May 8, 2019 | Inpatient Rehab (IRF)
CMS recently released its annual proposed rule for Inpatient Rehabilitation Facilities (IRF), which reflects a continuing trend of stability in the space overall. However, CMS estimates its proposed changes to case mix calculations and other changes would result in a less positive overall impact for some for-profit providers. Click to read more.
May 7, 2019 | Legislation/ Budgets/ Macro, Medicare, Payers
CBO released a report on policy details that legislators must consider in designing a single payer health care system that attempts to achieve universal coverage. The budget office did not estimate the cost impact of a new health care system, in part reflecting the lack of consensus around a specific proposal. We continue to believe that a true single payer system is not politically feasible, even under an all Democratic government. It’s possible that the proposals coalesce around a more moderate approach to expand the government’s role in paying for health care, alongside private insurers,...
May 3, 2019 | Managed Care Friday
1. 25,000: People living with Parkinson’s in Michigan out of the roughly 1 million nationally. BCBS of Michigan is teaming up with the Kirk Gibson Foundation to raise awareness and provide resources. In the meantime, there continues to research on Parkinson’s. A new study released this year says a new device may be helpful in slowing or reversing the progression of the disease. The experimental study investigated whether using a novel delivery system could regenerate dying dopamine brain cells in patients with Parkinson’s and even reverse their condition. It could be ‘the first...
Apr 30, 2019 | Post-Acute Care, Skilled Nursing Facilities (SNF)
CMS proposed SNF payment and policy updates for FY2020, which includes full implementation of the payment modification starting October 1, 2019. Full implementation of the payment modification – known as the Patient Driven Payment Model, or PDPM – was widely expected. This proposal only includes small changes to prior announcements, such as broadening the definition of group therapy. The proposal also would increase overall payments to SNFs by 2.5%, which is in line with estimates. Click to read more.
Apr 29, 2019 | Behavioral, Inpatient Psych
CMS recently released proposed updates to the Inpatient Psychiatric Facilities (IPF) Prospective Payment System (PPS). The proposed rule is stable for IPFs, with an estimated update to prospective payment rates of 1.7%, and the addition of one measure to the IPF Quality Reporting Program. Click to read more.
Apr 26, 2019 | Medicare, Physician Fee Schedule, Physicians
CMS recently announced the Primary Cares Initiative, which is a new set of primary care payment models developed by the CMS Innovation Center (CMMI) to test capitated/value-based rates for primary care services in Medicare FFS. This brief includes an overview of the five new payment models that will be offered through two different paths: Primary Care First (PCF) and Direct Contracting (DC). Click to read more.
Apr 22, 2019 | Exchanges, Payers
2019 Open Enrollment into individual market Exchange plans experienced some decline in the number of consumers selecting plans, although the decline was more modest than expected. Although large insurers continue to dominate enrollment in most markets, fewer counties and states had only a single carrier offering Exchange plans. GAO also reported on continued trends in enrollment concentration across individual, small and large group plans into just a few, large insurers. Click to read more
Apr 18, 2019 | ASC, Hospitals, Outpatient
In a two-part Q&A, BRG Expert Dr. Henry Miller spoke with Becker’s ASC Review, discussing the outpatient payment landscape (click to read more), and four ASC payment trends to watch (click to read more).
Apr 17, 2019 | Home Health, Inpatient Rehab (IRF), LTCHs, MedPAC, Post-Acute Care, Skilled Nursing Facilities (SNF)
MedPAC recently released its annual March report, which includes 2020 payment update recommendations to Congress for services reimbursed by Medicare. This brief focuses on the post-acute care (PAC) recommendations, including SNFs, home health, LTCHs, and IRFs. Click to read more.
