To The Point
FREE PUBLISHER'S MESSAGE Seven ways new players are consolidating the market and changing the dynamics of the traditional care at home model.
The Care at Home Market Shake-Up
SUBSCRIBER CONTENT Payers, health systems, Private Equity firms, and SPAC’s acquisition of care at home companies are quickly changing market dynamics, and signaling change is ahead. This is a must-read to understand trends and insights reshaping the future.
Solutions to Building a Palliative Care Program in the Ambulatory Care Setting
Educational materials, tools, training, and resources for integrating palliative care into ambulatory care for patients with serious life-threatening chronic illness or conditions.
To The Point
FREE PUBLISHER'S MESSAGE It’s not business as usual for home health, hospice, palliative care, in-home providers, and community-based organizations.
Market Signals Broaden Continuum-of-Care Services
Expanding continuum of care services is an important strategy for future market positioning. We explore how providers, payers, and physicians are broadening services to expand partnership referrals, create innovation, and ensure sustainability.
Does Your Organization Have the Right Clinical Service Lines to Reduce the Cost of the Top Five Medical Conditions and Expenditures?
SUBSCRIBER CONTENT New information will help your organization better align clinical services to reduce the cost of the highest medical conditions and their expenditures. The data can be used in conversations with various payer sources to align your organization’s services to reduce the cost of care and readmissions.
OIG’s Audit: Home Health Telehealth Payments
On a temporary basis, CMS issued blanket Section 1135 to healthcare professionals in response to the COVID-19 public health emergency (PHE). But now the OIG wants to be sure the rules are being followed. This Remington Report special report dives into the subject of home health telehealth payments.
To The Point
FREE PUBLISHER'S MESSAGE As we turn the corner into 2021, healthcare leaders should be asking themselves four key questions to address greater sustainability.
Should Your Organization Be Preparing for Greater Value-Based Payments?
SUBSCRIBER CONTENT Beginning in 2021, several value-based payment models will begin the shift from fee-for-service to value-based. Earmark this as the transformation of payment reform for care at home providers and how they will be paid in the future.
How is Your Organization Prepared to Participate in New Non-Traditional Care-at-Home Models?
SUBSCRIBER CONTENT New choices to receive care at home centers on patients receiving acute level care in the home. Non-traditional care at home models is expanding into a new era. The twist to non-traditional programs is to keep care at home leadership’s eyes wide open about the impact to their organizations. Waivers are changing rules, policies have changed, and the role of who can care for patients in the home is transforming models.
How is Technology Expanding Care at Home and How Does it Effect Your Organization’s Future?
SUBSCRIBER CONTENT The invisible technology boundaries expand the rules of who can offer care in the home, how they will be paid, and it creates a less restrictive policy environment to deliver care at home. The opportunity to reshape care delivery and create a more efficient and cost-effective healthcare system is achievable because of the acceleration and adoption of technology.
How is Your Organization Rethinking Strategic Positioning to Offer Continuum-of-Care Services from Pre- And Post-Discharge to End-of-Life?
SUBSCRIBER CONTENT The question for leadership is how do you want to position your organization? As an integrator? Or as an aggregator? For care at home providers, the goal is to create a post-acute continuum model as patients transition from one care setting to another whether that be in-home personal care services, skilled home health, palliative care, or hospice.
2021 Regional Outcomes for Medicare Require Full Financial Risk
SUBSCRIBER CONTENT Geographic direct-contracting model (GEO) is the latest CMS Center for Medicare and Medicaid Innovation (CMMI) model which allows Direct Contracting Entities to accept full financial risk for all traditional Medicare enrollees in their region. Three options enhance Medicare benefits and provide waivers for care in the home.
2021 Healthcare Outcomes Go Statewide and Regional
SUBSCRIBER CONTENT A growing number of initiatives are expanding to address social determinants of health. Payers, health systems, community-based organizations, and government entities are partnering together to create statewide efforts to improve community health and social care.
To The Point
There are seven advancing care models supporting care in the home. Each of these models has the commonalities of technology, new reimbursement models, chronic care management, and greater movement toward value-based payments.
Physicians Are Expanding Care into the Home
SUBSCRIBER CONTENT Home-based medical care models are shaking-up the $260 billion primary care market. Three physician models, new reimbursement models, telehealth, and chronic care management are key drivers.
