care consultations comes to the forefront in a study of 130,000 adults with serious illness. The study analyzed adults receiving palliative care consultants, and those that did not and the impact to hospital savings. A new rule protecting DME, expanding telehealth and focusing on improved care was announced giving emphasis to rural healthcare.
In this week’s FutureFocus, is the announcement of CMS discussing a Request for Information (RFI) for feedback on solutions to achieve better data sharing between providers. A similar RFI was announced recently in FY 2019 PPS updates. There is a possibility of revising Conditions of Participations. Another merger between three home care companies will form one of the largest providers of home-based care in the U.S. In another announcement, Humana and Landmark announce an in-home care program for chronic conditions.
In this week’s FutureFocus, we discuss the announcement of the recent mega-mergers reshaping the future of post-acute services. The transactions position Humana to become the largest hospice provider, and ProMedica Health System as the second largest post-acute and long-term care provider. In our Washington Report, CMS's Center for Medicare & Medicaid Innovation (CMMI) is changing its direction. We share their 8 new focus areas.
In this week’s FutureFocus, we provide a recent study related to readmissions and implications for post-acute providers. In another article, we address recommendations being considered for new performance measures for Home Health and Hospice. This is a must read. There is new legislation to allow hospice to dispose of unused medications in the home after a patient expired. This legislation is supported by NAHC.
In this week’s FutureFocus, we provide insights about Medicare Advantage Plans and the recent announcement of expanding primary health-related benefits. Attorney, Elizabeth Hogue, warns providers to be cognizant of the experience levels of private duty companies working with the government or commercial insurers. In our Washington Report, we call attention to the Annual Anti-Fraud Report and the findings about home health providers. We remind providers that the low volume appeals settlements deadline have been extended.
In this week’s FutureFocus, we explore the changing landscape of palliative care. More payors are entering the market and recent announcements are advancing two alternative payment models (APMs). In our Industry News section, are major announcements shifting the landscape of the home health market and information technology. In our Legal section, Attorney, Elizabeth Hogue, talks about guidelines for home health agencies with regard to refusal of services and/or non-compliance.
In this week’s FutureFocus, is important information about the future of post-acute payments. MedPAC, the committee that reports to Congress on Medicare, is recommending prior to the implementation of the PAC PPS in 2019, that blending the relative weights of the setting-specific payment systems and the unified PAC PPS be considered. We provide the details. This is a must read. In our Washington Report, we provide insight into two alternative payment models for advanced illness recommended by HHS.
In this week’s FutureFocus, we discuss an OIG report and its findings that sixty-one percent of Medicare claims for outpatient therapy did not comply. We provide the 10 reasons. Attorney, Elizabeth Hogue, discusses how to contest survey deficiencies. Our Washington Report provides insight into Trump's opioid initiative and responses from NAHC and NHPCO.
In this week’s FutureFocus, Attorney Elizabeth Hogue provides additional insights about hospital discharge planners and their recommendations of post-acute providers. Elizabeth ties into the discussion Conditions of Participations (CoPs) and standards of care. In our Washington Report, we discuss an OIG report and the vulnerability to fraud in unverified home health agency patient lists. Don't miss the CMS Special Open Door Forum on the IMPACT Act and improving care coordination. We provide details and additional reading for that call.
In this week’s FutureFocus, we provide insights into how quality data influences discharge planning. Ongoing discussions at MedPAC are evaluating current discharge planning procedures and the future of the IMPACT Act for PAC providers. In another article, we focus on Medicare reimbursement changing for physicians and new opportunities for post-acute providers to integrate chronic care management solutions. We provide resources and insights to tackle the topic. In the news, is talk about social determinants and the responsibility of providers. Learn how health systems, ACOs and payors are looking at different solutions.
In this week's FutureFocus, we provide insights into how MedPAC (The Medicare Payment Advisory Commission that reports to Congress) is discussing different ways to pay for sequential stays in a unified payment system for post-acute. In the report, MedPAC provides recommendations for 2018 and beyond. In another article, we explore how ACOs are managing high-risk patients. The insights provide ways post-acute providers can provide value. Our last article lends perspectives on how much Medicare households spend on health-related expenses.
In this week’s FutureFocus, we provide detailed insights into discussions MedPAC is having on changing protocols for current discharge planning practices. This could be a game changer for post-acute providers and patient choice. This is a must read. In our Washington Report, we call attention to the Trump Administration proposal for a Medicare post-acute payment system.
In this week’s FutureFocus, we TrendTrack new telehealth reimbursement and future services. In 2017, there were 210 telehealth related bills. Telehealth is finally finding its place in the healthcare delivery system. In another article, we provide insights into health care spending. In 2020, home health is projected to be the fastest growing sector at 6.7 percent annually, from 5.1 percent in 2017.
In this week’s FutureFocus, we discuss four reforms coming to your organization. Key topics will impact home health payment reform, hospice, a new hospital discharge penalty, and the expansion of telehealth. We provide insights to each reform.
