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?
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.
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.
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.
How can providers offer support for caregivers? A key way for providers to assist may be to collaborate with charitable organizations in the community.
As we shift away from traditional Medicare models, it may be time to reassess whether the traditional Medicare limitation on DME continues to make sense for both patients and payer sources.
Direct contracting creates the seismic change to level the playing field for small and large organizations, tests risk-sharing payments, creates a playground to test payments that operated in silos, and creates greater financial alignment.
Evaluation of the first two performance years, 2016-2017.
The Merit-based Incentive Payment System (MIPS) is one of two tracks under the Quality Payment Program, which moves Medicare Part B providers to a performance-based payment system.
Post-acute providers, patients, and their families have very successfully raised issues with hospital administrations related to patients' right to choose.
Nearly 100 U.S. lawmakers submitted a letter to CMS concerned about proposed cuts in Medicare payments for physical and occupational therapy services.
CMS is planning to combine and standardize eight separate Compare websites into one point of entry, offer Medicare beneficiaries a consistent look and feel.
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."
The Medicare Payment Advisory Commission recommended that Congress reduce the payments for Home Health by 7% in 2021.
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.
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 ACO adds 200 new long-term care facilities, new appointments, home medical equipment acquisitions, mergers and acquisitions, and more.
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.
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.
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.
Sentara Home Care Services is comprised of 10 home health agencies that span across Virginia and parts of northeastern North Carolina. Recognizing the challenges of the Patient-Driven Grouper Model (PDGM) and the high cost of complex wounds, Sentara redefined their program to include technology, and a shared risk model with their supply company resulting in cost reductions and improved outcomes.
Case Study: Integrated Community Partners Coupled With a Paramedic Program Redefines In-Home Interventions
TANDEM365 is a complex medical case management program coupled with a robust community paramedicine program that offers rapid response and in-home intervention capabilities. Blending population health management with community paramedicine, the goal of TANDEM365 is to connect all providers across the healthcare continuum to effectively coordinate care and prevent gaps.
Each year, we assemble this list as a way to examine the past year and to potentially identify trends. Trends that both reflect and influence the current environment, but also shed some light on what may lay in store for the future.
Now is the time for all home care providers to review agreements and their practices with regard to payments to referring physicians.
The tides are shifting the expectations of home care. Pressure from reimbursement, shifting payment models, and value-based care are driving the change.
Medicare improperly paid acute-care hospitals $54.4 million for 18,647 claims subject to the Post-Acute Care Transfer (PACT) policy.
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.
Starting November 1, UnitedHealthcare will not pay for unplanned surgeries in an outpatient setting unless it determines the site is medically necessary.
The proposed rules recognize that incentives are different in a healthcare system that pays for value rather than the volume of services provided.
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.
New Discharge Planning Conditions of Participation require hospitals to assist patients, their families/caregivers in selecting a post-acute care provider.
A GAO report explored the efforts to manage high-expenditure beneficiaries, which are 5% of all Medicaid beneficiaries but nearly half of all expenditures.
A unified value-based incentive program for SNFs, home health services, inpatient rehabilitation facilities, and long-term care hospitals is recommended.
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.
Through initiatives that change how heathcare is delivered and physicians are paid, CMS is driving toward the goals of improving quality and reducing costs.
Physician and post-acute providers can partner together to provide chronic care management through annual wellness programs visits.
In this interview with Dr. Brian Amdahl, we ask questions related to post-acute’s value, payment reform and the challenges ahead.
House calls markedly improve the quality of life of home-limited patients and their caregivers while dramatically reducing healthcare costs.
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.
Payers and providers are redefining and rethinking how new models of care can move the needle toward value-based care.
Community paramedicine is a new model of healthcare in which paramedics function outside their customary emergency response and transport roles.
A study in the Annals of Emergency Medicine, looked at why heart failure patients go to the Emergency Room.
Study estimates a total annual value opportunity of $31 billion in the Medicare market through integration of mental health medical treatments.
This document answers frequently asked questions about billing chronic care management (CCM) services to the Physician Fee Schedule.
