Legal: HIPAA Violations To Avoid
Compliance with HIPAA can be complex. Examples of violations, or “HIPAA stories,” may make requirements more understandable. Here are some of those stories.
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.
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.
Legal: Workforce Hiring and the Crackdown on “No-Poach” Agreements
“Poaching agreements” may produce artificial suppression of employees’ compensation and may violate the federal Sherman Act.
Legal: 6 Fraud and Abuse Issues to Avoid When Marketing to Referral Sources
The Office of Inspector General has stated that there are two major types of fraud and abuse compliance that must be addressed through ongoing evaluation processes.
Legal: Practitioners Liable for Harm to Patients and Fraudulent Conduct Despite Physicians’ Orders
Practitioners owe a duty of care in the diagnosis and treatment of patients even though they are working under the supervision of licensed physicians.
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.
The Number of Home Health Agencies Decline
According to the most recent MedPAC report, the number of home health agencies has been declining since 2013 after several years of substantial growth.
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.
Legal: Kickbacks to Discharge Planners and Case Managers – A Recent Case
Case managers/discharge planners continue to come under fire from fraud enforcers for violations of the federal anti-kickback statute.
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.
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?
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.
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 2022 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.
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.
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.
Physician Leadership: Why Post-Acute Integration Matters
In this interview with Dr. Brian Amdahl, we ask questions related to post-acute’s value, payment reform and the challenges ahead.
House Calls – A Physician’s Perspective
House calls markedly improve the quality of life of home-limited patients and their caregivers while dramatically reducing healthcare costs.
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.
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.
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.
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.
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.
Insights, Drivers and Constraints of Community-Based Primary Care Practices
Care management is a key component of policy development, future legislation and new regulations. How is this changing the future of healthcare?
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.
Why Do Providers Continue to Enter Into Business/Referral Relationships Without Meeting Applicable Requirements?
Why do providers continue to enter into business/referral relationships without meeting applicable requirements, thereby violating the law?
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.
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.
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.
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.
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.
Hospitals Can Provide Free In-Home Services to Discharged Patients: OIG Advisory
The OIG posted Advisory Opinion No. 10-03 on March 6, 2019, which permits hospitals to provide free, in-home follow up care to discharged patients.
Successful Metrics Improve Your Organization’s Profitability and Performance
Monitoring the health of your organization supported by real-time key performance indicator data can help to de-risk the future of your organization.
