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.
Alzheimer’s Facts and Figures
In 2019, Alzheimer’s and other dementias will cost the nation $290 billion. by 2050, these costs could rise as high as $1.1 trillion.
Medicare Plans by State 2019
In 2019, access to MA plans remains high: 99 percent of Medicare beneficiaries have access to an MA plan, and 97 percent have an HMO or a local preferred provider organization (PPO) plan operating in their county of residence.
2017 Medicare Enrollment by State
Medicare enrollment percentage in each state and the District of Columbia is listed below from largest to smallest.
7.8 Million Direct Care Job Openings
Long-term care employers will need to fill 7.8 million total direct-care job openings from 2016 to 2026, according to a new analysis from PHI.
2018 Annual Average Salaries for Full-time Nurses
The 2018 annual average salaries for full-time nurses are ranked for all 50 states.
Healthcare Outlook 2020: Five Reasons Why Post-Acute Models Will Be Redefined
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.
To the Point
There is greater attention to “un-siloing” the care continuum. Lean into innovation. Market dynamics suggest the time is now.
Physician ACOs Key Data
Physician participation in accountable care organizations (ACOs) reached a milestone in 2018. More than half of physicians reported their practice was part of an ACO.
Physical Therapists Face Layoffs in Post-Acute and Hospital
Changes to reimbursement for skilled nursing facilities and the physician fee schedule final rule have a major impact on the future of physical therapists and occupational therapists.
Healthcare Outlook 2020: Five Reasons Why Post-Acute Models Will Redefine
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.
Harnessing the Home as the Central Hub for Chronic Care Management
There’s been a significant industry-wide interest on “downshifting care” to lower-cost delivery environments. Harnessing the home as a central hub is getting the attention of physicians, payers and health systems as a way to transform traditional care management models with integrated home-based medicine.
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.
Making Travel Plans Soon?
You might want to pay attention to the water quality! A recent study ranks the water served on major and regional US airlines.
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
FREE ARTICLE: 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
FREE ARTICLE: 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.
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.
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.
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
Kaiser Permanente Colorado and VNA-Denver jointly offer intense, consistent education to elderly heart failure patients discharged from the hospital.
Pre-Hospice Home-Based Transition Program
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.
Payer and Physician Models for Chronic Care Management
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
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
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
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
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
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
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
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?
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
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
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.
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