May 8, 2018 | Skilled Nursing Facilities (SNF)
CMS recently released a proposed rule outlining FY2019 Medicare payment updates and quality program changes for skilled nursing facilities (SNFs). The proposal includes bigger changes for FY2020, shifting from RUG-IV to the Patient-Driven Payment Model (PDPM) system. Therapy minutes would no longer be a payment factor under PDPM. Instead, payments would be based on clinical characteristics – along with other factors. Click to read more.
May 2, 2018 | Hospitals, Inpatient, LTCHs
CMS pays approximately 3,330 acute care hospitals for inpatient stays under the Inpatient Prospective Payment System (IPPS). Subject to certain adjustments, a hospital receives a single payment for the case based on the payment classification – Medicare Severity Diagnosis-Related Groups (MS-DRGs) – which is assigned at discharge. CMS recently released the FY2019 proposed rule for the IPPS. Click to read more.
Apr 27, 2018 | Managed Care Friday
1. 100: Dollars for helping MA plans with diagnosing patients properly. If your doctors suspect a patient has a condition that hasn’t been formally diagnosed or coded this year, they can get $100 financial incentives as part of a diagnosis rewards program – about two thirds of MA plans in our poll this month say they pay this to PCPs, some pay more or less. ‘It’s for identifying a condition that’s not been diagnosed and coded but should be…but it works both ways – like if you figure out a patient no longer has a condition’ 2. Divorce or Separation? A Tennessee couple we are interviewing...
Apr 23, 2018 | Legislation/ Budgets/ Macro
CBO recently published its annual update of economic and fiscal projections for the US over the next 10 years. CBO deficit and debt projections for the period from 2018 to 2028 are very negative. The annual deficit projections and cumulative national debt projections are the largest since World War II. These levels of deficit spending and debt accumulation are very likely to bring deficit-reduction efforts back to the center of the US political debate in the 2020s. The 2024 Presidential election cycle has the potential to be focused on fiscal policy. Click to read more.
Apr 20, 2018 | Managed Care Friday
1. 70%. Likelihood of acquiring Alzheimer’s disease has been shown to be this much lower in people who eat a vegan diet. 2. Autism’s Cliff: No, we aren’t taking about a fall-off in rates but rather a fall-off in services. Only 36% of autistic young adults attend any postsecondary education. Solutions are needed now for young people on the spectrum who are seeking an independent life. Only about 19% of young autistic adults live independently away from parents and without supervision. Read more on seeking solutions for the transition into adulthood here. 3. Lab Payment Ending: Starting in...
Apr 19, 2018 | Post-Acute Care
FFS spending on post-acute care (PAC) has not kept pace with total Medicare FFS spending over the past several years. In this brief, we will discuss this trend, factors contributing to it, and what can be expected going forward. Click to read more.
Apr 16, 2018 | Medicare Advantage, Part D
Medicare Part D is a voluntary outpatient prescription drug benefit for people on Medicare. Since the program’s inception in 2006, enrollment in Medicare Part D drug plans has consistently grown, but enrollment varies by state. In this brief, we will utilize enrollment data from CMS to provide an overview of the growth in Part D drug enrollment through the years and how Part D plan enrollment penetration varies by state. Click to read more.
