Apr 12, 2018 | Medicare Advantage, Part D
On April 3, CMS released the 2019 Part D Payment Policy and Final Call Letter. CMS did not elaborate much on its view on rebate policies, but did note that it believes it has legal authority to make some changes. The rule also clarified how MA plans can negotiate with hospitals and 340B pharmacies for the provision of drugs, and included policies to limit and better track opioid prescriptions.Click to read more.
Apr 11, 2018 | Medicare Advantage
On April 3, CMS released the 2019 Medicare Advantage (MA) Final Call Letter. The final rates are aligned with previous years’ trends, resulting in an increase in plan payment of 3.4% before taking into account expected payment increases from coding intensity trends. This is the biggest increase in years, and should help continue the explosive growth in MA enrollment seen over the past 10 years. Separately from rate setting, CMS finalized its proposal to expand the supplemental benefits that MA plans can offer, potentially making MA an even more attractive option for Medicare beneficiaries,...
Apr 6, 2018 | Managed Care Friday
1. Six Million: Adults in the U.S. who suffer from panic disorder. That’s 2.7% of the population. Women are twice as likely to be affected as men, according to research from the Anxiety and Depression Association of America. Many people don't know that their disorder is real and highly responsive to treatment. People with the disorder experience spontaneous feelings of panic as their brain goes into a fight or flight mode. The University Health News Daily states that causes of panic attacks in women arise more than men because researchers have identified 3 notable causes: serotonin...
Apr 3, 2018 | Legislation/ Budgets/ Macro, Medicare
Each year, the HHS Office of Inspector General (OIG) releases scores of reports on Medicare and Medicaid payment topics. So far, several reports have been issued already in 2018 and the OIG recently updated its work plan to make public other topics its currently working on. Click to read more.
Apr 2, 2018 | Legislation/ Budgets/ Macro
The FY 2018 Appropriations have finally been completed. Discretionary accounts relevant to the healthcare sector, such as FDA, NIH and CDC have received modest increases over FY 2017 funding levels. Programs related to opioid treatment and prevention have received more than $3 billion of additional spending. The omnibus did not contain any additional subsidies to insurance companies participating in the ACA exchanges. Click to read more.
Mar 30, 2018 | Managed Care Friday
1. 1948: Average daily price of a typical hospital room according to 15 Ohio hospital prices. That’s at least a dozen urgent care visits. 2. Catholic Systems Move Into Rx Field: Ascension, the world’s largest Catholic health system, is 1 of 4 systems involved in creating a non profit generic drug company. Intermountain Healthcare is spearheading the effort. Trinity System is also involved. The company will be directly manufacturing generics, or subcontract this work, with a goal of improving the supply of medications and getting control over pricing given recent spikes in generic drug costs....
Mar 28, 2018 | Physical Therapy
In a review of 300 physical therapy claims, a new HHS OIG report found that 61% of physical therapy claims do not meet Medicare requirements. However, CMS’s response questioned the accuracy of the OIG findings. Click to read more.
Mar 27, 2018 | Physician Fee Schedule
The Secretary of HHS is statutorily given the authority to periodically revise and revalue RVUs (relative value units) at least every 5 years for all of the codes established under the physician fee schedule (PFS). In this brief, we will provide an overview of the review process and ook at a few examples of reviews that have occurred in the past several years – a few of which resulted in cuts of 20% or more. Click to read more.
Mar 23, 2018 | Managed Care Friday
1. 65 Seconds: Amount of time it takes for someone new in the U.S. to develop Alzheimer’s disease – which by 2050 is expected to shrink to one person every 33 seconds. 5.7 million Americans are living with it now and depending on which state you live in, assisted or senior living can cost approximately $2,525 to $5,745 a month. My grandmother, who spent her childhood in the mountains near Napoli, spent her last 12 years in Fairlawn New Jersey with the disease. I lived with her for part of that time – she was only in a SNF near the end, when pneumonia got her. The pipeline of drugs to address...