Payers Expanding Care at Home Models
SUBSCRIBER CONTENT Building home care capacity will give plans more flexibility to meet patients on their own terms and could improve outcomes. Learn what is changing models of care in the home.
State Medicaid Programs are Expanding Value-Based Payments
SUBSCRIBER CONTENT States are developing plans to increase Medicaid provider participation in and adoption of value-based care models. How will these new payment models work?
Medicare Advantage Plans Expand Supplemental Benefits
SUBSCRIBER CONTENT Medicare Advantage Plans are expanding supplemental benefits in 2021. Learn what services are expanding and how this expands your partnerships.
Medicaid Managed Care are Linking Bonus Programs Tied to Performance
SUBSCRIBER CONTENT States are expanding value-based payments (VBP) in Medicaid and leveraging their Medicaid managed care programs to advance their payment reform goals. We discuss the details.
New Care Models Allow Payers to Take on Risk for Dual-Eligible Beneficiaries
SUBSCRIBER CONTENT CMS' innovation center (CMMI) is about to roll out a new model allowing insurance plans to take on financial risk for patients enrolled in both Medicare and Medicaid. How will this affect payers? What other new models can you expect in the future?
Expanded Access for Rural Communities and Transformation of Care
SUBSCRIBER CONTENT The Community Health Access and Rural Transformation (CHART) Model expands telehealth services, links residents to non-local healthcare providers, and provides more than $8.7 million in grant funding. What are the new opportunities for your organization?
To The Point
During COVID-19, home-based care created a new sense of urgency which will continue beyond the pandemic. Find out why.
Telehealth: 2021 New Billing Codes for Physician Home Visits and Care Planning
SUBSCRIBER CONTENT CMS has released proposed policy changes for 2021 Medicare payment rates under its annual Physician Fee Schedule. Telehealth codes allow physicians to bill for home visits and care planning. We dive into the codes and what they mean.
Home-Based Primary Care Models are Disrupting the Traditional Primary Care Market
SUBSCRIBER CONTENT Home-based medical care models are shaking-up the $260 billion primary care market. How are integrated primary care delivery models addressing chronic care management in the home?
The Vulnerabilities of COVID-19 Expand Insurers Capabilities In the Home
SUBSCRIBER CONTENT Insurers' strategies to provide greater services in the home are moving rapidly. Changing models have insurers partnering-up with primary care physicians, telehealth, and pharmacies to deliver care in the home. We provide insights to insurers' reactions post COVID-19 and beyond.
Strategy Insight: How To Align Financial and Clinical Incentives with Payers and the Most Costliest Medical Conditions
In this article, we take a look at data reflecting the costliest medical conditions by payers. This becomes an important strategy as payers begin to move more value-based care contracting into the home care space and look to treating higher acuity patients in the home.
COVID-19 Discharge Status Reveals Under-Utilization of Home Health and Hospice Services
CMS released a data snapshot of COVID-19 hospitalizations, length of stay, and discharge status for 109,607 patients. Payer sources include Fee-for-service (FFS) claims data, Medicare Advantage (MA) encounter data, and Medicare enrollment information.
To The Point
As healthcare providers await more news about expanding telehealth regulations, home care, hospice, palliative care, and community-based providers are in a unique position to further their value to physicians, ACOs, health systems, insurers, and Medicaid and Medicare.
Telehealth’s Outlook Beyond COVID-19
SUBSCRIBER CONTENT Telehealth is healthcare’s hottest topic. How should providers support and drive growth? What new opportunities will improve outcomes? How will telehealth reshape care delivery?
COVID-19 Case Study: Intermountain Healthcare’s Hospital-Level Care In Patients’ Homes
SUBSCRIBER CONTENT Intermountain at Home’s hospital-level care in patient’s homes supports their health system in the event of a surge of COVID-19 patients. Their models include home-based post-hospital care, palliative, and end-of-life care as well as medical equipment maintenance.
COVID-19 Medicare Emergency Waivers For Discharge Planning And Home Care Providers
SUBSCRIBER CONTENT CMS has provided blanket waivers with a retroactive effective date of March 1, 2020 through the end of the emergency declaration to help providers during COVID-19. We gathered the waivers for discharge planning, in-home care providers, and other post-acute care settings.
