Message From Lisa Remington
May/June 2023 Issue
FREE CONTENT In the May/June issue of The Remington Report, we provide a special industry report for home-based care providers to identify the gaps in care delivery.
Lack of Patient Discharge Instructions Disrupt Care Transitions
May/June 2023 Issue
SUBSCRIBER CONTENT Learn the five key areas that home-based care organizations could assist in discharge planning.
ED Patients: Partnering with Home-Based Care to Fill Gaps in Care
May/June 2023 Issue
SUBSCRIBER CONTENT The emergency department (ED) is the hospital's front door, providing over 70% of all hospital admissions. How can home-based care providers partner with EDs?
Message From Lisa Remington
March/April 2023 Issue
FREE CONTENT In the March/April issue of The Remington Report, we report on the trends, transformation, and opportunities impacting ACOs.
16 Key ACO Trends to Know in 2023
March/April 2023 Issue
SUBSCRIBER CONTENT The importance of key ACO trends is to better understand the plan to decrease fee-for-service and increase value-based payments. Growth through three initiatives will be the foundation to reach CMS’s goal of 100% of Medicare into an accountable care program.
ACO Reach Model Expands Home-Based Care Primer
March/April 2023 Issue
SUBSCRIBER CONTENT This article summarizes the major provisions of the new ACO Reach Model and the expanded role of home-based care providers.
5 Trends and Policies Impacting Social Determinants and Outcomes
The focus on social determinants of health in 2023 is uniting payers and providers to increase their efforts to find solutions and improve outcomes. Driven by policy and payments, change is coming.
Message From Lisa Remington
January/February 2023 Issue
FREE CONTENT In the January/February issue of The Remington Report, we unlock the big wave of changes ahead for home-based care in 2023.
30-Day Readmission Trends to Improve Outcomes
January/February 2023 Issue
SUBSCRIBER CONTENT Key studies and data can help providers reduce readmissions, improve outcomes, and increase partnerships.
Trends Driving Home-Based Care’s Contracting Options with Medicare Advantage Plans
January/February 2023 Issue
SUBSCRIBER CONTENT Home care is big business for payers. No better industry is more aligned with payer goals than home-based care. We address six strategies to evaluate contracting with Medicare Advantage plans.
Do You Know Which Principal Diagnosis Has the Highest Rate of 30-Day Readmissions?
As a home-based care provider, all referral partners have the same goal – how to reduce readmissions and the cost. It’s important to continue to hone in on data that can help your organization better understand your role in preventing readmissions and reducing the cost of care.
Clinical Service Lines that Reduce the Cost of the Top 5 Medical Conditions
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.
Message From Lisa Remington
November-December 2022 Issue
FREE CONTENT In the November/December issue of The Remington Report, we tackle topics impacting team-based care, care transitions, case studies, and workforce improvement.
5 Ways High-Functioning Team-Based Care Reduces Clinician Burnout
November-December 2022 Issue
SUBSCRIBER CONTENT Fostering effective team-based care improves both the patient’s and the team’s experience of care delivery. In this article, we discuss the two different approaches to team-based care, the five core principles, and how to reduce clinician burnout.
Pre-Hospice Home-Based Transition Program
November-December 2022 Issue
SUBSCRIBER CONTENT Sharp HealthCare pre-hospice program called Transitions, is designed to give elderly patients the care they want at home and keep them out of the hospital.
2023 Providers are Responsible for Social Determinants of Health Quality Measures
Research shows that social determinants can be more important than health care or lifestyle choices in influencing health. Numerous studies suggest that SDOH account for between 30-55% of health outcomes.
To the Point
September/October 2022 Issue
FREE CONTENT How are the changing financial, economic, and market conditions impacting your decisions about your workforce? A major change is coming that will determine your future staffing needs.
Workforce: How Will Medicare Fee-For-Service Trends Change the Way You Think About Future Staffing Needs?
September/October 2022 Issue
SUBSCRIBER CONTENT With all the evolving changes occurring in healthcare, you may have missed CMS’s initiatives aligning value-based arrangements across traditional Medicare programs. We discuss the eight trends to help your organization think about the impact on your labor force and referral partners.
