Product featured in this article: Coverage Discovery As of the end of March 2021, more than 53 million Americans have been fully vaccinated, allowing for cautious optimism as we prepare for the next phase of the COVID-19 journey. Unfortunately for pharmacists, the vaccination program has… Read More »Navigating the complexities of health coverage and reimbursement beyond the pandemic
The first quarter of 2021 has been one of investor optimism as the vaccine rollout continues ahead of expectations and economic activity begins to accelerate in response. Within the Health IT industry, the already strong investment and M&A trends seen in 2020 have only accelerated. Over the… Read More »Q1 2021 Health IT/Digital Health PC/VE, M&A, IPOs/ SPACs Activity
There’s widespread agreement that it’s important to help older adults and people with disabilities remain independent as long as possible. But are we prepared to do what’s necessary, as a nation, to make this possible? This story also ran on NPR. It can be republished… Read More »Biden Seeks $400 Billion to Buttress Long-Term Care. A Look at What’s at Stake.
Jessica Scruton, BSN, RN, CCM, VP of Clinical Transformation for Lightbeam Health Solutions COVID-19 forced many health systems to reassess and reconfigure their care management processes and staffing models so that clinicians could better manage more of their acute, complex, and otherwise healthy patients remotely… Read More »Time and Goals Should Drive Your Post-COVID-19 Care Management Strategy
Sandeep Pulim, MD, Chief Medical Officer at Bluestream Health There’s no question that the demand for telehealth and virtual care has grown exponentially over the last twelve months. With that growth has come a fundamental shift in the attitude toward virtual care. No longer do… Read More »How a Virtual Care Mindset Leads to Greater Patient Acceptance and Sustainable Telehealth Growth
Here are a few highlight’s from the March 2021 report on Medicare Payment Policy from the Medicare Payment Advisory Commission (MedPAC). Leading causes of death The leading cause of death are heart disease, cancer, and respiratory disease. Note that these figures are from 2018. MedPAC… Read More »Highlights from MedPAC’s Spring 2021 Report
In 2020, Medicare premiums and cost sharing were estimated to consume 24 percent of the average Social Security benefit, up from 14 percent in 2000. The Medicare Trustees estimate that in another 20 years, these costs will consume 31 percent of the average Social Security… Read More »Medicare eats the world
By MIKE MAGEE In the fog of the Covid pandemic, many are wondering what ever happened to prior vocal support for universal coverage and Medicare-for-All. Expect those issues to regain prominence in the coming months. A bit of recent history helps explain why. The January… Read More »Time to Reboot “Medicare-For-All”
Can’t see the audio player? Click here to listen on SoundCloud. Congress is out of session, but that hasn’t stopped Democrats from planning their next round of health legislation. Together with President Joe Biden, they are looking at a broad array of possibilities, from allowing Medicare… Read More »KHN’s ‘What the Health?’: Planning for Round Two
Peter Nelson, VP & General Manager, Global Alliances at GHX There’s an old adage that every challenge is merely an opportunity in disguise. COVID-19 highlighted the healthcare industry’s ongoing challenge with producing clean, standardized data. As the industry looks to rebound from the severe financial… Read More »Boost Operational, Clinical and Financial Performance with Good Data
Medicare Advantage beneficiaries spend $1,640 less per year on healthcare than those enrolled in traditional fee-for-service Medicare plans, a new report shows. But, despite the difference in savings, satisfaction levels for both types of plans are similar.
It has been six months since the U.S. Centers for Medicare & Medicaid Services (CMS) gave home health agencies and other Medicare providers a reprieve from having to pay back advance and accelerated payment loans. But recoupment for these loans is just around the corner.… Read More »What Home Health Providers Need to Know About Medicare Loan Recoupment
Moving the Needle on Prescription Drug Costs: Using the Innovation Center and Other Demonstration Authority
This brief examines how the CMS Innovation Center (also known as CMMI) and Section 402 demonstration authority could become pathways for the Biden Administration to implement policy changes related to prescription drug costs.
Medicare sequestration is making headlines this week, as legislation to pause the 2% payment cuts moves through Congress. Here is a recap of what the sequester cuts are, why hospitals want it gone and how lawmakers are working to make that happen.
