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FutureFocus

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Keep Thinking Ahead of the Curve

FutureFocus, an executive resource, helps our healthcare leaders to see around corners, navigate disruption, build futures, broaden their views of the industry, and embrace change.

FutureFocus cuts through the “white noise,” while making sure we are connecting you to meet the future of healthcare.

Smarter Ideas    •     Strategy     •    Vision    •   Innovation

As a barometer of change, we monitor complex key trends and forces of change to roadmap the future to de-risk decision-making and drive opportunity innovation.

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FutureFocus is offered complimentary.

FutureFocus April 17, 2019 Hip And Knee Replacement: Home Discharge Insights

In this FutureFocus, we take a look at large studies that conclude patients after knee and hip replacement discharged to home have overall lower costs and lower rates of medical complications.

Future Focus March 28, 2019: Revised Guidelines For Home and Community-Based Services

In this FutureFocus is the new guidance issued by CMS about where Medicaid beneficiaries can receive home and community-based services. This impacts several settings such as assisted living facilities that, in the past, were using waivers to provide certain services. All PAC providers should be reading this to understand opportunities/challenges to their organizations.

FutureFocus March 27, 2019: EHR Incentives for PAC Providers: What Will CMS Recommend?

In this FutureFocus is important discussions about the future adoption of EHRs across post-acute sectors. A new RFI has been issued by CMS to ask for stakeholder feedback about the best ways to incentivize EHR adoption in post-acute. We have pulled out from the RFI important communications about proposed patient information hospital’s would be required to provide to post-acute providers at admission and discharge.

FutureFocus March 21, 2019: PDGM Analysis By Type of Agency

In this FutureFocus, are details about the revision of home health payments in 2020. The breakdown includes PDGM and the impact by agency type. A recap of the value-based purchasing program in home health has mixed reviews.

FutureFocus March 19, 2019: 2020 Payment Reductions Home Health and Hospice

In this week’s FutureFocus are the details and recommendations for 2020 base payment reductions for home health and hospice by MedPAC, the committee that reports to Congress on Medicare. Of interest too, is the recommendation to change the existing hospital quality payment program to a single program called HVIP.

FutureFocus March 14, 2019: Hospitals Can Provide Free In-Home Services to Discharged Patients: OIG Advisory

In this week’s FutureFocus, is an OIG Advisory explaining how hospitals can provide free, in-home care to discharged patients. Attorney, Elizabeth Hogue describes the details and requirements.

Remington FutureFocus March 13, 2019 - Payment Changes for the Future of Home Health: Bundled versus Patient Stay

In this FutureFocus, the future payments for post-acute providers is being discussed. Will the future of post-acute payments be based on episode of care (bundled payments) or individual patient stay? Weighing-in is MedPAC, the committee that reports to Congress on Medicare. This is a must read to understand the future of PAC payments and the IMPACT Act.

FutureFocus February 20, 2019: Chronic Care and ED Visits New Solutions Being Tested

In this week’s FutureFocus, we discuss new solutions to chronic care management and ED visits. New options are being tested through a five-year pilot program providing better options for Medicare beneficiaries following a call to 911. For providers, quality and accountability are tied to the new model.

FutureFocus January 23, 2019: Medicare Advantage Plans Testing Hospice Benefit

Great news in this FutureFocus issue. CMS under the Value-Based Insurance Design (VBID) model will be testing the Medicare hospice benefit in Medicare Advantage Plans. Additionally, other socioeconomic supplemental benefits and telehealth services will be expanded. VBID Model aim to contribute to the modernization of Medicare Advantage through increasing choice, lowering cost, and improving the quality of care for Medicare beneficiaries.

FutureFocus December 12, 2018: Quality Measures Under Consideration 2019

Meaningful measures are a key focus of our communications. Meaningful measures are a window into the future of how quality measures will align providers across the healthcare continuum. In this FutureFocus, we provide insights and resources for your organization.

Future Focus December 5, 2018: Discharge Planning New Rules Delayed

We have been keeping a close eye on discharge planning.  In this week’s FutureFocus, we provide more details about CMS delaying new discharge planning rules. This is important for your organization to know because it provides insight into the future and the considerations for discharge planning, the IMPACT act, and the new roles for hospitals and post-acute providers.

FutureFocus November 28, 2018: Seven and Thirty Day Readmission Patterns by Payor

In this week’s FutureFocus we provide 7-day and 30-day readmission patterns by payer. We continue to focus on this topic for a number of reasons. First, the data is analysis for your organization to examine internally. Secondly, your organization can work more closely with other stakeholders to compare and partner on diagnosis.

FutureFocus November 14, 2018: MarketWatch: Medicare Advantage Contracting and Supplemental Benefits

In this FutureFocus, is our MarketWatch on Medicare Advantage contracting and supplemental benefits. We are learning that beneficiaries choosing MA plans are not advised on each plan’s supplemental benefits and benefits may be restricted on eligibility criteria. We discuss what providers should do about denials from Medicare Advantage plans, and the four ways MA plans manage post-acute providers.

FutureFocus November 7, 2018: Functional Status Not Accounted For In Medicare Advantage Plans

In this week’s FutureFocus we provide our readers with information about how functional status is incorporated into Medicare Advantage (MA) Plans. While there is a risk adjustment model, the model does not account for a beneficiary’s functional status. This will see changes starting in 2019 and 2020.