Payers: 2020 Supplemental Benefits for Chronic Conditions Doubled
In 2020, Medicare Advantage (MA) plans have doubled the number of condition-specific supplemental benefits from approximately 820 to 1,850. However, the new Special Supplemental Benefits for the Chronically Ill (SBBCI) for 2020 didn’t fare as well.
Physician Assistant Workforce Under Turmoil
Twenty-one states have taken action to suspend or waive certain practice requirements for physician assistants in response to COVID-19.
COVID-19 Healthcare Workforce and Revenue Reductions: U.S. Home Health Workforce
A recent survey across the U.S revealed the devastation of reduced revenue, patient’s refusal to accept physician-ordered care, and loss of the workforce.
COVID-19 Healthcare Workforce and Revenue Reductions: Aides and Personal Care Workforce
3.5 million low-wage workers are in the health and social services industry, with the greatest number of those (1.3 million) working as aides or personal care workers
COVID-19 Healthcare Workforce and Revenue Reductions: Physician Workforce
The data from the Bureau of Labor Statistics found dentists' offices had the most losses with 503,000. Physicians' offices lost 243,000.
COVID 19: Proactive Post-Acute Solutions for Health Systems and Physicians
SUBSCRIBER CONTENT In our interview with Paula Thompson, RN, MS, CRNI, President and CEO of Fidelity Health Care, we learn how her organization has advanced partnerships with five health systems and physician practices.
COVID-19: Broadening Telehealth Solutions
SUBSCRIBER CONTENT MaineHealth Care at Home began using telehealth in 2001. In our Interview with Donna DeBlois, RN, BSW, MSB, MBA, AHCA, President of MaineHealth Care at Home, we learn how her organization is expanding telehealth to a broader patient population under COVID-19.
To The Point
COVID-19: The solutions home care, palliative care, hospice and DME are providing to demonstrate value.
COVID-19: End-of-Life Care for Patients and Providers
Are health care systems, patients, and families prepared for tough conversations and decisions about health care preferences and medical interventions?
COVID-19 Best Practices Infection Prevention: Compliance and Training
COVID-19 training and prevention resources at your fingertips. You will find these resources important for compliance and infection prevention.
Payment Recommendations for 2021
In its March 2020 report to the Congress, MedPAC makes payment policy recommendations for provider sectors in fee-for-service (FFS).
Report: Medicare’s Hospital Post-Acute Care Transfer Policy to Hospice
The Bipartisan Act (BBA) of 2018 Act updated the hospital transfer policy for early discharges to hospice care. The law required that, beginning in FY 2019, discharges to hospice care would qualify as a post-acute care transfer and be subject to payment adjustments.
Payers Advancing Knee Replacement Care Into the Home
Aggressive moves by payers teaming up with big players such as CVS are advancing their healthcare programs into the home. How does this impact healthcare organizations?
Case Study: Payer and Provider Model: Managing Higher Acuity in the Home
Landmark estimates about 20 percent of chronically ill patients currently experience a gap in the care they are receiving, which can be addressed through medical care, support and education provided in the home.
Medicare’s Option to Avoid the Emergency Department
The Center for Medicare and Medicaid Innovation’s Emergency Triage, Treat, and Transport (ET3) Model is designed to test expanded care destination alternatives to the ED for Medicare beneficiaries who call 911.
Hospital-Level Care in the Home Lowered Costs and had Better Outcomes
A recent study in the Annals of Internal Medicine found that at-home patients fared better than those in the hospital when it came to price and outcomes.
Medicare Advantage Plans Proposed Rules 2021-2022 Changes Care Management Requirements
Medicare Advantage and Part D programs for contract years 2021 and 2022Â has provisions changing care management requirements for special needs plans.
8% Physical Therapy Cuts Questioned By Lawmakers
Nearly 100 U.S. lawmakers submitted a letter to CMS concerned about proposed cuts in Medicare payments for physical and occupational therapy services.Â
End-Stage Renal Disease Beneficiaries Can Enroll in Medicare Advantage Plans
In a proposed rule issued on February 5, CMS announced that beneficiaries with ESRD will be able to enroll in Medicare Advantage Plans starting in 2021.