Mark Prather MD, MBA, CEO & Co-founder at DispatchHealth The COVID-19 pandemic has transformed how we interact with one another, with businesses, and with the world around us. From social distancing to hand sanitation to remote working, its impact on society is immense. And among… Read More »How the Pandemic is Accelerating the Shift to Alternative Care Delivery Models
When Democrats pushed through a two-year expansion of the Affordable Care Act in the covid-relief bill this month, many people celebrated the part that will make health insurance more affordable for more Americans. This story also ran on NPR. It can be republished for free.… Read More »Democrats Gave Americans a Big Boost Buying Health Insurance. It Didn’t Come Cheap.
Let’s say you need a surgery. Let’s say that it’s a serious surgery. There are a number of choices that you (or your doctor) may make. The surgery could be done in a hospital where you are admitted as an inpatient. On the other hand,… Read More »Will Medicare beneficiaries pay more for outpatient vs. inpatient surgeries?
Using the most current data available, this analysis describes current sources of coverage among Medicare beneficiaries in 2018, including sources of supplemental coverage among traditional Medicare beneficiaries.
Democrats, newly in control of Congress and the White House, are united behind an idea that Republican lawmakers and major drugmakers fiercely oppose: empowering the Department of Health and Human Services to negotiate the prices of brand-name drugs covered by Medicare. This story also ran… Read More »Democrats Eye Medicare Negotiations to Lower Drug Prices
A cost-saving change in Medicare launched in the final days of the Trump administration will cut payments to hospitals for some surgical procedures while potentially raising costs and confusion for patients. This story also ran on The Washington Post. It can be republished for free.… Read More »Under New Cost-Cutting Medicare Rule, Same Surgery, Same Place, Different Bill
An innovative care concept designed to keep patients at home and out of skilled nursing facilities (SNFs) is reportedly gaining ground in Congress and among special interest groups. The concept — known as “Choose Home” — is a type of SNF-at-home model that leverages both… Read More »SNF-at-Home Concept Earning ‘Very Positive Feedback’ in Congress, Among Special Interest Groups
What You Should Know: – Strive Health, a Denver-based provider of value-based kidney care today announced $140 million in Series B funding with Alphabet’s independent growth fund, CapitalG, as the lead investor. Strive has more than doubled its presence in regional markets and grown its employee base by more than 600% in… Read More »Strive Health Raises $140M for Value-Based Kidney Care Platform
What You Should Know: – Unite Us, the tech company creating coordinated care networks nationwide, has just announced a $150M Series C round of funding led by ICONIQ Capital, bringing its valuation at $1.65 billion. – Unite Us is leading the care transformation movement towards whole-person health… Read More »Unite Us Nabs $150M, Reaching $1.6B Valuation to Address Social Determinants of Health
Margins for Medicare-certified home health agencies are projected to remain strong in 2021, despite ongoing challenges tied to the COVID-19 pandemic and the shift to the Patient-Driven Groupings Model (PDGM). Margins are anticipated to be so robust, in fact, that Congress should reduce the 2021… Read More »Home Health Profit Margins Projected to Remain Strong in 2021
Rick Halton, Vice President of Marketing, Lumeon The COVID-19 pandemic made healthcare visits over video or phone the norm, likely turning telehealth into a permanent fixture within the U.S. healthcare system. In fact, the majority of patient access leaders at large hospitals believe 20-30 percent… Read More »Quality Virtual Care Matters for Patients – Even More Than Telehealth
CMS has increased the Medicare payment rate to $40 for administering single-dose Covid-19 vaccines and $80 for two-dose vaccines. The payment increase aims to support providers as they ramp up vaccine administration.
Despite the once-in-a-generation COVID-19 pandemic, the home health industry’s transition to the Patient-Driven Groupings Model (PDGM) was pretty seamless. Looking into the not-too-distant future, the U.S. Centers for Medicare & Medicaid Services (CMS) will now likely attempt to make modest tweaks to a handful of… Read More »CMS Could Target LUPAs, Functional Impairment in Future PDGM Adjustments
A number of different federal agencies buy prescription drugs. However, the price at which these pharmaceuticals are purchased varies dramatically. To quantify this variation, a 2021 report from the Congressional Budget Office examines the following prices: Medicare Part D: the prescription drug program for Medicare… Read More »How much does the U.S. federal government pay for pharmaceuticals?
