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.
Legal: Antitrust Guidance for HR Professionals
It’s a new environment for anti-trust enforcement, especially in the healthcare industry. Providers should pay close attention to this issue.
Study: Increasing Your Partnership Value with Hospitals
Increase your partnership value with hospitals by leveraging this study, which showed home health vs. no post-acute care was associated with reduced 30-day readmissions and better outcomes.
Action Strategy: High-Risk Readmissions: Skilled Nursing Facility to Home
Patients discharged with heart failure from a skilled-nursing facility to home face the highest risk of readmissions in the first two days after a SNF discharge.
Action Strategy: Timely Care Transitions: Planning the Next Site of Care as The Priority
Achieving a timely transition of care while simultaneously lowering the risk of readmission remains one of the toughest challenges in the quest for value-based outcomes.
Does Hospice Save Money Across All Payers?
A recent study published in the Journal of the American Medical Association of 5,464 beneficiaries reveals that total health expenditures were lower for those who used hospice.
Legal: Liability for Negligent Wound Care
To prove that providers rendered negligent wound care, patients must prove all of the following: Duty, breach, cause, and injury or damage.
OIG Report: Medicare Payments of $6.6 Billion Provided to Medicare Beneficiaries Outside the Medicare Hospice Benefit
Analysis of trends and payment patterns indicate non-hospice payments for Medicare Part A and B items and services totaled $6.6 billion from 2010 through 2019.
Legal: Non-Compete Agreement Trends
Although the trend is certainly against non-compete agreements or restrictive covenants in the health care industry, some state courts have affirmed their use.
Complaints About Referrals Must Be Based on Facts
The owner of a supplier of home medical equipment (HME) complained that her company did not receive referrals from TidalHealth Nanticoke Hospital. The Court dismissed the owner’s lawsuit because she could not prove her claims. This case illustrates why providers who complain about practices of referral sources must have facts to support their claims.Â
Legal: What Can Discharge Planners/Case Managers Accept from Providers Who Want Referrals?
Discharge planners, case managers, and social workers certainly cannot accept cash payments from providers in exchange for referrals of patients. But what can they accept from providers who want referrals?
Innovative Care-at-Home Services to Reduce Readmissions and Expand Collaborative Partnerships
According to the American Geriatric Society, 62%Â of all hospital readmissions for seniors are preventable. Learn how your peers are innovating and expanding care at home services to reduce readmissions and expand collaborative partnerships.
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.
The Latest on Recoupment of Overpayments
In a November 2021 decision, the U,S, Court of Appeals said that CMS can recoup overpayments from providers even though its appeals are still pending before Administrative Law Judges.
Legal: What Can Providers Give to Patients?
Providers, including marketers, are tempted to give patients free items and services. But be careful! These activities may violate laws prohibiting providers that participate in state and federal health programs from giving free items and services to patients.
5 Ways to Improve Medical Supply Management, Reduce Costs, and Improve Outcomes
SPECIAL REPORT Interviews with two organizations share how they tackled challenges to improve medical supply management, reduce the cost of care, and improve outcomes.
Why is It Important to Understand Hospital Stays By Medical Condition?
Your partners – ACOs, payers, commercial insurers, physicians, and health systems – seek ways to reduce hospitalizations and re-hospitalizations. A critical measurement of your value is to show how your organization can reduce the cost of care, decrease re-hospitalizations, and improve outcomes.
The Obesity Crisis and Chronic Illness Attributed to 64% of Hospitalizations
The 18th annual report by Trust for America’s Health on the obesity crisis in the United States has been released. This year, special features highlight the interaction of the COVID-19 pandemic with social, economic, and environmental conditions that impact hospitalizations, social determinants of health (SDOH), and outcomes.
The Ten Most Frequent Diagnoses for Inpatient Stays
September-October 2021 Issue
FREE CONTENT In this article, we discuss the 10 most frequent principal diagnoses and their costs impacting hospital inpatient stays.
Closing the Patient Communication Gap With Your Referral Partners
SPECIAL REPORT Across the board, we see from referral sources and other care providers alike that they really feel as if they’re part of the care team now instead of the end of the line where a patient goes when they get out of the hospital. Your peers share their thoughts and solutions.
Six Real-Time Medication Reconciliation Solutions
SPECIAL REPORT Four peers share solutions to improve clinical handoffs, the advantages of timely information, how to drive better outcomes, and how to boost clinical productivity.
Seamless Care Transitions: Six Smart Ways to Stay in Communication with Your Referral Sources
SPECIAL REPORT Your referral partners increasingly expect robust communications to make patient transfers as seamless as possible, for both the patient and providers, which means you need strategies to create seamless transitions. Learn what leading home health and hospice agencies are doing in this free special report.
Nine Payer and State Medicaid Managed Care Investments in Social Determinants
July-August 2021 Issue
FREE CONTENT In this article, we take a look at social determinant insights and investments from the perspective of Medicare Advantage plans, Medicaid managed care and healthcare providers.
6 Ways to Identify, Increase, and Manage Referrals
The Remington Report presents six ways to accelerate home health and hospice growth through improved referral processes, including questions you should be asking your referral sources.
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
6 Ways to Recharge Clinical Engagement and Work-Life Balance
SPECIAL REPORT Work-life balance is something nurses are constantly trying to achieve, and many nurses are falling short of that goal.​ Here, then, are strategies and actions to improve clinician experiences.
