iqtsupport, Author at DeBrunner & Associates

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C. The following is MACPAC’s own summary of the sessions. The Commission wrapped up its work on the June 2019 Report to Congress on Medicaid and CHIP at the April meeting, with sessions reviewing four of the report’s five draft chapters on Thursday morning, and votes on potential recommendations later in the afternoon. First on Thursday’s agenda was a draft June chapter on Medicaid prescription drug policy, which contained draft recommendations to provide states with a grace period to determine Medicaid drug coverage and [...]

iqtsupport2019-04-16T06:00:59-04:00April 16, 2019|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid regulations|

Medicare Advantage Permitted to Address Non-medical Needs

Starting in 2020, Medicare Advantage plans will be permitted to provide non-medical benefits to their chronically ill members. As described in the Centers for Medicare & Medicaid Services’ “final call letter’ for 2020, MA [Medicare Advantage] plans are not prohibited from offering an item or service that can be expected to improve or maintain the health or overall function of an enrollee only while the enrollee is using it. In other words, the statute does not require that the maintenance or improvement expected from an SSBCI [special supplemental benefits for the chronically ill] result in a permanent change in an [...]

iqtsupport2019-04-16T06:00:54-04:00April 16, 2019|Medicare|

Feds Looking to Bundle Medicare Post-Acute Payments?

Bring us your ideas for bundling Medicare post-acute-care payments, the head of the Center for Medicare and Medicaid Innovation recently told a gathering of hospital officials in Washington, D.C. As reported by Fierce Healthcare, CMMI director Adam Boehler told hospital officials that Now is the time to bring us ideas. We’re really in listening mode…I think there’s been a lot of intrigue and interest we’ve heard from people. So we’re gathering stakeholder input there on that and it’s a great time to give us thoughts on where we can lower costs. Learn more from the Fierce Healthcare article "CMMI's Adam [...]

iqtsupport2019-04-15T06:00:16-04:00April 15, 2019|Center for Medicare and Medicaid Innovation, CMMI, Medicare, Medicare post-acute care, post-acute care|

SNF Discharge May Affect Hospital Readmission Rates

Heart failure patients discharged from skilled nursing facilities after two days or less may be as much as four times more likely to be readmitted to a hospital than those who stay longer, according to a new analysis. The study also found that the hospital readmission rate falls by half for patients who remain in a skilled nursing facility for one to two weeks. The analysis evaluated Medicare data for heart failure patients at least 65 years old and did not adjust for their severity of illness. These findings suggest that the current emphasis on limiting patients’ time in post-acute-care [...]

iqtsupport2019-04-11T06:00:21-04:00April 11, 2019|Medicare, Medicare post-acute care, post-acute care|

Medicaid Expansion Helping FQHCs

Federally qualified health centers have benefited from Medicaid expansion, a new survey has found. According to a new Commonwealth Fund report, a survey comparing FQHCs in states that expanded their Medicaid programs to FQHCs in states that did not expand their Medicaid programs found that FQHCs in expansion states are: more financially stable more likely to provide behavioral health services, including medication-assisted treatment for opioid addiction, counseling, and coordination of care with social service providers more likely to engage in value-based care Because of Medicaid expansion, FQHCs now are paid for services they previously provided at no charge to low-income, [...]

iqtsupport2019-04-10T06:00:05-04:00April 10, 2019|Medicaid|

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues. The issues on MedPAC’s April agenda were: Expanding the use of value-based payment in Medicare Medicare Shared Savings Program performance Redesigning the Medicare Advantage quality bonus program Increasing the accuracy and completeness of Medicare Advantage encounter data Evaluating patient functional assessment data reported by post-acute-care providers Options for slowing the growth of Medicare fee-for-service spending for emergency department services Options to increase the affordability of specialty drugs and biologics in Medicare Part D Improving payment for low-volume and isolated outpatient dialysis [...]

iqtsupport2019-04-09T06:00:04-04:00April 9, 2019|Alternative payment models, hospitals, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, post-acute care|

Groups Work to Create New Codes for Social Determinants

Social determinants of health could have their own ICD-10 codes if a new initiative from the American Medical Association and United Healthcare succeeds. The two are working together to develop new ICD-10 codes that would take into consideration social determinants of health such as housing and food security, access to transportation, and ability to pay for medicine. The project launches at a time when research suggests that social determinants of health can affect nearly 80 percent of health care outcomes. Learn more in the Health Analytics IT article “AMA, UnitedHealth Partner for Social Determinants ICD-10 Project.”

iqtsupport2019-04-08T06:00:59-04:00April 8, 2019|Uncategorized|

New Web Site Shows Maximum 340B Prices

Providers can now see the maximum prices for 340B-covered drugs on a new web site established by the federal Health Resources & Services Administration. The web site, mandated by Congress after the U.S. Department of Health and Services’ Inspector General found that some providers are being overcharged, will enable 340B-eligible providers to identify the maximum price they can be charged for covered drugs. This, HRSA believes, will help providers avoid being overcharged in the future. Learn more in the Becker’s Hospital Review article “HRSA launches 340B ceiling price website” and visit the new web site itself (registration required).

iqtsupport2019-04-05T09:34:14-04:00April 5, 2019|340b|

Medicare Advantage Networks Not Narrowing

The primary care networks offered by Medicare Advantage plans are broadening and not narrowing, as some people have long feared. According to a study published in the journal Health Affairs, only 1.8 percent of Medicare Advantage plans offer narrow primary care provider networks, down from 2.7 percent in 2011. Meanwhile, the proportion of plans offering broad networks has grown from 80.1 percent in 2011 to 82.5 percent in 2015. In 2015, broad network plans enrolled 63.9 percent of Medicare Advantage participants, up from 54.1 percent in 2011. This is considered important because the proportion of Medicare beneficiaries enrolled in Medicare [...]

iqtsupport2019-04-04T13:00:55-04:00April 4, 2019|Medicare|

Moody’s: Challenging Times Ahead for Academic Medical Centers

Academic medical centers will struggle in the near future, according to Moody’s Investor Services. While academic medical centers still have a number of strengths – offering higher-end services, high demand for their inpatient services, and generally strong cash flow margins – they also face a number of challenges that make life more difficult for them in a value-based payment world. Among those challenges, most notably, are higher costs associated with teaching and research, higher-acuity patients, and payment pressure from insurers. Another challenge: the shrinking gap between academic medical center hospitals and others as more care is delivered on an outpatient [...]

iqtsupport2019-04-04T06:00:55-04:00April 4, 2019|Uncategorized|

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