May 3, 2022 | Hospitals, LTCHs, Physician Fee Schedule
CMS Proposed IPPS and LTCH Rules, Project Payment Increases for FY 2023: Inpatient hospitals are expected to see a 3.2% increase in operating payments, while long-term care hospitals will get a proposed 0.7% payment increase. Click to read more.
Apr 29, 2022 | Managed Care Friday
118-634%: The range of median price markups for oncology drugs purchased and administered by certain hospitals, according to a new study published in JAMA Internal Medicine. The study analyzed the prices of 25 top-selling cancer therapies at 61 National Cancer Institute-designated cancer centers and looked at how those negotiated prices for commercial payers compared to acquisition costs. Prices varied between cancer centers and between payers within the same center but for every drug included in the study, the median hospital negotiated price was at least twice the acquisition cost. ...
Apr 26, 2022 | Medicaid, Medicare, MedPAC
MedPAC: Assessing payment adequacy and updating payments for hospital inpatient and outpatient services, physician/other health services, ASCs, and SNFs. MACPAC: Publishing March 2022 Report to Congress on Medicaid and CHIP, as well as reports reviewing policy levers related to HCBS, Medicaid managed care capitation rate setting, and health equity. Click to read more.
Apr 26, 2022 | Skilled Nursing Facilities (SNF)
CMS Proposes Net -0.7% Decrease in FY2023 SNF Payments: CMS proposed payment policy changes that would result in an overall $320M decrease in payments to SNFs for FY2023. The decrease is driven by a required budget neutrality adjustment of -4.6% to account for overpayments from the transition to the Patient Driven Payment Model. Click to read more.
Apr 22, 2022 | Managed Care Friday
86: No, not the painful year for Red Sox fans when that ball scooted through Billy Buckner’s legs, but the portion of Aetna Medicare Advantage members in Florida who reported less loneliness, thanks to Aetna’s partnership with Papa, a platform connecting members with people for companionship, transportation and assistance with everyday tasks. The partnership began in 2020 after observing that 80% of eligible members felt lonely or depressed. By 2021, 62% of Aetna PPO members and 52% of Aetna DSNIP members reported feeling less lonely and happier overall after using the companionship...
Apr 19, 2022 | BRG Publications
The BRG Healthcare Transactions and Strategy quarterly compliance bulletin compiles noteworthy developments in the healthcare sector related to compliance, program integrity, and enforcement activities. In the first quarter of 2022, we have taken note of: DOJ/HHS activity OIG Medicare Hospice Services Analysis Three Comparative Billing Reports One GAO report OCR activity Approved and proposed additions to the RAC audit list Click to read more.
Apr 15, 2022 | Managed Care Friday
518: The number of “available” pediatric psychiatric residential beds in South Carolina, though state agency leaders say that about half of those are actually occupied by children from outside the state. This means South Carolina children with immediate psychiatric needs are waiting days and even weeks for care, and many end up traveling to other facilities across the state line. This strange phenomenon largely occurs due to different Medicaid rates between states. Kaiser Health News recently reported that about 90 children covered by Medicaid in Montana are at psychiatric facilities across...