Legal Perspective on Patient Choice
What are the fraud implications when patients' rights are violated? What is the role of physicians in patients' freedom of choice? The Remington Report gets answers from Attorney Elizabeth Hogue.
3 Secrets for Accelerating Home Health and Hospice Growth and Referrals
SPECIAL REPORT How to empower your team, drive efficiency of care, prevent readmissions, and gain a competitive advantage for your home health and/or hospice agency.
The Four Frustrations Your Referrals are Voicing: Is Your Organization Losing Referrals?
SPECIAL REPORT What referring hospitals, ACOs, and physicians want from home health, hospice, palliative care and private duty providers to make their lives easier.
5 Top Strategies to Grow and Manage Referral Partners
SPECIAL REPORT For five top strategies, we discuss actionable steps that can be taken by home health, hospice, palliative care, and private duty organizations to gain a competitive advantage.
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.
Vital to Survival Business Intelligence: Operational, Financial, and Clinical
SPECIAL REPORT The compelling ways business intelligence drives actionable results.
4 Strategies to Dramatically Improve Productivity, Volume, and Revenue
SPECIAL REPORT National leaders discuss how to lean into new approaches to accelerate business growth, improve performance, and address technologies that create faster reimbursement, better work-life balance for clinicians, and optimal patient outcomes. They share how their organizations address four key questions.
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.
How Community-Based Care is Being Redefined
SPECIAL REPORT The shift from end-of-life care to building a continuum-based approach, plus strategies for growth, market position, and innovation revealed.
Remington’s Industry Report 2021 Leadership Perspectives
SPECIAL REPORT National leaders discuss how to lean into new approaches to accelerate business growth, improve performance, and address technologies that create faster reimbursement, better work-life balance for clinicians, and optimal patient outcomes. They share how their organizations address four key questions.
7 Models That Will Accelerate Value Based Payments in 2021
This year, 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. This white paper explains the seven value-based models impacting care-at-home providers.
2021 Payer Opportunities Collection
Your organization has new opportunities to grow and expand payer partnerships. A one-size-fits-all approach no longer exists, which is why we have bundled four articles from the Nov-Dec 2020 issue of The Remington Report into this complimentary compendium. Read about how to expand internal and external education, leverage critical investments in your workforce, and enhance actionable data needed by payers.
Physicians Expanding Care Into the Home
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.
COVID-19 Readmissions
In this free industry report, The Remington Report provides key data analysis to help your organization mitigate COVID-19 readmissions, along with five action steps for your organizations to explore.
6 Ways Care in the Home is Changing Your Business
In this free industry report, The Remington Report shares six ways care in the home is changing the future of healthcare. Leaders will need to address these strategically if they intend to realize continued growth in a significantly changing marketplace.
The No. 1 Reason Why Patients are Not Getting Home Health Care After a Hospital Discharge Referral
In this free industry report, The Remington Report unveils the major reason why patients are not getting home health care after a hospital discharge referral, plus four strategies you can use to boost referrals.
Four Ways to Combat the Under-Utilization of Home Health and Hospice
In this free industry report, The Remington Report offers up four strategies to increase the utilization of home health and hospice in the age of COVID-19.
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.
Legal: Managing the Risks of Wound Care
Wound care is a risky business these days. Providers who render wound care services are at risk for many things, including liability for negligent wound care, violation of fraud and abuse prohibitions based on substandard wound care, and liability for abandonment when wound care services are discontinued.
Industry Business News
CMS has made three new appointments to their quality division, the Visiting Nurse Service of New York has settled its lawsuit, and Orlando Health and LHC Group has inked a partnership. The latest executive moves in healthcare, along with other industry business news, can be found here.
COVID-19 Discharge Planning Waivers Link to Patients’ Freedom of Choice
The Centers for Medicare and Medicaid Services (CMS) has issued a number of waivers of various requirements for healthcare providers related to discharge planning for hospitals and critical access hospitals (CAHs).
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: 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: Protecting Healthcare Workers
Concern for healthcare workers in every setting knows no bounds! Providers' imperative is clear: everything possible must be done to keep them safe.
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.
Peer Case Study: Community-Based Paramedicine Model
CMS recently announced the Emergency Triage, Treat, and Transport model, which provides greater flexibility to ambulance care teams to address emergency health care needs of certain Medicare beneficiaries following a 911 call.Â
CMS Is Rolling Out Community Care Corps: Volunteer Caregivers
How can providers offer support for caregivers? A key way for providers to assist may be to collaborate with charitable organizations in the community.
Encompass Health Case Study
Encompass Health, in collaboration with McKesson, saved 17% to 19% on their supply spend, increased efficiencies, and achieved greater patient satisfaction.
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.
Patients’ Right to Freedom of Choice of Providers – Unexpected Allies
Post-acute providers, patients, and their families have very successfully raised issues with hospital administrations related to patients' right to choose.
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.
Fraud and Abuse Enforcers Target Discharge Planners Again
Recent federal cases make it quite clear that marketers for home health companies and discharge planners/case managers must just say, "NO!" The "jig is up."
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.
Arrangements with Referring Physicians and Home Care Providers: Recent Action
Now is the time for all home care providers to review agreements and their practices with regard to payments to referring physicians.
Industry Business News
LHC Group announces senior management change, and Amedisys acquires Asana Hospice.
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.
Proposed Stark Law Reform: What It Means To Post Acute Providers
The proposed rules recognize that incentives are different in a healthcare system that pays for value rather than the volume of services provided.
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.
