Mar 9, 2020 | Dental, Medicare, Medicare Advantage
gain coverage through other plans. A recent paper coauthored by BRG’s Eva DuGoff, published in Health Affairs, analyzed coverage and utilization rates for these services among Medicare beneficiaries. Click to read more.
Mar 6, 2020 | Managed Care Friday
19: Percent of hospitals in a poll last week considering or establishing in-house specialty pharmacies. This developing trend is interesting given a new UnitedHealthcare policy starting in April. Hospitals will be required to obtain specialty medications from UHC’s specialty pharmacies when administered in the hospital outpatient setting, unless otherwise authorized. This means the hospital can’t bill for the medication and can’t bill the patient. The pharmacy will bill United and the hospital can only bill for ‘administering’ the drug. The insurer says they may deny the full claim if the...
Mar 4, 2020 | Legislation/ Budgets/ Macro
CBO’s latest 10-year budget analysis projects historic federal budget deficits for the next decade—with rapidly rising federal healthcare costs a major contributor. Over the next 10 years, CBO estimates that federal healthcare costs will increase from 5.4% of GDP to 7.0% of GDP by 2030. This reiterates that the federal government will face significant fiscal pressures as the Medicare population grows and issues such as the solvency of the Medicare Part A trust fund loom over the next decade. Click to read more.
Mar 3, 2020 | ASC, Medicare
In February 2020, CMS submitted a proposed rule to extend the Comprehensive Care Joint Replacement (CJR) Model for an additional three years (2021-2023), and to include outpatient hip and knee replacements in the episode of care definition, with additional adjustments to other pieces of the model to account for these new changes. Click to read more.
Feb 26, 2020 | Medicare, Physician Fee Schedule, Physicians
While a lot of attention is being paid to the big increases in evaluation and management (E&M) office visit codes and the offsetting -8% cuts to non-E&M codes scheduled for 2021, some other big fights with potentially large impacts on Medicare physician payments are also looming on the horizon. Click to read more.
Feb 25, 2020 | Physician Fee Schedule, Physicians
Recent developments in dermatology reimbursement and legislation. Click to read more.
Feb 21, 2020 | Managed Care Friday
77: Percent of employers in our poll of 219 small, midsize, and large companies who say the time to diagnosis for pain and orthopedic issues is “excruciatingly slow” and “wasteful,” and has led to issues with “presenteeism, productivity” and ultimately higher health cost spend per employee. “Not just low back pain, but neck pain, knee pain, upper back, elbow – we have been pressing in recent years to use PT first for several weeks but sometimes an X-ray is needed right away to rule out issues,” says Dave Simmons, a medical director consultant for self-insured employers. Palliative Care:...
Feb 20, 2020 | Hospice, Medicare, Medicare Advantage
CMS released the 2021 Medicare Advantage Advance (MA) Notice on February 5, 2020. The proposed rate updates are estimated to increase MA plan payments by +0.93%, with another +3.56% increase due to plan risk coding behavior. CMS also published more details on the voluntary demonstration program that allows Medicare Advantage plans to cover the Medicare hospice benefit. Specific capitation rate detail are expected to be released shortly. Click to read more.
