iqtsupport, Author at DeBrunner & Associates

ACOs, APMs Proliferate

The number of accountable care organizations and alternative payment models is growing, as is the number of people served by such programs. According to a new study published on the Health Affairs Blog, there are more than 900 ACOs across the country – a 10 percent increase over a year ago. 32 million Americans are served by ACOs today – 2.2 million more than a year ago. Among them, 59 percent are served through commercial contracts, 29 percent by Medicare contracts, and 12 percent under Medicaid contracts. ACO growth is greatest in metropolitan areas, the states with the greatest ACO [...]

iqtsupport2017-06-30T06:00:29-04:00June 30, 2017|Accountable Care Organization, ACO|

Denied Hospital Claims Exceed A Quarter of a Trillion Dollars a Year

Insurers deny about $262 billion in hospital inpatient and outpatient claims a year, according to a new study. That amounts to about nine percent of approximately $3 trillion in claims hospitals file with insurers a year. Of that rejected $262 billion, roughly 63 percent is recoverable but that costs hospitals $118 per claim, or nearly $9 billion a year in costs associated with that recovery. Learn more about this analysis produced by Change Healthcare in this Healthcare Finance News article.

iqtsupport2017-06-29T06:00:16-04:00June 29, 2017|hospitals|

HHS Needs to Do More on Physician Training

The federal government needs to do more to ensure an adequate supply of primary care physicians and their deployment in non-urban areas outside of the northeastern U.S. Or so concludes a new study performed by the U.S. Governor Accountability Office. According to the GAO report, efforts by the U.S. Department of Health and Human Services have resulted in progress toward meeting both of these goals – but not enough progress. With the federal government spending $15 billion on graduate medical education, GAO believes, HHS can and should do more to ensure an adequate supply of primary care physicians throughout the [...]

iqtsupport2017-06-28T06:00:41-04:00June 28, 2017|Medicare|

Elderly Patients Return to Hospitals After Observation Stay

More than one in five Medicare patients who have observation stays in the hospital return to that hospital within 30 days, according to a new study published in The BMJ. Among those returning to the hospital, 8.4 percent return to the emergency room, 2.9 percent have another observation stay visit, and 11.2 percent are admitted to the hospital. Another 1.8 percent pass away within 30 days. The numbers are similar for Medicare patients who only visit the emergency room. Learn more about the study’s findings and its implications for improving post-discharge care in The BMJ article “Outcomes after observation stays [...]

iqtsupport2017-06-26T06:00:39-04:00June 26, 2017|Medicare|

MedPAC to CMS: Speed Up Move to New Post-Acute Payment System

Medicare should adopt a unified system for post-acute-care payments even earlier than its target date of 2024. Or so the Medicare Payment Advisory Commission told Congress. MedPAC’s idea? Implement such a system by 2021 and phase it in over a three-year transition period, the agency said in its annual report and recommendations to Congress Learn more about what MedPAC recommended and why it recommended it in this McKnight’s Long-Term Care News article. Find MedPAC’s annual report to Congress here.

iqtsupport2017-06-22T06:00:15-04:00June 22, 2017|Medicare post-acute care, MedPAC|

MedPAC Delivers Annual Report to Congress

The Medicare Payment Advisory Commission has issued its annual report and recommendations to Congress. The major issues addressed in the report include: implementing a unified payment system for post-acute care reforming Medicare payment for drugs under Part B redesigning the merit-based incentive payment system (MIPS) and strengthening advanced alternative payment models using premium support for Medicare the relationship between clinician services and other Medicare services payments from drug and device manufacturers to physicians and teaching hospitals in 2015 the medical device industry stand-alone emergency departments hospital and skilled nursing facility use by Medicare beneficiaries who reside in nursing facilities the [...]

iqtsupport2017-06-21T06:00:29-04:00June 21, 2017|Medicare, Medicare post-acute care, MedPAC|

States Lag in Reducing Nursing Home Utilization

States are not making adequate progress toward keeping seniors and the disabled out of nursing homes by making greater use of home and community-based services. Or so concludes a new study from AARP. According to the study, only nine states and Washington, D.C. spend more on home and community-based services and long-term services and supports than on nursing homes. Minnesota leads the nation, spending 69 percent of its long-term-care money on home and community-based services. Other leaders include Washington state (65 percent), New Mexico (64 percent), and Alaska (63 percent). Alabama pulls up the rear with only 14 percent. The [...]

iqtsupport2017-06-19T06:00:20-04:00June 19, 2017|Medicaid, Medicaid long-term services and supports|

The Prospect of a Medicaid Work Requirement

Over the past three years a dozen states have proposed establishing a work requirement for eligibility for their Medicaid programs and in its proposed FY 2018, the Trump administration has called for extending the ability to impose such a requirement to all states. But how would a Medicaid work requirement work? To whom would it apply and what kinds of work might satisfy such a requirement for the approximately 22 million Medicaid recipients (out of 76 million total recipients) to whom it might apply? A new Commonwealth Fund report looks at these and other issues. Go here to find the [...]

iqtsupport2017-05-31T16:28:01-04:00May 31, 2017|Medicaid, Medicaid regulations|

Medicare Delays New and Expanded Bundled Payment Programs

Medicare has delayed the launch of its mandatory Medicare Cardiac Rehabilitation Incentive Payment program until January 1. It also has delayed the expansion of its Comprehensive Care for Joint Replacement program through a new Surgical Hip and Femur Fracture Treatment program. Originally scheduled to begin on May 20 and then pushed back to July 1, now it, too, will not begin until January 1. Medicare’s Acute Myocardial Infarction program and Coronary Artery Bypass Graft program will still begin on July 1. For further information, see this Federal Register notice announcing the delays.

iqtsupport2017-05-26T06:00:29-04:00May 26, 2017|Medicare|

New Book Addresses Social Risk Factors in Medicare

In the new book Accounting for Social Risk Factors in Medicare Payment, the National Academies of Sciences, Engineering, and Medicine addresses the question of what social risk factors might be worth considering in Medicare value-based payment programs and how those risk factors might be reflected in value-based payments. The book, the culmination of a five-part NASEM process, focuses on five social risk factors: socio-economic position race, ethnicity, and cultural context gender social relationships residential and community context Addressing such factors in Medicare value-based payments, the book finds, can help achieve four important goals: reduce disparities in access, quality, and outcomes [...]

iqtsupport2017-05-24T11:47:42-04:00May 24, 2017|Medicare|

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