Mar 9, 2020 | Dental, Medicare, Medicare Advantage
gain coverage through other plans. A recent paper coauthored by BRG’s Eva DuGoff, published in Health Affairs, analyzed coverage and utilization rates for these services among Medicare beneficiaries. Click to read more.
Mar 6, 2020 | Managed Care Friday
19: Percent of hospitals in a poll last week considering or establishing in-house specialty pharmacies. This developing trend is interesting given a new UnitedHealthcare policy starting in April. Hospitals will be required to obtain specialty medications from UHC’s specialty pharmacies when administered in the hospital outpatient setting, unless otherwise authorized. This means the hospital can’t bill for the medication and can’t bill the patient. The pharmacy will bill United and the hospital can only bill for ‘administering’ the drug. The insurer says they may deny the full claim if the...
Mar 4, 2020 | Legislation/ Budgets/ Macro
CBO’s latest 10-year budget analysis projects historic federal budget deficits for the next decade—with rapidly rising federal healthcare costs a major contributor. Over the next 10 years, CBO estimates that federal healthcare costs will increase from 5.4% of GDP to 7.0% of GDP by 2030. This reiterates that the federal government will face significant fiscal pressures as the Medicare population grows and issues such as the solvency of the Medicare Part A trust fund loom over the next decade. Click to read more.
Mar 3, 2020 | ASC, Medicare
In February 2020, CMS submitted a proposed rule to extend the Comprehensive Care Joint Replacement (CJR) Model for an additional three years (2021-2023), and to include outpatient hip and knee replacements in the episode of care definition, with additional adjustments to other pieces of the model to account for these new changes. Click to read more.
Feb 26, 2020 | Medicare, Physician Fee Schedule, Physicians
While a lot of attention is being paid to the big increases in evaluation and management (E&M) office visit codes and the offsetting -8% cuts to non-E&M codes scheduled for 2021, some other big fights with potentially large impacts on Medicare physician payments are also looming on the horizon. Click to read more.