ICYMI: Bipartisan lawmakers urge new administration to oppose changes to six protected classes policy
On January 19, 2021 – the last full day of the Trump administration – CMS released a Part D Payment Modernization Model Request for Applications (RFA) for calendar year 2022. This model would provide “formulary flexibility” by exempting participating Part D plans from some of… Read More »ICYMI: Bipartisan lawmakers urge new administration to oppose changes to six protected classes policy
Eric Demers, CEO of Madaket Health Provider data management is usually discussed from the provider perspective: the busy staff, the needless paperwork amid a pandemic, the faxing, emailing and uploading of data. In these scenarios, the health plans are often painted as the villains for… Read More »Payers Struggle with Provider Data Management Too
Among its many provisions, last year’s Coronavirus Aid, Relief and Economic Security (CARES) Act pressed pause on the government’s 2% payment cut to all Medicare-reimbursed health care providers. The “sequestration holiday” was immediately seen as a common-sense lifeline for cash-strapped home health providers on the… Read More »2% Cut to Home Health Agencies, Other Medicare Providers Nearing Unwanted Return
Analysis: Spending on Health Care Would Drop by an Estimated $352 Billion in 2021 if Private Insurance Used Medicare Rates to Reimburse Hospitals and Other Health Care Providers
Total health care spending for people with private health insurance would be an estimated $352 billion lower in 2021 if private insurers used Medicare rates to pay hospitals and other health care providers, rather than the substantially higher rates they currently pay, a new KFF… Read More »Analysis: Spending on Health Care Would Drop by an Estimated $352 Billion in 2021 if Private Insurance Used Medicare Rates to Reimburse Hospitals and Other Health Care Providers
Limiting Private Insurance Reimbursement to Medicare Rates Would Reduce Health Spending by About $350 Billion in 2021
This analysis estimates the total annual reduction in health care spending by employers and privately insured individuals that would result from having private insurers reimburse hospitals and other health care providers at Medicare rates. In total, we estimate spending for the privately insured population would… Read More »Limiting Private Insurance Reimbursement to Medicare Rates Would Reduce Health Spending by About $350 Billion in 2021
States Have Made Progress in Vaccinating Older Adults Against COVID-19 in Recent Weeks, But No State Has Vaccinated At Least Half of its Older Population
Twenty-two states and the District of Columbia have vaccinated at least one-third of their residents who are 65 and older against COVID-19, an updated KFF analysis finds, but no state has crossed the threshold of vaccinating 50 percent or more of its older population. The share… Read More »States Have Made Progress in Vaccinating Older Adults Against COVID-19 in Recent Weeks, But No State Has Vaccinated At Least Half of its Older Population
This analysis examines COVID-19 vaccination rates among older adults in states that report these data at the person-level. It also looks at the change in vaccination rates between February 4 and February 23 among a subset of these states.
Ford Blakely, SVP & GM, Medallia Zingle Although the vaccine’s rollout is slowly underway, Covid cases worldwide are continuing to reach all-time highs as new mutations make the virus even more contagious than ever before. Not surprisingly, patients’ concerns about visiting their healthcare providers in… Read More »3 Ways to Boost Patient Confidence with Real-Time Contactless Communication
It’s clear that rewarding providers for value, not volume, of services reduces unnecessary and costly care, but transitioning from the traditional fee-for-service model is challenging. Providers respond best to a transparent, data-driven approach in which “value” is clearly and objectively defined. But how can health… Read More »Webinar: Improving value-based care through data-driven insights—lessons from Florida Blue Medicare
This story also ran on CNN. It can be republished for free. Opening another front in the nation’s response to the pandemic, medical centers and other health organizations have begun sending doctors and nurses to apartment buildings and private homes to vaccinate homebound seniors. Boston… Read More »Countless Homebound Patients Still Wait for Covid Vaccine Despite Seniors’ Priority
Earlier this month, PhRMA submitted comments to CMS regarding the Part D Payment Modernization Model Request for Applications (RFA) for calendar year 2022. This RFA was released on January 19, 2021 – the last full day of the Trump Administration. Since the inception of the… Read More »Key excerpts: PhRMA submits comments to keep the six protected classes protected
Use Our Content It can be republished for free. The federal government has penalized 774 hospitals for having the highest rates of patient infections or other potentially avoidable medical complications. Those hospitals, which include some of the nation’s marquee medical centers, will lose 1% of… Read More »Medicare Cuts Payment to 774 Hospitals Over Patient Complications
