As home health and home care operators move toward the ninth month of the COVID-19 pandemic, it’s important to take stock of what has been accomplished from a policy perspective. Many of 2020’s regulatory changes will be fleeting, but others will shape the future of… Read More »NAHC Pushing for Palliative Care, SNF-at-Home Medicare Benefits
Medicare’s annual open enrollment period is right around the corner. In fact, beginning October 15 and running through December 7, newly qualified patients and current Medicare beneficiaries may review their coverage options and select their health plans for 2021. Finding a health insurance plan that… Read More »Open Enrollment: How to find a Medicare plan that meets your needs
Medicare doesn’t currently cover drugs approved under emergency use designations. But CMS Administrator Seema Verma said the agency was coming up with a plan to make sure Medicare beneficiaries were covered once a coronavirus vaccine is developed.
When it announced plans to go public through a blank-check company, Clover Health shared ambitious projections for its future membership. Much of that growth is pinned on plans to launch a direct contracting business.
This analysis estimates the share of older adults who reported anxiety or depression amid the COVID-19 pandemic.
Healthcare providers won’t have to start paying back Medicare advance loans until a year after they were issued. Under the original timeline, hospitals were supposed to start paying back the loans in August.
This brief provides an overview and status update of the Medicare accelerated and advance payment program, which provided $100 billion in loans to Medicare providers in the spring of 2020 to compensate for revenue shortfalls due to the coronavirus pandemic. The brief describes who got… Read More »Medicare Accelerated and Advance Payments for COVID-19 Revenue Loss: More Time to Repay
Now that the dust has settled on the Patient-Driven Groupings Model (PDGM), some have returned their attention toward the idea of another major reimbursement overhaul: a unified post-acute payment system. There had been mounting momentum behind a unified payment model for post-acute care providers headed… Read More »Payment Reform, COVID-19 May Derail a Unified Post-Acute Care Payment System
Humana, Fresenius Medical Care Expand Partnership to Improve Care Coordination for Medicare Advantage Members
What You Should Know: – Humana Inc. and Fresenius Medical Care North America (FMCNA) today announced an agreement to broaden their collaboration toward improving the health of eligible Humana Medicare Advantage members – The agreement between Humana and Fresenius Medical Care North America goes into… Read More »Humana, Fresenius Medical Care Expand Partnership to Improve Care Coordination for Medicare Advantage Members
What You Should Know: – Innovaccer unveils new risk adjustment solution to help providers better segment their population to refine the risk scoring process and improve coding accuracy and efficiency, thereby improving performance on risk-based contracts. – The solution utilizes Artificial Intelligence (AI) and Natural… Read More »Innovaccer Unveils Risk Adjustment Solution For Improved Coding Accuracy
Home health is often utilized as a recovery tool when patients transition out of the hospital because of its ability to improve outcomes. But many of the Medicare beneficiaries who receive referrals after being discharged aren’t actually receiving these services. Overall, the past several decades… Read More »Half of Patients Referred to Home Health Don’t Receive Services — But Providers Can Change That
What You Should Know: – Walmart announced it will begin selling Medicare insurance plans during this year’s annual enrollment period, Oct. 15 through Dec. 7. Today, Walmart announced the launch of Walmart Insurance Services, LLC, a licensed insurance brokerage, which will assist people with enrolling… Read More »Walmart to Offer Medicare Insurance Plans During 2020 Open Enrollment
Lower Flu Vaccination Rates Among Black, Hispanic, and Low-Income Seniors Suggest Challenges for COVID-19 Vaccination Efforts
People 65 and older, who have been hardest hit by COVID-19 in terms of hospitalizations and deaths, are also at high risk of severe flu illness and are more likely to die of the flu than younger people. This analysis explores variation in the rate… Read More »Lower Flu Vaccination Rates Among Black, Hispanic, and Low-Income Seniors Suggest Challenges for COVID-19 Vaccination Efforts
What’s the Latest on Prescription Drug Proposals from the Trump Administration, Congress, and the Biden Campaign?
This slideshow explains the similarities and differences among major proposals to lower prescription drug costs introduced by the Trump Administration, members of Congress, and the Biden campaign.