What are the Highest Chronic Care Conditions in Medicare, Medicare Advantage Plans, and Special Needs Plans?
Payers are developing care models specific to the level of need. There is not a one-size-fits-all care-management strategy. Payers tend to categorize medical conditions by risk.
To the Point
July/August 2022 Issue
FREE CONTENT Payers are gaining a foothold in the care-at-home market. Five critical trends support the rapid advancement. The challenges and opportunities are discussed in this issue of The Remington Report.
Trend #1: Payers Are Accelerating Into the Home-Based Care Market
July/August 2022 Issue
SUBSCRIBER CONTENT How should your organization be responding to payers expanding their position in home-based care? What key trends support this advancement? What are key strategies to partner and align with payers? In this article, we cover the key market changes, the disruption, and growth opportunities for home-based care organizations.
Trend #2: Payers Expanding Home-Based Care Models Nationally
July/August 2022 Issue
SUBSCRIBER CONTENT Payers are deepening their care delivery models focused on the home. In the past, we may have thought of payers in traditional roles as a medical-cost manager. Today, they are acquiring home-based care organizations to control readmissions, cost, and outcomes.
Trend #3: Highest Chronic Care Conditions in Medicare, Medicare Advantage Plans, And Special Needs Plans
July/August 2022 Issue
SUBSCRIBER CONTENT Different payers such as Medicare, Medicare Advantage, and Special Needs Plans are focusing on the highest chronic care conditions to reduce the cost of care. In this article, is the data by payer and a discussion about how organizations can support a better aligned financial and quality partnerships.
Trend #4: Growth in Medicare Advantage Plans 2022 Signals Future in Managed Care Contracting
July/August 2022 Issue
SUBSCRIBER CONTENT Medicare Advantage enrollment is growing at a fast pace. The number of plans is expanding geographically, and payers will continue to invest in the Medicare Advantage market. In this article, we dig deep into the growth of Medicare Advantage by enrollment, states, and the future. The market signal is strong to put Medicare Advantage contracting as a high priority.
Trend #5: Payer and Home-Based Provider Partnering to Reduce the Cost of Care
July/August 2022 Issue
SUBSCRIBER CONTENT Important to all payers is the value your organization brings to reducing the cost of care. Available data can gear-up your partnership value quickly. In this article, we sliced and diced data to provide an overall macro/micro picture of how to reduce the cost of care.
ACOs Perspective About Home-Based Care
A recent study in the Journal of Managed Care was an eye-opener when it comes to better understanding home-based care from an ACO perspective.
To the Point
May/June 2022 Issue
FREE CONTENT In this issue of the Remington Report, we take a deep dive into the post-acute transfer policy, the impact to your organization, what it means to hospitals, and how to drive greater value as a hospital partner.
Post-Acute Care Transfer Policy: The Overpayment for Discharges
May/June 2022 Issue
SUBSCRIBER CONTENT Medicare improperly paid acute-care hospitals $54.4 million for 18,647 claims subject to the Post-Acute Care Transfer policy.
To the Point
March/April 2022 Issue
FREE CONTENT In its 10th annual round of penalties, Medicare is reducing its payments to 2,499 hospitals, or 47% of all facilities for readmissions.
High-Risk Readmissions: Skilled Nursing Facility to Home
March/April 2022 Issue
SUBSCRIBER CONTENT Readmission after skilled-nursing facility (SNF) discharge following heart failure hospitalization is highest during the first two days home.
Is Socioeconomics a Main Influencer of Readmissions?
March/April 2022 Issue
SUBSCRIBER CONTENT Researchers examined the common reasons why some hospitals have more readmissions treating a disproportionate share of patients with low incomes, poor health and other negative circumstances.
Discharge Planning Patterns: Care Transitions and Readmissions
March/April 2022 Issue
FREE CONTENT A recent study examined the patterns of Medicare beneficiaries post-acute care transitions among assisted living residents and their outcomes in the first 30 and 60 days after hospital discharge.
To the Point
January/February 2022 Issue
FREE CONTENT As the care-at-home industry continues to grow and expand, there are both opportunities and challenges in the future.
