May 24, 2019 | Managed Care Friday
1. 16: Number of cancer groups participating in Humana’s new oncology payment model for Medicare Advantage and commercial patients. The program is in its 5th month – but efforts to pay differently for cancer aren’t new by any stretch. Before the days of ‘value-based payment’ there were pioneers at Aetna and Humana designing shared savings models from scratch. The model is the fourth for the plan to target specialty services – orthopedics, maternity, and spinal fusion for MA patients. 2. The Cayman’s: Perhaps not a fit for the big insurers, but a handful of medical groups taking global risk...
May 23, 2019 | Drugs, Products
In October 2017, BRG professionals published a white paper evaluating the breakdown in site of care for top physician administered drugs covered by Medicare Part B that are used to treat several conditions (e.g. breast cancer, rheumatoid arthritis, and multiple sclerosis). This paper by BRG Expert Eleanor Blalock is an update to prior analysis to reflect Medicare claims data through 2017 and provide a broader view of all Part B drugs. Click to read more.
May 22, 2019 | Legislation/ Budgets/ Macro
Discussion of Congressional action on “surprise medical bills” has increased. The White House has stated support for reform and bills have been introduced in both Houses of Congress supporting legislation. Click to read more.
May 21, 2019 | Hospitals, Inpatient, LTCHs, MedPAC, Outpatient
MedPAC recommends that Congress update Medicare inpatient and outpatient payment rates for 2020 by 2%. The Commission is also recommending a new hospital value incentive program (HVIP) that would replace the current quality incentive programs. This brief discusses these recommendations and other key highlights from the March MedPAC chapter on hospitals. Click to read more.
May 17, 2019 | Managed Care Friday
1. 30 for 30: According to the NCQA, patients with a new onset low back pain diagnosis normally should not receive imaging within the first 30 days of diagnosis but there may be instances when imaging should be considered. You can access an evaluation chart to use with patients presenting low back pain: click here 2. Fall Risk: In our poll of Medicare Advantage plan care managers and medical directors, 91 of 153 said this was the number one ‘avoidable outcome’ issue that their networks are struggling to reduce. My dad fell down stairs two years ago and, though he luckily survived, continues...
May 16, 2019 | Hospitals, Inpatient, LTCHs
CMS has released the 2020 proposed rule for the hospital inpatient (IPPS) and the long-term care hospital (LTCH) payment systems. CMS estimates a 3.5% increase to IPPS payments and a 0.9% increase to LTCH payments in 2020. Additionally, CMS has proposed changes to the hospital wage index to decrease disparities between states. Click to read more.
May 15, 2019 | Medicaid, Medicare, Payers
The dual eligible population is generally medically complex, and thus has historically accounted for a disproportionately large share of expenditures in both the Medicare and Medicaid programs. Lack of alignment between the programs can be costly and result in fragmented care. In an effort to better integrate care for duals, CMS discusses in a recent letter to State Medicaid Directors three opportunities: the capitated financial alignment model, managed fee-for-service model, and state-specific models. Click to read more.
May 13, 2019 | Drugs, Medicare Advantage, MedPAC, Part D, Payers, Post-Acute Care, Products
MedPAC’s April meeting covered topics related to value-based payment, shared savings, Medicare Advantage star ratings and encounter data, emergency department spending growth, Part D specialty drugs, post-acute care assessments, and dialysis. The Commissioners voted on draft recommendations, including that CMS should establish national coding guidelines for emergency departments. Click to read more.
May 10, 2019 | Managed Care Friday
1. 49: Percent of 316 high school and college students we polled this month who say they ‘know someone’ with an eating disorder, ‘or think they do,’ but just 20% say they’ve told anyone about it. ‘It’s hard to talk about it. I’ve told a counselor,’ said one 11th grader, but others say they ‘aren’t sure exactly.’ One female polled said part of the issue is the classes and culture focus ‘so much on watching what we eat … and a lot of us don’t really know how to do that…and sometimes the issue ‘escalates.’ A freshman at a college in Texas says ‘it’s hard for a lot of kids who have had to deal...