This side-by-side comparison examines President Trump’s record and former Vice President Biden’s positions across a wide range of key health issues, including the response to the pandemic, the Affordable Care Act marketplace, Medicaid, Medicare, drug prices, reproductive health, mental health and opioids, immigration and health… Read More »Health Care and the 2020 Presidential Election
Gerry Miller, Founder & CEO at Cloudticity The coronavirus pandemic accelerated telemedicine exponentially as patients and doctors switched from in-person visits to remote consultations. Health providers rapidly scaled virtual offerings in March and April and traffic volumes soared to unprecedented levels, with practices “seeing 50… Read More »3 Telemedicine Security and Compliance Best Practices
What You Should Know: – NovuHealth and Revel merge to bring together NovuHealth’s personalized healthcare loyalty programs with Revel’s applied behavioral research and health action technologies. – Together, Revel and NovuHealth work with more than 50 healthcare organizations, including seven of the top 10 largest… Read More »Revel, NovuHealth Merge to Create Largest Healthcare Member Engagement Platform
For more than a decade, Medicare Part D has provided seniors affordable and comprehensive prescription drug coverage. Its unique, market-based structure has kept overall Part D program costs far below initial projections, coming in at nearly $350 billion less than the Congressional Budget Office’s initial… Read More »Three reasons why repealing the Part D non-interference clause is a bad idea
Andy Aroditis, CEO, NextGate The COVID-19 pandemic is not just a medical crisis. Since the highly contagious disease hit American shores in early 2020, the virus has dramatically changed all sectors of society, negatively impacting everything from food supply chains and sporting events to the… Read More »Accounting for the Social Determinants of Health During the COVID-19 Pandemic
What You Should Know: – Independence Blue Cross and Signify Health launches social determinants of health network, CommunityLink to connect data from multiple CBOs to integrate social directly into medical care in the Philadelphia area. – CommunityLink represents one of the first examples nationwide of… Read More »Independence Blue Cross, Signify Launches Social Determinants of Health Network in Philly
When food production technology made it possible, wheat flour processors started to eliminate the tough exterior (bran) and nutrient-rich core (germ) of the kernel to get at the large, starchy part (the endosperm) only. The bread produced from this process is white and fluffy, and… Read More »Why Hasn’t A More Holistic Approach to Patient Care Become The Norm?
Finding previously unidentified insurance coverage can feel a little like a game of hide and seek. Patients may not always be aware of their insurance or eligibility for Medicare and Medicaid, and, in an effort to both improve the patient financial experience and simultaneously improve… Read More »Finding unidentified coverage without a Social Security Number (SSN)
Earlier this month, the Congressional Budget Office (CBO) gave an update to its federal budget projections between 2020 and 2030. As expected, things look grim for 2020. CBO projects a federal budget deficit of $3.3 trillion in 2020, more than triple the shortfall recorded in… Read More »CBO: COVID-19’s impact on the federal budget
Most People Are Unlikely to See Drug Cost Savings From President Trump’s “Most Favored Nation” Proposal
This policy watch examines the likely impact of an executive order signed by President Trump in July 2020 related to prescription drugs, which would use lower international drug prices to set prices for a limited set of drugs in the U.S.