Medicare Advantage: 5 Care-At-Home Supplemental Benefits Skyrocket in 2022
January/February 2022 Issue
SUBSCRIBER CONTENT CMS’s reinterpretation of “primarily health-related” benefits has led to more Medicare Advantage (MA) plans offering services.
7 Trends Changing Medicare Advantage Plans In 2022
January/February 2022 Issue
SUBSCRIBER CONTENT CMS projects that nearly 30 million people are signing up for MA in 2022. Here are seven trends to watch for.
Patient Discharge: Is Your Organization Asking Hospitals, SNFs, and Physicians for “Z” Codes?
January/February 2022 Issue
SUBSCRIBER CONTENT Z codes are a set of ICD-10-CM codes used to report social, economic, and environmental determinants known to affect health and health-related outcomes.
Oncology Hospital-at-Home Program Reduces Readmissions and ED Visits
Launched in 2018, Huntsman at Home in Utah was one of the first programs in the United States to provide acute cancer care at home.
To The Point
November-December 2021 Issue
FREE PUBLISHER'S MESSAGE In this issue of The Remington Report, we will provide actionable insights to guide your organization forward.
To The Point
September/October 2021 Issue
FREE PUBLISHER'S MESSAGE In this issue of The Remington Report, we will guide your business readiness for adoption of new transformations, look at opportunity identification to create new revenue, and provide ways to achieve better outcomes.
Four Key Trends Impacting Chronic Care Management, Physician Practices, and Payers
July/August 2021 Issue
SUBSCRIBER CONTENT Four significant trends are impacting chronic care management and the future of physician groups and payers. Moving forward this can change your referral growth and the need to expand your managed care contracts.
Five Payer Strategies Ramping-up Home Care Usage
July/August 2021 Issue
SUBSCRIBER CONTENT Payers are targeting their member populations that will benefit the most from at-home care. The center of their home health offerings is focused on high-cost patients, palliative care, diabetes, home care visits, telehealth, and at-home testing.
Telehealth’s Future for Medicare and Medicaid Managed Care
A new report from the GAO titled, "COVID-19 Program Flexibilities and Considerations for Their Continuation," investigates the future of telehealth
The Care at Home Market Shake-Up
May/June 2021 Issue
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.
Market Signals Broaden Continuum-of-Care Services
March/April 2021 Issue
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?
March/April 2021 Issue
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.
Should Your Organization Be Preparing for Greater Value-Based Payments?
January/February 2021 Issue
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?
January/February 2021 Issue
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?
January/February 2021 Issue
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?
January/February 2021 Issue
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
January/February 2021 Issue
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
January/February 2021 Issue
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.
Physicians are Expanding Care Into the Home
November-December 2020 Issue
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
November-December 2020 Issue
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
November-December 2020 Issue
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
November-December 2020 Issue
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
November-December 2020 Issue
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
November-December 2020 Issue
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
November-December 2020 Issue
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?
Telehealth: 2021 New Billing Codes for Physician Home Visits and Care Planning
September/October 2020 Issue
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
September/October 2020 Issue
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
September/October 2020 Issue
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.
Telehealth’s Outlook Beyond COVID-19
July/August 2020 Issue
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
July/August 2020 Issue
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
July/August 2020 Issue
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
May/June 2020 Issue
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
May/June 2020 Issue
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.
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 2022 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.
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.
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.
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.
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.
Managed Care Organization and Visiting Nurse Association’s Elderly Heart Failure Program – A Pilot Study
SUBSCRIBER CONTENT Kaiser Permanente Colorado and VNA-Denver jointly offer intense, consistent education to elderly heart failure patients discharged from the hospital.
Payer and Physician Models for Chronic Care Management
SUBSCRIBER CONTENT Fragmentation of the care delivery system is widely recognized as a cause of missed opportunities to treat both acute and chronic conditions.
House Calls to Frail Elders Reduce Costs, Hospital Use, and Nursing Home Placements
SUBSCRIBER CONTENT The program at Washington Hospital Center has lowered total costs of care and has reduced average inpatient length of stay from 8 to 6 days.
