Jan 1, 2021 | Managed Care Friday
15: Percent increase in reimbursement starting in February for physicians who do certain procedures in ASCs rather than hospitals under a Michigan Blue plan policy. The change applied to PPO membership, as HMO patients are "managed" and use ASCs more often already. Penn & Tella: This is how my brother-in-law from Boston’s north shore pronounces the magician pair but it’s also a new telehealth program from Penn Medicine that has reduced rehospitalizations 75% among patients who’ve had hip or knee replacements. The program, Home Connect, gives patients wearable devices and text messages to...
Dec 29, 2020 | Drugs, Infusion, Medicare
As expected, a judge in the US District Court in Maryland issued a temporary nationwide injunction halting implementation of the Trump Administration’s Most Favored Nation rule that would have lowered reimbursement for top Part B drugs as of January 1, 2021. Click to read more.
Dec 29, 2020 | Drugs, Pharmacy
In an 8-0 opinion, the Supreme Court ruled that an Arkansas state law regulating PBM pricing is not preempted by federal ERISA law. This opinion overturned lower court rulings but was not a surprise, as the Supreme Court has previously set a relatively high bar for ERISA preemption. Click to read more.
Dec 28, 2020 | Legislation/ Budgets/ Macro, Medicare, Physician Fee Schedule, Physicians
The COVID-19 relief and federal spending bill signed by President Trump on December 27 includes a range of consensus health policies, primarily around transparency and data reporting, as well as minor expansion of provider authorities and consumer-friendly policies. The bill also intervened to mitigate the impact of the evaluation and management services (E&M) budget neutrality adjustment (BNA) on Medicare physician payments. Click here for a summary of the bill Click here for a summary of the E&M BNA impact
Dec 22, 2020 | Legislation/ Budgets/ Macro, Medicaid, Medicare
HHS OIG and CMS have finalized reforms to the Stark Laws, Anti-Kickback Act, and Beneficiary Inducement rules to facilitate the growth of value-based care arrangements that rely on greater cooperation between providers and incentives for beneficiary behavior. Click to read more.
Dec 21, 2020 | Legislation/ Budgets/ Macro
An Out-of-Network (OON) Surprise Billing compromise announced recently is based entirely on dispute resolution, without using benchmarks, and has been enacted in the end-of-year COVID relief package. Click to read more.
Dec 18, 2020 | Managed Care Friday
49: The percent of Medicaid, Medicare, and commercial payers who named this their top priority for 2021 in what is a bit of surprise but an indication of how the health system continues to evolve. The new #1, the full Top 20 priorities and what moved up and moved out since last year will be reported in the 15th edition of the Healthcare Payer Index coming out soon. Stay tuned. Alternative Pay: 31% of surveyed payers say they are thinking about the next generation of payment models and one model, likely developed by some insurers, will target severely mentally ill populations. But creating...
Dec 17, 2020 | Physician Fee Schedule
CMS has finalized 2021 updates to the physician fee schedule. This brief summarizes key provisions in the rule, which were mostly finalized as proposed. Click to read more.