The Trump administration’s latest effort to use COVID-19 rapid tests — touted by one senior official as a “turning point” in arresting the coronavirus’s spread within nursing homes — is running into roadblocks likely to limit how widely they’ll be used. Federal officials are distributing… Read More »Trump Is Sending Fast, Cheap COVID Tests to Nursing Homes — But There’s a Hitch
Can’t see the audio player? Click here to listen on SoundCloud. Democrats have shown a remarkably united front, including on health care, in their socially distant, made-for-TV convention this week. That’s likely due, at least in part, to the physical separation of party members who disagree… Read More »KHN’s ‘What The Health?’: Democrats in Array (For Now)
Earlier this month, my husband picked up the phone and learned his 92-year-old father had been taken to the hospital that morning, feeling sick and short of breath. We were nearly 2,000 miles away, on a vacation in the mountains of southern Colorado. No, it… Read More »We Put Off Planning, Until My Father-in-Law’s Medical Crisis Took Us by Surprise
An attack ad, which was released in mid-July, states that Montana Gov. Steve Bullock, a Democratic candidate for the Senate, supports a government-run health care program that would wreak havoc on the state’s health care infrastructure. “Bullock’s health care plan will force rural hospitals to… Read More »GOP Senate Ad Misrepresents Mont. Governor’s Stance on Rural Hospitals, Public Option
Can’t see the audio player? Click here to listen on SoundCloud. California Sen. Kamala Harris, the newly named running mate for presumptive Democratic presidential nominee Joe Biden, doesn’t have a lot of background in health policy. But that’s unlikely to prevent Republicans from using her on-again,… Read More »KHN’s ‘What the Health?’: Kamala Harris on Health
What You Should Know: – Revenue cycle management provider Waystar acquires eSolutions, a provider of Medicare and Multi-Payer revenue cycle management, workflow automation, and data analytics tools at a $1.3B valuation. – The acquisition will create the first unified healthcare payments platform with both commercial… Read More »Waystar Acquires Medicare RCM Company eSolutions at $1.3B Valuation
What You Should Know: – Cone Health has signed a letter of intent to merge with Norfolk, Virginia-based Sentara Healthcare for a combined $11B in assets. – The merger creates one large health system totaling of 17 hospitals – 11 Sentara hospitals in Virginia and one… Read More »Cone Health to Merge with Sentara Healthcare Totaling $11B in Assets
Today, in honor of National Immunization Awareness Month, we’ll take a look at how Medicare Part D supports access to critical vaccines and strengthens public health. Vaccines represent some of the most impactful advances in public health, helping to prevent the spread of many infectious… Read More »Supporting access to vaccines for Part D beneficiaries
OIG: Medicare Overpaid $267M for Hospital In-Patient Claims with Post-Acute Transfers to Home Health Services
Hospitals improperly coding for post-discharge services contribute to hundreds of millions of dollars in Medicare overpayments. And the majority of incorrect payments are often related to home health services. That’s according to a new audit report from the Department of Health and Human Services (HHS)… Read More »OIG: Medicare Overpaid $267M for Hospital In-Patient Claims with Post-Acute Transfers to Home Health Services
As the coronavirus pandemic paralyzed most nonemergency medical practices this spring, the dialysis business, vital to the survival of patients with kidney disease, rolled ahead and in some cases grew. Yet when the Trump administration sent billions in federal relief funds to medical organizations, at… Read More »Business Is Booming for Dialysis Giant Fresenius. It Took a $137M Bailout Anyway.
This brief provides an overview and status update of the Medicare accelerated and advance payment program, which provided $100 billion in loans to Medicare providers in the spring of 2020 to compensate for revenue shortfalls due to the coronavirus pandemic. The brief describes who got… Read More »Medicare Accelerated and Advance Payments for COVID-19 Revenue Loss: Time to Repay?
Irv Lichtenwald, President & CEO of Medsphere Systems Corporation In the late 1940s, the United Kingdom was busily reassembling country and what remained of the empire in the aftermath of World War II. Among many revelations, the war had convinced Britain’s leaders of the need… Read More »COVID-19 Underscores Why Certain Aspects of the American Healthcare System Should Change Forever
Oak Street Health, which operates primary care centers for Medicare patients, went public on Thursday for $328 million. Its capitation payment model has helped the company continue on where many clinics have struggled during the Covid-19 pandemic.
Can’t see the audio player? Click here to listen on SoundCloud. President Donald Trump keeps promising to unveil a comprehensive plan to replace the Affordable Care Act, but it keeps not appearing. However, this week he did order an expansion of telehealth for Medicare beneficiaries and… Read More »KHN’s ‘What the Health?’: Still Waiting for That Trump Health Plan
The Centers for Medicare & Medicaid Services (CMS) has proposed a new rule that would make certain COVID-19-related telehealth flexibilities introduced over the past few months permanent for Medicare beneficiaries. The move comes in conjunction with an executive order from President Trump to improve rural… Read More »CMS: True Telehealth Change Will Require Congressional Action
Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names. Standing Up for the Homeless Many aspects of your story on homeless camps being “swept,” moved or cleared during this… Read More »Readers and Tweeters Defend Human — And Animal — Rights
The executive order would call on the Department of Health and Human Services to develop a new pilot payment model for rural hospitals, and would set up a task force to improve broadband infrastructure in rural communities.