FutureFocus October 31, 2018: Medicare Advantage Plans 2019: Testing New Payment Models and Care Delivery

This week’s FutureFocus, provides the insight into Medicare Advantage Plans in 2019. An increase in the number of plans, geographic reach and widening supplemental benefits increase the need for a continuum of care model. What are the key supplemental benefits offered in 2019? How do MA plans manage post-acute providers to lower the cost of care and better outcomes? We examine answers to these questions.

FutureFocus October 24, 2018: Medicare Advantage and the IMPACT Act: Social Risk Factors Best Practice

This week’s FutureFocus insight is a window into your future. All payers are focusing on social risk factors. Strong market signals are brewing.  Social risk factors become a readmission penalty in 2019, the IMPACT Act is required to conduct studies on socioeconomic status, and Medicare Advantage Plans are incorporating supplemental benefits to address social determinants. Social risk factors will become a common quality measure across the continuum. Get a head of the curve to learn what this means for your organization.

FutureFocus October 17, 2018 Episode-Based Payments And Outcome Measures Under A Unified Payment System For Post-Acute Care: Refinement on the Way

In this week's FutureFocus, is discussion about MedPAC diving deeper into the future of PAC PPS. An episode-based payment design and two uniformly defined outcomes-based measures for discharge to community and avoidable admissions and readmissions are in planning development. Analysis we provide ties this advancement back to ACOs, PAC value-based purchasing, and the IMPACT Act. A must read.

FutureFocus October 3, 2018: Six Ways PAC Providers Can Partner With Physicians Under Alternative Payment Models (APMs)

In this week’s FutureFocus, we discuss the impact of alternative payment models (APMs). To mitigate risk under APMs, PAC partnerships will be key. Under the new physician reimbursement model MACRA, APMs are providing greater financial incentives, and moving payment models into more risk-bearing arrangements. We explain in layman’s terms, MACRA, MIPS, APMs, and new partnership strategies for PAC providers.  

FutureFocus September 26, 2018: Five Trends Focused On Social Determinants

In this week’s FutureFocus, we discuss new developments focused on social determinants. Emerging trends and policy are integrating social determinants into readmission policies, Medicare Advantage Plans, expanded government oversight, payor plan benefits, and Medicaid Managed care. This is a market signal that social determinants are coming to the forefront of care. Stakeholders will be teaming-up with PAC providers, community-based organizations and using big data to identify patients at higher risk.

FutureFocus September 19, 2018: Post-Acute Payment Model Emerging: How This May Impact Your Future

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.

FutureFocus September 12, 2018 Home Health Payment Reform Insights

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?

FutureFocus September 5, 2018 Paradigm Shift For Hospice Begins

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.

FutureFocus August 8, 2018

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. 

FutureFocus June 27, 2018 Discharge Planning: CMS Guidance Needed

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.

FutureFocus June 20, 2018 Patient Choice Hitting Other Areas of Healthcare

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.

FutureFocus June 6, 2018: Pre-Claim Review Demo Re-Start - What You Need to Know

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.

FutureFocus May 23, 2018: Medicare Advantage Plans and PAC Providers - New Insights

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.

FutureFocus May 16, 2018: Patient’s Right to Freedom of Choice: Key Findings

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.

FutureFocus May 9, 2018: Revising Conditions Of Participation To Increase Data Sharing

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.

FutureFocus May 2, 2018: Multi-Mega Deals Change Post-Acute Future

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.

FutureFocus April 25, 2018: Readmission Insight for Post-Acute Providers

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. 

FutureFocus April 18, 2018 CMS Expands Benefits For Medicare Advantage: Impact To PAC Providers

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.

FutureFocus April 11, 2018 MarketScan: Payors Expanding Into Palliative Care

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. 

FutureFocus April 4, 2018 Redistribute Post-Acute Payments Based on Patient Condition

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.

FutureFocus March 28, 2018 Surveys and Compliance 10 Things To Know

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.

FutureFocus March 21, 2018 Trending Industry News

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.

FutureFocus March 14, 2018 - Quality Data And Discharge Planning: Changes Ahead

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.

FutureFocus March 8, 2018: Paying for Sequential Stays in a Unified PPS Payment System

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.

FutureFocus March 7, 2018: New Discharge Planning Protocols For Post-Acute Providers Under Discussion

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.

FutureFocus February 28, 2018: TrendTracking New Telehealth Reimbursement and Future Services

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.

FutureFocus February 21, 2018: Reforms Ahead: Hospital Discharges, Telehealth, Hospice, and Payment Systems

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.

FutureFocus February 7, 2018 Post-Acute Cost By Care Settings For The Dual Eligible: Eight Things To Know

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.

FutureFocus January 31, 2018 Preventable Hospitalizations for Home Health

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.

FutureFocus January 24, 2018 Policy Insights

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.

FutureFocus January 17, 2018: New Voluntary Bundled Payment Model: Impact To Post-Acute Providers

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. 

FutureFocus January 11, 2018: Five Top Payer Trends

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.

 

FutureFocus January 10, 2018 ACO Savings Not Related To Reduced Hospitalizations

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.

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