Skilled Nursing Facilities Moving Into Value-Based Payments in 2019
In the proposed rules announced by CMS, SNFs will get an $800 million, or 2.1%, Medicare payment increase under the proposed rule for FY 2017.
Champions of Change: Primary Care Caring for Older Adults
SUBSCRIBER CONTENT Key takeaways from the perspective of primary care office help stakeholders to better understand care management population health models.
Medicare Advantage vs. Medicare Fee-for-Service Longitudinal Site of Death Study
People who are continuously enrolled in Medicare Advantage are less likely to die in a hospital than those continuously enrolled in Medicare fee-for-service.
Home Health Agency Value-Based (HHVPB) Model Background
All Medicare-certified home health agencies in nine states will compete on value in the HHVBP model, where payment is tied to quality performance.
Examples of Payer Value-Based Incentives with Providers
SUBSCRIBER CONTENT A recent filing by Humana indicates the insurer is instituting a new bonus plan that is not just tied to financial performance, but also to health outcomes.
Largest Value-Based Comprehensive Primary Care Model Launched
CPC+ is a national advanced primary care medical home model that aims to strengthen primary care through a regionally-based multi-payer payment reform.
Nine Building Blocks of Care Management
Successful care coordination programs employ a variety of tools to improve quality of care and reduce costs, including flexibility in design.
Montefiore Health System’s Care Management Program
SUBSCRIBER CONTENT Located in the Bronx and Hudson Valley, New York, Montefiore Health System (MHS) serves one of the poorest and most disproportionately disease-burdened counties in the nation with nearly 80% of the payer mix from Medicare and Medicaid.
Medicare Population Characteristics
In 2011, two-thirds of beneficiaries had three or more chronic conditions, more than one quarter of all beneficiaries reported being in fair or poor health.
Care Coordination High Priority for Bundled Payment Models
CMS recently proposed a new payment model that would bundle payment to acute care hospitals for heart attack and cardiac bypass surgery services.
Measuring Compliance Program Effectiveness in Healthcare
The OIG held a roundtable to discuss a broad range of ideas regarding how healthcare organizations can measure their compliance program effectiveness.
Study: Hospice Top 13 Diagnosis
Cancer accounts for less than one-half of all hospice admissions. Here is a list of the top 13 diagnoses for admissions to hospice care.
The Five Barriers to Accessing Palliative Care
Barriers to palliative care access in the United States occurs in five domains. Learn what these domains are in this article.
Payers Expanding Into Palliative Care
Payers and Alternative Payment Models (APMs) are turning to palliative care programs as a way to offer value-based end-of-life care.
Hospice Study: Increasing Hospice Decreases Hospital Readmissions Among All Nursing Homes
Increasing hospice services can reduce hospital admissions among all residents of a nursing home, including those not enrolled in hospice.
What Happens to Medicare Costs When Beneficiaries Do Not Receive Help With Daily Activities?
One of five people with self-care disabilities reported negative consequences from not having help with activities they had trouble performing on their own.
Third-Leading Cause of Readmissions are Falls
Fall-related injuries are a major reason why seniors are readmitted to the hospital within a month after being discharged, a new study finds.
What is the Definition of Patient-Centered Care?
A panel of eldercare experts released its definition for person-centered care, which stresses collaboration between the patient, family, and provider.
Study: Community-Based Linkages To Population Health
A recent study in the New England Journal of Medicine by Partners HealthCare System examines community-based linkages to population health.
Medicaid and Medicaid Managed Care Models Prepare for Value-Based Models
Medicaid’s reform will lead to greater care coordination, a focus on reducing costs and more possibilities of risk and preferred provider networks.
Episode-Based vs. Stay Based Payments: Discussions for Future Payments
A report from MedPAC staff outlined the pros and cons of an episode-based payment approach compared to a stay-based payment approach.
Quality Measures Development the IMPACT Act
Congressional approval of the IMPACT Act in October 2014, mandates the development and implementation of a standardized post-acute care assessment, too.
What Does a Unified PAC Payment System Look Like?
Exploring similarities in PAC settings flushes out what is presently aligned for the model to work, and identifies where there are gaps.