In this week’s FutureFocus, we explore post-acute costs by care settings for the dual eligible. Important data helps to understand why costs are higher within the entire post-acute discharge period and in particular areas of post-acute. This important data ties back to Medicare Spending per Beneficiary. In another article, we discuss medication non-adherence solutions for Medicare patients. Our Washington Report addresses how CMS is launching a low volume appeals initiative.
In this week’s FutureFocus, is an important development to the future of home health. CMS is developing potentially preventable hospitalizations for the home health setting. This is an indicator of a future quality measure. In another move, CMS is continuing its moratoria on enrollment of new Medicare home health agencies in certain states. We provide the details. In an effort to detect fraud, the Department of Veterans Affairs (VA) and CMS are partnering to share data, data analytics and best practices.
In this week’s FutureFocus, we discuss recommendations for future Medicare payments for home health, hospice and SNF. It is recommended that therapy payments be eliminated in home health. In another article, we provide key findings related to ACOs and the importance of discharge planning. In a related article, improper discharges from SNFs may start receiving civil penalties. Don’t miss the most common reasons for discharges from SNFs.
In this week's FutureFocus, we address the new voluntary bundled payment model and the impact to post-acute providers. Participants may receive payments on 32 different clinical episodes. Medicare-enrolled or not Medicare enrolled providers or suppliers may participate. We provide the details. In another article, the American Hospital Association comments on MedPAC's proposal for changes to post-acute payments and their concerns with moving this forward.
In this week’s FutureFocus, we provide insight into the top five payers representing 43 percent of the country's total insured population. Six key findings define the five payers. In another article, we call your attention to 2018 financial penalties for nursing homes being scaled back and what that means to the industry. With so many changes, we keep you focused on important resources you won't want to miss.
In this week’s FutureFocus, we look at an interesting fact about MSSP ACOs and the relationship to hospitalizations. A Harvard study finds ACO preventable hospital admissions didn't decrease, but instead rose. In another article, we look at readmission penalties. Since the onset of the Readmission Reduction Program (HRRP), penalties have continued to rise. The analysis compares FY 2013-2017. In our Washington Report, we examine the Medicare Extenders Package and the impact to post-acute providers.
In this week’s FutureFocus, we discuss the 32 quality measures under consideration for 2018. 40 percent of the measures are outcome measures. Our next article discusses health spending by type of services. In home health, Medicare and Medicaid made-up 77 percent of home health spending. Ramping-up for value-based purchasing, the physician compare website now will include star ratings and performance information.
In this week’s FutureFocus, learn how six health systems around the U.S. are transitioning their organizations from fee-for-service into value-based models. Each are using different strategies and models to reach their goals. Important data has been tracking how many Medicare beneficiaries are in an ACO. Learn what those numbers are in 2017. In another article, we share how CMS is addressing accuracy for the Hospice Compare website.
In this week’s FutureFocus, we address 2019 recommendations for payment rates for home health and post-acute providers. There are changes ahead for Medicare payments and the unified post-acute prospective payment system. In 2018 payers are moving forward with value-based payment models. We discuss the impact to post-acute providers. Spending on Medicare beneficiaries for end-of-life accounts for approximately 25% of total spending. We provide four key trends.
In this week’s FutureFocus, we discuss the future of bundled payment models and the opportunities for providers in the future. CMS has announced a move to reduce DME Medicaid spending. We explain the tie-back to the 21st Century Cures Act. CoPs are back in the news. We discuss the flexibilities announced for home health to meet the January 13, 2018 implementation date.
In this week’s FutureFocus, we examine key elements to a successful home-based palliative care (HBPC) program. The case study at Sharp Healthcare is a pre-hospice program keeping patients out of the hospital. A new survey finds that adults age sixty-five and older have more chronic conditions compared to other nations.
In this week’s FutureFocus, we provide data on how ACOs are performing. In the Washington Report, we explain how Medicaid waivers are being revamped. 2018 will be a big change year for Medicaid. This is the first announcements of change. Don’t miss our resource on the five barriers to accessing palliative care.
In this week’s FutureFocus, we discuus the expansion of payment for telehealth under the final 2018 Physician Fee Schedule. In this week’s Washington Report are updates on regulations: PPS, HHGM and reforming regulations.
In this week’s FutureFocus, we explore seven industry perspectives for hospice and palliative care. We examine industry-wide solutions, and public education that can assist families and caregivers in understanding such a critical benefit. In another topic, we discuss a new pilot program for physicians to test value-based care. In this week’s Washington Report, we report on two new bills to expand chronic care management.
In this week’s FutureFocus, we explain what episode and episode groups mean to physicians under MACRA. How are costs triggered? What happens when there are overlapping episodes? This knowledge becomes important in understanding how physicians will be paid in the future. In this week’s Washington Report are details and findings of a recent report on DME, access and a new bill introduced.
In this week’s FutureFocus, RN and LPN salaries across the healthcare continuum are detailed. Over 10,000 nurses participated in this survey. In this week’s Washington Report, are the insights about the opposition building to CMS PPS Groupings Model. Senators and consumer groups weigh-in.
