Dec 15, 2020 | ASC, Medicare, Outpatient
For 2021, CMS has finalized a 2.4% rate update to the outpatient hospital payment system; CMS is also eliminating the inpatient-only list for all procedures by 2024. After a recent court ruling in CMS’s favor, the agency is reducing the Medicare FFS reimbursement for 340B-eligible drugs to ASP-22.5% in the HOPD setting. Click to read more.
Dec 14, 2020 | BRG Publications
BRG’s annual Federal Policy Review is a guide to federal healthcare policy for 2020 and 2021. BRG’s policy experts review macro trends in healthcare spending and coverage, federal legislative efforts, and regulatory updates to each of the Medicare payment systems. Click to read more.
Dec 11, 2020 | Managed Care Friday
40: The number of additional onsite primary care clinics Walgreens and VillageMD are opening in 2021 through their partnership, focused on sites in Texas, Arizona, and Florida. Physicians, nurses, and pharmacists will staff the clinics, and an app will allow patients to also utilize virtual and telehealth services. Walgreens has stated its long-term plan is to open as many as 700 of these clinics over the next five years. Moving to the Pharm: BCBS of Michigan is moving two drugs from the medical benefit to the pharmacy benefit because “they can be safely administered in the member’s home.”...
Dec 10, 2020 | BRG Publications
BRG’s third annual Healthcare Investment Index reviews recent healthcare investment activity and prospectively surveys investors about future areas of interest in the next year. Click to read more.
Dec 9, 2020 | BRG Publications, Medicaid
The COVID-19 pandemic and associated economic recession have raised widespread concern regarding potential Medicaid cuts. While the program is likely to head into 2021 in a state of relative stability, state budget shortfalls are likely heading into state fiscal year 2022, and small across-the-board cuts are likely in at least some states. Click to read more.
Dec 7, 2020 | Drugs, Medicare, Part D, Payers, Physicians
HHS proceeded with two rules aimed at reducing drug prices: benchmarking Medicare Part B prices to international levels and modifying the Part D rebate exemption from the anti-kickback rule. The rules now face legal challenges and the possibility of being reversed by the Biden Administration. Click to read more.
Dec 4, 2020 | Managed Care Friday
Social Service Payment: Identifying the social factors of health is part of a new program from a Michigan health plan. Starting in January, the plan will provide financial incentives to healthcare providers if they screen patients and report back these social risk factors. Click here to read more. Extra Point: At about 11:45am on Tuesday the 8th, one of our panel discussions will feature Mona Chitre, the longtime chief of pharmacy and VP of integrated clinical strategy for Excellus BCBS, the head of healthcare strategy and payment transformation from Blue Carolina, Troy Smith, and a pair of...
Nov 30, 2020 | 340B, BRG Publications
Our BRG colleagues Aaron Vandervelde, Kevin Erb, and Lauren Hurley have published a study on for-profit pharmacy participation in the 340B program. Their work examines the history and the growth of contract pharmacy within 340B and its impact on the program. Click to read more.
Nov 24, 2020 | ESRD, Medicare Advantage, Physician Fee Schedule, Physicians
Recent developments in nephrology reimbursement and legislation include E&M reform, value-based care initiatives, and full eligibility for ESRD enrollees to join Medicare Advantage plans. Click to read more.
Nov 20, 2020 | Managed Care Friday
$100M: The amount Ochsner Health in Louisiana committed to spending over the next five years to build community health centers in underserved areas. Louisiana consistently rates in the very bottom of US health rankings and the health system aims to increase their ranking by opening 15 centers across the state. They will be located strategically in rural and underserved areas, providing more alternatives to patients who frequently use the ER as primary care. Interception: An adult and pediatric practice in Nevada says Anthem’s teledentistry partner has “picked off some of the patients we...
