Feb 28, 2023 | Medicare, Physician Fee Schedule
Recent Developments in PT/OT, Chiropractic, and Physiatry: Impact of policy in PFS rules mixed for PT/OT, chiropractic, and physiatry specialties. Spending for all three specialties has been mixed in recent years. Click to read more.
Feb 24, 2023 | Managed Care Friday
757: It’s a palindrome as my smarter nieces remind me. It’s also the average cost in dollars for about 1 out of every 10 patients a day who go to some of the urgent care centers in a New England suburb, but then need to be transferred to the hospital via ground ambulance due to things like low heart rate or difficult to diagnose headaches. If you’re pursuing urgent care, keep in mind these centers didn’t really exist before this century, that 1 in 5 patients you see are “more than likely worried well” and could wait 3 days for their symptoms to resolve themselves, but some patients will be...
Feb 21, 2023 | Medicare Advantage
The 2024 Medicare Advantage (MA) Advance Notice proposes changes to certain hierarchical condition categories (HCCs) that CMS considers to reflect discretionary diagnosis codes, including for diabetes (a common chronic condition) and protein calorie malnutrition (a more unusual condition among MA enrollees). Click to read more.
Feb 17, 2023 | Managed Care Friday
58,200: The number of healthcare jobs added in January, with ambulatory healthcare services seeing the biggest increase. Despite this, health systems and independent providers are still struggling with staff shortages. Henry Ford said they’ve hired back only about 25% of their nurses who left during the pandemic and a recent article in NPR highlighted the increased use of mid-level providers in ERs. But It’s A Match: The number of internal medicine doctor residency training positions has fluctuated over the last three decades but offered 9,380 in 2022, the highest on record with 95% of them...
Feb 16, 2023 | BRG Publications
The eighteenth edition of the Healthcare Payer Index tracks priorities from government sponsored and commercial payers, including self-insured employer plans, how they have changed over time, and what payers will focus on in the year ahead. This year’s Top 20 includes four services new to the rankings, five new entries in the Top 10, and a new number 1. Join BRG expert Bryan Cote as he discusses the Top 20 Payer Priorities for 2023 - what it all means, why it matters, and how to interpret the rankings for your business. Bryan will also discuss insights from our recently published Value-Based...
Feb 14, 2023 | Medicare Advantage, Part D
CMS recently released the 2024 Advance Notice of Methodological Changes for MA Capitation Rates and Part C and Part D Payment Policies, projecting a modest positive impact to MA payments overall, indicating a 1.03% revenue increase and a 2.09% effective growth rate. The Advance Notice outlines several updates to the Part C Risk Model, Star Rating regulations, and Part D benefit-related IRA amendments and additions. CMS also published the Risk Adjustment Data Validation (RADV) Program Final Rule which includes updates to audit methodology. Click to read more.
Feb 10, 2023 | Managed Care Friday
35 Million: The number of prior authorization requests submitted to Medicare Advantage plans in 2021, about 6% of which were fully or partially denied. But good news for those who take the time to submit appeals - ~82% of the appeals ended up being overturned. Anthem had the highest number of PA requests per MA member in 2021, followed closely by Humana and Centene. But submitting and appealing prior authorizations takes time and energy and is likely contributing to provider burnout. A study from Medscape showed that more than half of physicians report feeling burned out and nearly 25% feel...
Feb 8, 2023 | Medicaid, Uncategorized
The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: CO: Medicaid budget request includes small across-the-board rate increase KS: Medicaid expansion legislation introduced NY: Governor Hochul releases FY2024 budget proposal Click to read more.