While home-based medical care has been shown to reduce hospitalization rates and lower costs for both homebound and non-homebound populations alike, it continues to be drastically underutilized in the current health care ecosystem. As a result, there are millions of older Americans — especially those… Read More »Home-Based Medical Care Can Reduce Hospitalizations and Lower Costs — But It’s Still Underutilized
Telehealth has quickly transformed the healthcare industry. Rather than scheduling an appointment, waiting up to a few weeks, and going to a doctor’s office or another healthcare facility, we can now access many types of care from the convenience of our smartphones. However, telehealth has… Read More »Telehealth and COVID-19: Overcoming New Challenges for Providers and Payers
Home health providers have experienced varying degrees of disruption to their business models over the past dozen or so years, from the Patient Driven Groupings Model (PDGM) to smaller regulatory changes. But at the end of the day, the cost of doing business has gone… Read More »Why the Proposed Medicare Rate Increase for 2021 Is ‘No Cause for Celebration’
Home health providers that are looking to tap into new revenue streams may turn to more Medicare Part B services moving forward. But these companies need to have a firm understanding of the reimbursement rules in order for their efforts to be fruitful. The Patient-Driven… Read More »What Home Health Providers Need to Know Before a Medicare Part B Expansion
Today, we are excited to bring you a special edition of our Medicare Catalyst series in honor of Medicare’s 55th anniversary. On this date in 1965, President Lyndon B. Johnson signed into law legislation that established the Medicare and Medicaid programs. To celebrate this milestone,… Read More »Medicare’s 55th anniversary: Celebrating the success of Part D
ST. LOUIS — Haley Organ thought she had everything figured out. After graduating from a small private college just outside Boston, she earned her master’s degree, entered the workforce and eventually landed a corporate job here as a data analyst. Life seemed to be going… Read More »Missourians to Vote on Medicaid Expansion as Crisis Leaves Millions Without Insurance
Health and well-being company Humana Inc. (NYSE: HUM) has spent the past few years adding to its health care services portfolio while aggressively investing around a home-based care strategy. The Louisville, Kentucky-based company has now revealed its latest step in that direction. On Wednesday, Humana… Read More »Humana Helps Fast-Track In-Home Primary Care Company Heal’s Growth with $100M Investment
What You Should Know: – W2O announced today the acquisition of Discern Health, a leading healthcare consultancy based in Washington, DC, and Baltimore, to strengthen its strategic capabilities in assisting clients with critical healthcare policy trends and value-based reimbursement models. – Discern Health brings experts with… Read More »W2O Acquires Discern Health to Strengthen Value-Based Care Capabilities
Jay Desai, CEO & Co-Founder, PatientPing As COVID-19 continues to impact the country, providers across the continuum face new challenges delivering care and ensuring safety for their patients and themselves. During this period, sharing real-time information about patients’ care encounters across provider types and care… Read More »How ADT-Based E-Notifications Can Enable Better Safety for COVID-19 Patients
The impact of the Patient-Driven Groupings Model (PDGM) doesn’t appear to be universal. In fact, each home health care agency’s performance under the model seems to depend on a few somewhat uncontrollable factors, new PDGM data suggests. “CMS created a model that was based on… Read More »Early Data Shows PDGM’s Regional Winners, Losers
Can’t see the audio player? Click here to listen on SoundCloud. President Donald Trump — who has spent the past six months trying to play down the coronavirus pandemic — seems to have pivoted. In back-to-back briefings on July 21 and 22, Trump cautioned that the… Read More »KHN’s ‘What The Health?’: Trump Twists on Virus Response
Everyone involved even tangentially in health care today is completely consumed by the coronavirus pandemic, as they should be. But the pandemic is accelerating a problem that used to be front and center in health circles: the impending insolvency of Medicare. With record numbers of… Read More »Another Problem on the Health Horizon: Medicare Is Running Out of Money
As hospitals continue to experience overcapacity challenges due to the COVID-19 emergency, 911 ambulance crews and community paramedics have found themselves treating more patients at home. Historically, ambulance crews and community paramedics — both of which operate in the emergency medical services (EMS) space —… Read More »Ambulance Crews and In-Home Care Providers Seek Collaboration — Not Competition
New Long-Term Care Benefits Added to Medicare Advantage Plans Medicare’s coverage of long-term care is limited, but new benefits added to some Medicare Advantage plans will help more seniors to continue to live at home The Doctor Weighs In
The Centers for Medicare & Medicaid Services (CMS) was a little bit off with some of its predictions related to the Patient-Driven Groupings Model (PDGM). At least, that’s true when it comes to the first four months of 2020, according to Strategic Healthcare Programs (SHP)… Read More »PDGM Data Shows Reality-Versus-Expectations Mismatch for Case-Mix Components
Ernie Ianace, EVP Sales and Marketing at VitalTech “The numbers don’t lie,” is a famous old adage and quite appropriate with regard to the rapid rise and deployment of telehealth solutions in the medical community. It may have taken a global pandemic for society to… Read More »Telehealth’s Time Has Come. And It’s Here to Stay.