Congressional approval of the IMPACT Act in October 2014, mandates the development and implementation of a standardized post-acute care assessment tool.
Section 2(a) of the 2014 IMPACT Act requires post-acute providers to submit standardized patient assessment data, as well as standardized quality measures.
Four healthcare settings must report standardized data using the assessment instruments on at least five of the following eight quality measure domains.
Under the proposed rule, hospitals and critical access hospitals would be required to develop a discharge plan within 24 hours of admission or registration.
n keeping with the requirements of the IMPACT Act, measures for the other domains will be addressed through future rulemaking.
CMS has contracted with Abt Associates and RTI International to develop a cross-setting Post-Acute Care measure for medication reconciliation.
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.
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.
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.
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.
Key takeaways from the perspective of primary care office help stakeholders to better understand care management population health models.
All Medicare-certified home health agencies in nine states will compete on value in the HHVBP model, where payment is tied to quality performance.
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.
Successful care coordination programs employ a variety of tools to improve quality of care and reduce costs, including flexibility in design.
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.
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.
CMS recently proposed a new payment model that would bundle payment to acute care hospitals for heart attack and cardiac bypass surgery services.
The OIG held a roundtable to discuss a broad range of ideas regarding how healthcare organizations can measure their compliance program effectiveness.
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.
Barriers to palliative care access in the United States occurs in five domains. Learn what these domains are in this article.
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?
One of five people with self-care disabilities reported negative consequences from not having help with activities they had trouble performing on their own.
Fall-related injuries are a major reason why seniors are readmitted to the hospital within a month after being discharged, a new study finds.
A panel of eldercare experts released its definition for person-centered care, which stresses collaboration between the patient, family, and provider.
A recent study in the New England Journal of Medicine by Partners HealthCare System examines community-based linkages to population health.
Medicaid’s reform will lead to greater care coordination, a focus on reducing costs and more possibilities of risk and preferred provider networks.
A report from MedPAC staff outlined the pros and cons of an episode-based payment approach compared to a stay-based payment approach.
Congressional approval of the IMPACT Act in October 2014, mandates the development and implementation of a standardized post-acute care assessment, too.
Exploring similarities in PAC settings flushes out what is presently aligned for the model to work, and identifies where there are gaps.
Key strategies to accomplish clinical continuum includes reducing the cost of care and developing post-acute tools for redefining partnerships.
Novant participated in a VHA research project that significantly reduced overall readmissions and those related to adverse drug events.
From July to December 2014, VNA Healthtrends, a leading home health provider, enrolled 51 patients in their Hospital to Home Program.
Patients sent home after knee and hip replacements do not have higher rates of medical complications, returns to the hospital or E.R. visits
Aetna’s Compassionate Care Program is designed to improve the quality of patient care for individuals with life-threatening illnesses.
Early evidence suggests that, under episode-based incentives, clinicians and organizations can improve the value of care for certain episodes.
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
The use of health coaches supported by the tablet-based software significantly reduced readmission rates among at-risk Medicare patients.
CMS is shaping a framework intended to allow better comparisons of post-acute care provided in four different healthcare settings.
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 scores" can identify those who might benefit from making behavioral changes, helping improve outcomes and prevent unnecessary costs.
Data on 2,000 patients showed telephone follow-up for older adults following discharge from the emergency department did not affect readmission rates.
FirstHealth of the Carolinas has developed an innovative care delivery model to effectively manage high-risk patients with chronic disease.
MedPAC has had recent discussions on current discharge planning procedures, resulting in possible changes in the ways patients are discharged.
Medicare spending for home healthcare more than doubled between 2001 and 2017, accounting for $17.7 billion spent on home health services.
Approximately four million adults in the United States are home bound, and many of them cannot access office-based primary care.
In this issue of FutureFocus, we offer up 10 ways to identify future partnerships between physicians and the home care industry.
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.
New guidance has been issued by CMS about where Medicaid beneficiaries can receive home and community-based services, impacting many providers.
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.
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.
Monitoring the health of your organization supported by real-time key performance indicator data can help to de-risk the future of your organization.