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.
Through initiatives that change how heathcare is delivered and physicians are paid, CMS is driving toward the goals of improving quality and reducing costs.
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.
CMS published a rule on Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APM) incentives under MACRA.
CMS released the first major regulation under MACRA. For now, only physician offices – not hospitals – are governed by MACRA rules.
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.
Including unpaid caregivers into discharge planning for the elderly patient population reduces readmissions.
Study estimates a total annual value opportunity of $31 billion in the Medicare market through integration of mental health medical treatments.
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.
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.
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.
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.
All Medicare-certified home health agencies in nine states will compete on value in the HHVBP model, where payment is tied to quality performance.
CPC+ is a national advanced primary care medical home model that aims to strengthen primary care through a regionally-based multi-payer payment reform.
Successful care coordination programs employ a variety of tools to improve quality of care and reduce costs, including flexibility in design.
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.
Care management is a key component of policy development, future legislation and new regulations. How is this changing the future of healthcare?
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.
Payers and Alternative Payment Models (APMs) are turning to palliative care programs as a way to offer value-based end-of-life care.
Increasing hospice services can reduce hospital admissions among all residents of a nursing home, including those not enrolled in hospice.
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.
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.
Despite recommendations to the contrary, only about half of elderly patients with advanced cancer receive palliative care.
A new guidance statement to define high-quality primary palliative care delivery in medical oncology has been developed by ASCO and AAHPM.
Spending on Medicare beneficiaries in their last year of life accounts for about 25% of total Medicare spending on beneficiaries age 65 or older.
Four key trends in hospice care are contributing to a paradigm shift and impacting the future of Medicare hospice providers and other providers.
Highmark offers unique palliative care services to its Medicare Advantage members and supports hospital palliative care through value-based contracts.
The ACO Investment Model encourages new ACOs to form in rural areas and Medicare Shared Savings Program ACOs to take greater financial risk.
17 states are implementing accountable care strategies in Medicaid or state employee health programs and patterns have begun to emerge.
The ACO model has the right incentives to reduce variation, spur innovation, and improve quality in end-of-life (EOL) care
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 is focused on improving quality of care, improved care coordination, and reducing costs for Medicare-Medicaid enrollees.
A study by Dartmouth Institute For Policy and Clinical Practice finds coordinated care for patients with complex needs a big winner for ACOs.
A study in The American Journal of Accountable Care provides a window into how ACOs manage high-risk, moderate-risk and low-risk patients.
CMS is shaping a framework intended to allow better comparisons of post-acute care provided in four different healthcare settings.
Greater use of Medicare Advantage over traditional fee-for-service Medicare has been associated with fewer overall hospitalizations.
In 2015, the proportion of hospitals receiving a penalty increased to 78% – up from 64% and 66% in 2013 and 2014, respectively.
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.
Patients 65 and older who have ambulatory surgery are much more likely to be readmitted to the hospital within 30 days than younger patients.
Significant studies are questioning whether a 30-day interval for readmissions is the best measurement for Medicare-related penalties.
Data on 2,000 patients showed telephone follow-up for older adults following discharge from the emergency department did not affect readmission rates.
Older adults are at increased risk for adverse events after surgical procedures. Loss of independence is an important patient-centered outcome measure.
30-day readmission rates are widely used to measure hospital penalties. Yet, many question if this is the correct interval by condition.
Telehealth policy develops much more slowly than the rapidly advancing technology, but incremental changes are taking place.
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 2014, 14% of inpatient stays were readmitted within 30 days. More than one-third of these readmissions occurred within seven days.