The “Right Care” Drives Innovations to Improve Outcomes in Senior Care
SUBSCRIBER CONTENT Key strategies to accomplish clinical continuum includes reducing the cost of care and developing post-acute tools for redefining partnerships.
Pharmacist Post-Discharge Model Reduces Medication Errors
SUBSCRIBER CONTENT Novant participated in a VHA research project that significantly reduced overall readmissions and those related to adverse drug events.
From Hospital to Home: Knee & Hip Replacement Model
SUBSCRIBER CONTENT From July to December 2014, VNA Healthtrends, a leading home health provider, enrolled 51 patients in their Hospital to Home Program.
Home Care for Hip and Knee Patient: How Do Physicians Decide About Where Patients Should Go?
SUBSCRIBER CONTENT Patients sent home after knee and hip replacements do not have higher rates of medical complications, returns to the hospital or E.R. visits
Home-Based Palliative Care Models
SUBSCRIBER CONTENT Palliative care focuses on relieving patients’ stress, pain and other symptoms as their health declines, and it helps them maintain their quality of life.
Aetna’s Compassionate Care Program for Advanced Illness
SUBSCRIBER CONTENT Aetna’s Compassionate Care Program is designed to improve the quality of patient care for individuals with life-threatening illnesses.
Hospice Quality of Care Varies
In a large cohort study, hospice visits in the last 2 days of life by professional staff varied by race, hospice program, and geographic region.
Palliative Care and Cancer Insights
Despite recommendations to the contrary, only about half of elderly patients with advanced cancer receive palliative care.
Palliative Care Oncology Guidelines
A new guidance statement to define high-quality primary palliative care delivery in medical oncology has been developed by ASCO and AAHPM.
End-of-Life Medicare Spending and the Cost of Care Insights
Spending on Medicare beneficiaries in their last year of life accounts for about 25% of total Medicare spending on beneficiaries age 65 or older.
The Paradigm Shift for Hospice Providers Begins
Four key trends in hospice care are contributing to a paradigm shift and impacting the future of Medicare hospice providers and other providers.
Palliative Care and Payer Value-Based Contracting
Highmark offers unique palliative care services to its Medicare Advantage members and supports hospital palliative care through value-based contracts.
ACO Investment Model
The ACO Investment Model encourages new ACOs to form in rural areas and Medicare Shared Savings Program ACOs to take greater financial risk.
Medicaid ACO Market Scan
17 states are implementing accountable care strategies in Medicaid or state employee health programs and patterns have begun to emerge.
ACOs: Three Approaches to Improve End-of-Life Care
The ACO model has the right incentives to reduce variation, spur innovation, and improve quality in end-of-life (EOL) care
How Bundled Payments Support the Move to Value-Based Models
Early evidence suggests that, under episode-based incentives, clinicians and organizations can improve the value of care for certain episodes.
ACO and Home-Based Palliative Care Model Reduce Costs
SUBSCRIBER CONTENT A home-based palliative care program tested within an ACO showed cost savings and reduced hospital admissions for patients near the end of life.
The ACO Medicare-Medicaid Model for Managing High-Risk Patients
The ACO Medicare-Medicaid Model is focused on improving quality of care, improved care coordination, and reducing costs for Medicare-Medicaid enrollees.
ACOs: Lowering Medicare Spending Per Beneficiary for High-Need Patients
A study by Dartmouth Institute For Policy and Clinical Practice finds coordinated care for patients with complex needs a big winner for ACOs.
How ACOs Manage High-Risk, High-Need Patients
A study in The American Journal of Accountable Care provides a window into how ACOs manage high-risk, moderate-risk and low-risk patients.
Telehealth Readmissions at Geisinger Health Plans
SUBSCRIBER CONTENT Geisinger Health Plan published a study that found a telemonitoring intervention for heart-failure patients led to reductions in readmissions and cost.
Community-Based Health Coaches and Care Coordinators Reduce Readmissions Using Information Technology
SUBSCRIBER CONTENT The use of health coaches supported by the tablet-based software significantly reduced readmission rates among at-risk Medicare patients.
Readmission Insights Tied to Patient’s Socio-Demographic Status
CMS is shaping a framework intended to allow better comparisons of post-acute care provided in four different healthcare settings.