In this week’s FutureFocus we discuss two important industry insights related to the proposed rules on Home Health Value-Based Purchasing Model and the Proposed Updates to the Home Health Care Quality Reporting Program (HH QRP). In this week’s Washington Report, CMS comments on the OIG urging home health agencies to get surety bonds.
In this week’s FutureFocus we discuss important industry topics related to patient choice, discharge planning and the Home Health Groupings Model (HHGM) for CY 2019. MedPAC, the committee reporting to Congress on Medicare is taking a look at short and long-term options for patient choice and discharge planning. In a letter submitted to Seema Verma, Administrator CMS Department of Health and Human Resources, MedPAC weighed-in on the proposed implementation of the Home Health Groupings Model (HHGM) for CY 2019. We learn insights that may impact the future.
In this week’s FutureFocus, we discuss a recent GAO report that concludes by the GAO stating, "Using managed care to deliver long-term services and supports can be a strategy for states to expand home - and community-based care, which many beneficiaries prefer, and to lower costs." The industry should expect change to come in upcoming announcements. Also, providers should be preparing for the Medicare card changeover removing social security numbers to the new Medicare Beneficiary Identifier. This will require changes in your business processes.
In this week’s FutureFocus, our Washington Report discusses industry reaction to the proposed home health groupings model. Critics say the new model will redistribute payments away from medically-necessary home health services. In our second article, the American Hospital Association (AHA) is under discussion with the Department of Heath and Human Services to question the prototype being used as the foundation for the PAC PPS model.
In this week’s FutureFocus, we provide results about how ACOs are working and which two quality measures improved the most. In a separate article, we examine ways ACOs, hospice and palliative care can partner on quality, cost and access. Our Washington Report discusses a new CMS strategy targeting home health agencies identified as possible Medicare risks.
In this week’s FutureFocus, we provide details and insights to understanding physician value-based payments. Our Washington Report discusses how a recent OIG report is investigating hospice duplicate drug payments.
In this week’s FutureFocus, we discuss important developments affecting PAC providers. The launching of the Hospice Compare Website, the cancellation of cardiac bundles, and the scaling back of the CJR model. Our Washington Report provides insights and details about the decision to cancel and scale back these models.
In this week’s FutureFocus, are details about 30-day readmission penalties and what is ahead for the future. Our Washington Report provides insights you will want to know about the longstanding Competitive Bidding program and a recent report detailing findings.
In this week’s FutureFocus, are details of 9 recent payment and policy changes impacting hospice and skilled nursing facilities (SNF). Note that the SNF’s value-based payment program is ratcheting-up responsibilities for readmissions.
In this week’s FutureFocus, are details of recent policy and regulation changes impacting home health organizations. These major changes include a $950 million decrease in Medicare payments and impact the methodology of how home health will be paid in the future.
In this week’s FutureFocus, we provide a study on the importance of standardizing palliative care and the impact of 30-day readmission. Our Washington Report discusses the OIG’s new projects for home health agencies, hospice and telehealth.
In this week’s FutureFocus, we explore the five barriers to accessing palliative care. It becomes apparent that current reimbursement, and a lack of understanding palliative care will need to be addressed. Our Washington Report recaps the delay in CoPs and comments by CMS.
In this week’s FutureFocus, we provide insight into end-of-life spending and how ACOs are participating in end-of-life planning. The market is signaling a greater need for home health, hospice and palliative care partnerships. Learn how this impacts your organization.
In this week’s FutureFocus, we discuss MACRA. All home health and post-acute providers should familiarize themselves with how MACRA will change physician reimbursement and the impact to other stakeholders.
In this week’s FutureFocus, we focus on falls. We provide access to a falls prevention and coordinated care toolkit, and include a case study for reducing falls for hospice patients.
In this week’s FutureFocus, we discuss two changes ahead for providers. The first is a discussion about how key provider groups are having an impact on reducing regulatory burdens for acute and post-acute providers. Then, we share a new bill to enhance end-of-life planning
In this week’s FutureFocus, we discuss new market trends – the expansion of outpatient services and the new growth opportunities for PAC providers.
In this week’s FutureFocus, we explore the growth of Home-Based Palliative Care models. The Washington Report discusses the launching of the new Medicare Beneficiary identifier.
In this week’s FutureFocus, we continue to follow MedPAC’s recommendations for PAC providers. MedPAC publishes two annual reports in March and June. The information we share here is for MedPAC’s upcoming June Report. We invite you to sign-up for FutureFocus. You will receive it complimentary every Wednesday.
In this week’s FutureFocus, we discuss trends and integration strategies between Medicare Advantage Plans and PAC providers. The Washington Report discusses the Home and Community Based Services (HCBS) extension.
In this week’s FutureFocus, we provide the updates for 2018 proposed rules for post-acute providers. The Washington Report discusses a study on copays for home health.
In this week’s FutureFocus, we discuss the strategy of using caregivers in the discharge planning process. A recent study showed reductions in 90 and 180 day readmissions. Our Washington Report explains the new rule for national Accreditation Organizations to post all survey reports.