Jul 8, 2022 | Managed Care Friday
$100: The per member per day fine health plans will now face if they do not post the negotiated rates they pay to in-network providers and potential out-of-network billable amounts patients may owe, due to a new regulation that went into effect last Friday. Though hospitals have been slow to post their prices since that transparency rule went into effect, the much larger potential fines health plans face seems to be having the desired effect. Many large plans, including United Healthcare, have already posted the required information. But even full health plan compliance won’t automatically...
Jul 5, 2022 | Medicaid, Medicare, MedPAC
This brief summarizes recent activity at MedPAC and MACPAC including: MedPAC: Assessing payment adequacy and updating payments for hospital inpatient and outpatient services, physician/other health services, ASCs, and SNFs. MACPAC: Publishing June 2022 Report to Congress on Medicaid and CHIP, as well as reports reviewing policy levers related to SNF staffing levels and social determinants of health. Click to read more.
Jul 1, 2022 | Managed Care Friday
$12-36: The amount Optum claims their new lab benefit management solution can save health plans on a per member per year basis. Optum is launching a new program to combat unnecessary clinical testing, which can account for up to 30% of all tests ordered. Optum will work with Avalon to administer the solution. As Good As It Gets? Jack Nicholson’s character Melvin Udall in the 1997 movie put OCD on the map, showing moviegoers just how debilitating obsessive-compulsive disorder can be when ordering breakfast, navigating sideways, and trying to court the waitress. 25 years since the movie...
Jun 24, 2022 | Managed Care Friday
29: Percent of 412 schools we polled in the spring who are looking to “hire” allergists, as part of trend of schools becoming more like quasi health centers. Several even report issues with students with allergies and co-occurring eating disorders. By comparison, 74% say they are trying to increase “mental health counselor” staff. Once upon a time if you had an allergic reaction you had to go sit in that wobbly chair next to the art cart in the hallway until mom or dad showed up. Nowadays, schools try to know about your allergy before it happens. High Deductible, Low Detection: A Harvard...
Jun 23, 2022 | Home Health, Medicare, Post-Acute Care
For CY 2023, CMS estimates a -4.2% reduction to home health payments, resulting in an estimated $810 million payment decrease. This reflects a +2.9% proposed market basket increase and -6.9% decrease in payments due to proposed behavioral adjustment and reflects the effects of an update to the outlier payments threshold. Click to read more.
Jun 17, 2022 | Managed Care Friday
#1: The top bestseller in psychiatry this week is none other than the DSM-5 aka “the bible” of the psychiatry world. The latest version of the Diagnostic and Statistical Manual of Mental Disorders, released in March after nearly a decade without updates, has become a surprise hit likely due to increased demand for mental healthcare. The DSM is the top psychiatry bestseller on Amazon and the Wall Street Journal’s list, though physicians warn the book is intended for mental health professionals and not for self-diagnosing. But given the difficulties many still face in accessing mental...