Medicare Advantage Plans Expanding Telehealth Usage
CMS issued a proposed rule and the Advance Notice Part II to further strengthen and modernize the Medicare Advantage and Part D prescription drug programs.
Five Ways Post-Acute Providers Can Partner With Physicians
Physicians are thinking more seriously about how to succeed in the MIPS Cost category. Consider these 5 ways to help physicians reduce costs in healthcare.
CMS Combining Post-Acute Compare Websites Into One
CMS is planning to combine and standardize eight separate Compare websites into one point of entry, offer Medicare beneficiaries a consistent look and feel.
2020 ACOs Taking on More Risk
The number of ACOs taking on risk for cost increases grew from 93 ACOs at the start of 2019 to 192 at the start of 2020.
Insight Report: Payment Recommendations 2021
The Medicare Payment Advisory Commission recommended that Congress reduce the payments for Home Health by 7% in 2021.
Largest Home-Based Cardiac Rehab Reduces Readmissions to Less Than 2%
Kaiser Permanente’s virtual cardiac rehabilitation program has enrolled more than 2,300 patients, making it one of the largest such programs in the U.S.
More Deaths Occur in the Home vs. Hospital and Nursing Facilities
For the first time since the early 20th century, the home has become the common place among American’s dying of natural causes.
Post-Acute Business Industry News
Post-acute ACO adds 200 new long-term care facilities, new appointments, home medical equipment acquisitions, mergers and acquisitions, and more.
Healthcare Outlook 2020: Five Reasons Why Post-Acute Models Will Be Redefined
SUBSCRIBER CONTENT Market readiness is the theme for this year’s outlook. The talk of transformation has traction. Too many disruptors are in the healthcare market pushing out traditional models of care. Until you see the information gathered in one document, it may seem transformation is still a while away. Our study of trends and market signals indicate otherwise.
2020 Senior Living Communities Are Aligning with Medicare Advantage Plans to Address High-Cost, High-Need Patients
An integrated program of services can contribute to reducing the cost of care and services to Medicare beneficiaries residing in seniors housing.
2020 New Models For Chronic Care Management In The Home
The tides are shifting the expectations of home care. Pressure from reimbursement, shifting payment models, and value-based care are driving the change.
Post-Acute Care Transfer Policy: The Overpayment for Discharges
Medicare improperly paid acute-care hospitals $54.4 million for 18,647 claims subject to the Post-Acute Care Transfer (PACT) policy.
Physical Therapists Facing Layoffs Across the Healthcare Industry
Physical therapists once in such high-demand are facing massive layoffs across the industry because of reimbursement changes to skilled nursing facilities .
Chronic Care Management Payments Expand Under The Final 2020 Physician Fee Schedule Quality Payment Program
CMS is increasing payment for transitional care management services provided after discharge from an inpatient stay or certain outpatient stays.
Prior Authorizations: The Saga Continues For Providers
Starting November 1, UnitedHealthcare will not pay for unplanned surgeries in an outpatient setting unless it determines the site is medically necessary.
Insight and Analysis of Physician Reimbursement Changes 2020 and Beyond
What post-acute care providers need to know about a new rule that includes updated payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule.
Physician Stark Law Rules Revamped: New Rules Address Care Coordination
The new rules will give providers in value-based arrangements greater certainty and ease the compliance burden for providers across the industry.
Fall Prevention: Second-Leading Diagnosis For Readmissions
Falls were the leading reason for readmission among patients whose initial hospital was fall-related and who were discharged to home, even with home care.
Fall Prevention: Second-Leading Diagnosis For Readmissions
Falls were the leading reason for readmission among patients whose initial hospital was fall-related and who were discharged to home, even with home care.
Medicare Advantage Plans: 11 Major Changes In 2020
Private Medicare plans will soon include expanded plan options for seniors, more telehealth, and innovative plan designs and payment models.
Discharge Planning: Adding Caregivers Reduces Readmissions
Including unpaid caregivers into discharge planning for the elderly patient population reduces readmissions.
Discharge Planning Process Requires Post-Acute Quality Measures And More
New Discharge Planning Conditions of Participation require hospitals to assist patients, their families/caregivers in selecting a post-acute care provider.
Medicare Advantage Plans Add New Risk Codes For Dementia
Medicare Advantage (MA) Plans are adding two new dementia codes in their risk adjustment payment system and expanding flexibility in the MA benefit design.