The number of Medicare-certified home health agencies in the United States is dwindling — and it’s a trend that started long before the Patient-Driven Groupings Model (PDGM) kicked in. From 2018 to 2019, the number of home health agencies dropped by about 3.6%, a decrease… Read More »The Number of Medicare-Certified Home Health Agencies Is Dwindling
A bill introduced to the U.S. House of Representatives on Thursday would permanently lift site restrictions for Medicare patients to access telehealth. During the pandemic, several restrictions on where telehealth visits could be conducted and what services were eligible were temporarily lifted.
This brief discusses how drugs provided in inpatient hospital settings are covered and reimbursed for beneficiaries in traditional Medicare under current law. This is relevant for Medicare spending on COVID-19 patients who receive Gilead’s new antiviral drug remdesivir. We discuss the implications for hospitals and… Read More »How Could the Price of Remdesivir Impact Medicare Spending for COVID-19 Patients?
Oak Street Health — a network of value-based primary care offices for Medicare beneficiaries — has filed the initial paperwork to go public. The Chicago-based organization announced the news Friday. While Oak Street Health doesn’t provide home health care itself, its interdisciplinary care teams are… Read More »Aging-in-place Ally Oak Street Health Files to Go Public
What You Should Know: – 8 in 10 consumers said COVID-19 made telehealth “an indispensable part of the healthcare system, according to a new study commissioned by Change Healthcare. – 2020 Change Healthcare – Harris Poll Consumer Experience Index reveals 65% said they plan to… Read More »8 in 10 Consumers Stated COVID-19 Made Telehealth “Indispensable” in Healthcare Delivery
We Are in Store for the Greatest Change to Our Healthcare System Since the Affordable Care Act. Here’s Why.
By LOGAN CHO The COVID-19 pandemic has been harsher and lasted longer than many of us would have predicted. While our media has been inundated with updates on death tolls and economic depression, there has been little conversation of healthcare beyond the era of COVID-19.… Read More »We Are in Store for the Greatest Change to Our Healthcare System Since the Affordable Care Act. Here’s Why.
What You Should Know – Doctor On Demand raises $75M in Series D funding led by General Atlantic to expand comprehensive virtual care. – Doctor On Demand is seeing record usage this year – up 139% – for COVID-19 screenings, routine health issues, chronic conditions and behavioral health. San Francisco, CA-based Doctor… Read More »Doctor On Demand Raises $75M to Expand Comprehensive Virtual Care Platform
A proposed rule by the Centers for Medicare and Medicaid Services would expand payments for new dialysis machines when used at-home.
This issue brief analyzes hospital payments paid by private payers and by Medicare for a selection of inpatient services, including services requiring similar inpatient treatments to those used for COVID-19. It finds that private insurance payments for such services vary widely and exceed Medicare payment… Read More »Comparing Private Payer and Medicare Payment Rates for Select Inpatient Hospital Services
At the beginning of the year, the healthcare industry moved away from Medicare identifiers based on Social Security Numbers (SSNs), in favor of more secure Medicare Beneficiary Identifiers (MBIs). As with any large-scale change program, the shift was unlikely to be completely clear sailing. But… Read More »Medicare MBI: COVID-19 and Medicare Claims