Medicare Advantage Beneficiaries Have Fewer Readmissions
Greater use of Medicare Advantage over traditional fee-for-service Medicare has been associated with fewer overall hospitalizations.
Which Patient Populations Cause the Highest Readmissions?
In 2015, the proportion of hospitals receiving a penalty increased to 78% – up from 64% and 66% in 2013 and 2014, respectively.
Discharge Planning Framework Under The IMPACT Act
The IMPACT Act will require hospitals, rehab facilities, and home health agencies to develop a discharge plan based on the goals of each patient.
Patient Activation Measures For High-Risk Patients
Patient "activation scores" can identify those who might benefit from making behavioral changes, helping improve outcomes and prevent unnecessary costs.
Study: Readmission After Ambulatory Surgery for Seniors Leading to 30-Day Readmits
Patients 65 and older who have ambulatory surgery are much more likely to be readmitted to the hospital within 30 days than younger patients.
Analyzing the Readmission Cycle: News Ways to Look at Preventability
Significant studies are questioning whether a 30-day interval for readmissions is the best measurement for Medicare-related penalties.
Best Practice: How Do Post-Discharge Phone Calls Affect Readmissions?
Data on 2,000 patients showed telephone follow-up for older adults following discharge from the emergency department did not affect readmission rates.
A Comprehensive Care Management Model
SUBSCRIBER CONTENT FirstHealth of the Carolinas has developed an innovative care delivery model to effectively manage high-risk patients with chronic disease.
Discharge Planning: The New Focus on Patient Choice and Choosing Post-Acute Providers
SUBSCRIBER CONTENT MedPAC has had recent discussions on current discharge planning procedures, resulting in possible changes in the ways patients are discharged.
Readmission Risks After Surgical Procedures
Older adults are at increased risk for adverse events after surgical procedures. Loss of independence is an important patient-centered outcome measure.
Readmission Data For All Cause 7-Day and 30-Day
30-day readmission rates are widely used to measure hospital penalties. Yet, many question if this is the correct interval by condition.
Telehealth: 5 Things to Know About Payer Reimbursement
Telehealth policy develops much more slowly than the rapidly advancing technology, but incremental changes are taking place.
PDGM Model: Analysis By Type of Home Health Agency
Medicare spending for home healthcare more than doubled between 2001 and 2017, accounting for $17.7 billion spent on home health services.
The Post-Acute Care “Gap” Plaguing Healthcare
Approximately four million adults in the United States are home bound, and many of them cannot access office-based primary care.
Readmission Analysis By Payer: 7 & 30 Day By Diagnosis
In 2014, 14% of inpatient stays were readmitted within 30 days. More than one-third of these readmissions occurred within seven days.
How a Payer and In-Home Physician-Led Model Create New Solutions for Complex Care
This issue of FutureFocus highlights the innovation of an in-home, physician-led model working collaboratively with a payer to manage complex care.
10 Ways To Identify Future Partnerships Between Physician Practices and the Home Care Industry
In this issue of FutureFocus, we offer up 10 ways to identify future partnerships between physicians and the home care industry.
Where Do the Highest Risk of Readmissions Come From?
This issue of FutureFocus identifies the highest risk of readmissions that are impacting outcomes in the CMS value-based purchasing program.
CMS Primary Cares Initiative: New Payment Models For Care In The Home and Hospice for Chronic Care
The new Primary Cares Initiative that will transform care and payment for complex, high-need patients who are able to stay healthy in their own homes.
Hip and Knee Replacement: Home Discharge Insights
Studies show that patients sent home after knee and hip replacements do not have higher rates of complications than those who went to rehab facilities.
Labor: The #1 Challenge for Home Care Executives
As the Baby Boomer generation ages and the elderly population grows, the demand for the services of home health aides and personal care aides will continue to increase.
Revised Guidelines for Home and Community-Based Services
New guidance has been issued by CMS about where Medicaid beneficiaries can receive home and community-based services, impacting many providers.
EHR Incentives for PAC Providers: What Will CMS Recommend?
A new RFI has been issued by CMS to ask for stakeholder feedback about the best ways to incent EHR adoption in post-acute settings.