Post-Acute Unified Value-Based Incentive Program: 5% Withhold Recommended
A unified value-based incentive program for SNFs, home health services, inpatient rehabilitation facilities, and long-term care hospitals is recommended.
Care Management Challenges and Barriers for High-Cost Medicaid Beneficiaries
A GAO report explored the efforts to manage high-expenditure beneficiaries, which are 5% of all Medicaid beneficiaries but nearly half of all expenditures.
Care Management Challenges and Barriers for High-Cost Medicaid Beneficiaries
A GAO report explored the efforts to manage high-expenditure beneficiaries, which are 5% of all Medicaid beneficiaries but nearly half of all expenditures.
Post-Acute Unified Value-Based Incentive Program: 5% Withhold Recommended
A unified value-based incentive program for SNFs, home health services, inpatient rehabilitation facilities, and long-term care hospitals is recommended.
Strategic Planning: In Pursuit of a Predictable Future
Seven guided questions for strategic planning. Six external trends for home care companies to keep an eye on. 10 challenges ahead for home care companies.
Six Ways PAC Providers Can Partner with Physicians Under Alternative Payment Models (APMs)
Through initiatives that change how heathcare is delivered and physicians are paid, CMS is driving toward the goals of improving quality and reducing costs.
Seven Key Things You Should Know About MACRA
MACRA is a law that builds a new, fast-speed highway to take the healthcare system away from fee-for-service and toward coordinated care models.
Physician Transformation Models – What are MIPS and APMs?
CMS published a rule on Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APM) incentives under MACRA.
Physician Practice Transformation: A Primer on MIPS and APMs
CMS released the first major regulation under MACRA. For now, only physician offices – not hospitals – are governed by MACRA rules.
Physician Chronic Care Management (CCM): New Opportunities for PAC Partnerships
Physician and post-acute providers can partner together to provide chronic care management through annual wellness programs visits.
Home-Based Medical Care: The Top Six Types of Providers
The top six types of providers who provided home-based medical care (non-podiatry) in both 2012 and 2013 accounted for two-thirds of the providers.
Five Payer and Provider Strategies Changing the Status Quo
Payers and providers are redefining and rethinking how new models of care can move the needle toward value-based care.
Community-Based Services: Paramedics New Role
Community paramedicine is a new model of healthcare in which paramedics function outside their customary emergency response and transport roles.
Emergency Dept. Study: Top 10 Reason Heart Failure Patients Go To The ED
A study in the Annals of Emergency Medicine, looked at why heart failure patients go to the Emergency Room.
Discharge Planning: Adding Caregivers Reduces Readmissions
Including unpaid caregivers into discharge planning for the elderly patient population reduces readmissions.
Behavioral Health Report: Effective Integration For Seniors With Depression
Study estimates a total annual value opportunity of $31 billion in the Medicare market through integration of mental health medical treatments.
16 Things To Know About Stark Laws
The Stark Law is a set of U.S. federal laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient.
22 Key Facts About Physician CCM Billing
 This document answers frequently asked questions about billing chronic care management (CCM) services to the Physician Fee Schedule.
IMPACT Act – A Unifying Payment System for Post-Acute Providers
Congressional approval of the IMPACT Act in October 2014, mandates the development and implementation of a standardized post-acute care assessment tool.
IMPACT Act – Standardized Patient Assessment Data
Section 2(a) of the 2014 IMPACT Act requires post-acute providers to submit standardized patient assessment data, as well as standardized quality measures.
IMPACT Act – Quality Measure Domains
Four healthcare settings must report standardized data using the assessment instruments on at least five of the following eight quality measure domains.
IMPACT Act – New Discharge Planning Rules Impact 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.
IMPACT Act – Cross-Setting Standardization for Skin Integrity
n keeping with the requirements of the IMPACT Act, measures for the other domains will be addressed through future rulemaking.
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 medication reconciliation.
MedPAC: Unified Post-Acute Payment Within Reach
The PPS prototype that has been developed accurately predicts resource needs for nearly all patient groups, indicating it can be used to set fair payments.
2019 Guidelines for Home and Community-Based Services
CMS issued new guidance to clarify where Medicaid beneficiaries can receive home- and community-based services as defined in a 2014 regulation.