Use Our Content It can be republished for free. Marilyn Bartlett might be the closest thing health policy has to a folk hero. A certified public accountant who barely tops 5 feet, Bartlett bears zero resemblance to Paul Bunyan. But she did take an ax… Read More »Montana’s Health Policy MVP Takes Her Playbook on the Road
It’s been 48 days since the start of “no-pay RAPs” in home health care. During this time, providers have had to navigate a sea of challenges and unexpected speed bumps while adjusting to the new process. The U.S. Centers for Medicare & Medicaid Services (CMS)… Read More »Home Health Experts Offer Update on Transition to No-Pay RAPs
What You Should Know: – Vytalize Health acquires patient financial experience platform MedPilot to accelerate data-driven engagement technology to its ACO’s Medicare population. – An alumnus of the Cedars-Sinai Accelerator, MedPilot’s platform has already helped over 1 million patients to date and boasts a 97%… Read More »Vytalize Health Acquires Patient Financial Experience Platform MedPilot
The COVID-19 pandemic has underscored the stark racial and ethnic health inequities in the U.S., including among Medicare beneficiaries. Among this group, people of color, including older adults and others on Medicare, account for disproportionate shares of COVID-19 cases, hospitalizations and deaths, according to data… Read More »The COVID-19 Pandemic Has Hit People of Color the Hardest, Including Among People With Medicare
Differences in median per capita income among White, Black, and Hispanic adults ages 65 and older are narrower when comparing people with similar levels of education, although among college graduates, the gap in income continues to be wide between Hispanic and White seniors. The gaps… Read More »Does Education Narrow the Gap in Wealth Among Older Adults, by Race and Ethnicity?
This chart collection draws on primary and secondary data analyses by KFF and other sources to examine the characteristics, experiences, and outcomes of the Medicare population by race and ethnicity
What You Should Know: – Shares of Signify Health, a value-based care billing platform for in-home and bundled health services jumped more than 33% in its initial public offering (IPO), valuing the company at over $7.12B. – Today, Signify Health’s CEO Kyle Armbrester will also… Read More »Signify Health Shares Soar More Than 33% in IPO, Valuing Company at Over $7.12B
A Status Report on Prescription Drug Policies and Proposals at the Start of the Biden Administration
This brief provides a status update on prescription drug final rules advanced by the Trump Administration in its final months related to Medicare, importation, and 340B pricing for insulin and epinephrine, and an overview of key drug pricing proposals related to Medicare and prescription drug… Read More »A Status Report on Prescription Drug Policies and Proposals at the Start of the Biden Administration
Two in-home care providers — ConcertoHealth and Perfect Health — announced Wednesday that their organizations have merged. Together, the companies will operate under the name “ConcertoCare.” Aliso Viejo, California-based ConcertoHealth is a value-based care provider organization that delivers a variety of home-based care services. The… Read More »In-Home Care Providers ConcertoHealth, Perfect Health Merge to Form ‘ConcertoCare’
The Office of the Inspector General will audit Medicare Part B telehealth services to detect potential vulnerabilities and ensure compliance with regulatory requirements. To prepare, providers must first take stock of their programs and conduct audits of their own, experts say.
What You Should Know: – Anthem, Inc. has entered into an agreement with InnovaCare Health, L.P., to acquire its Puerto Rico-based subsidiaries, including MMM Holdings, LLC (“MMM”) and its Medicare Advantage (MA) plan MMM Healthcare, LLC as well as affiliated companies and Medicaid plan. … Read More »Anthem Acquires Puerto Rico’s Largest Medicare Advantage Plan
As context for understanding the rationale for efforts to limit drug price increases, this analysis compares changes in list prices for drugs covered by Medicare Part D in 2019 to the inflation rate, based on data from the most recent Medicare Part D drug spending… Read More »Price Increases Continue to Outpace Inflation for Many Medicare Part D Drugs
In the final hours of the previous Administration’s time in office, the Center for Medicare & Medicaid Innovation (the Innovation Center) (CMMI) announced new changes for CY 2022 to an existing five-year Part D Payment Modernization Model. This model would provide “formulary flexibility” by exempting… Read More »Action needed to preserve the six protected classes
What You Should Know: – Humana Inc. and DispatchHealth, a provider of in-home medical care, today announced an agreement to provide Humana members with access to an advanced level of care in the home – to help enhance patients’ experience and health outcomes. The Dispatch-Humana… Read More »Humana Taps DispatchHealth to Power Hospital-Level Care in the Home
This story also ran on NPR. It can be republished for free. Late last month, before President Joe Biden took office and proposed his pandemic relief plan, Congress passed a nearly 5,600-page legislative package that provided some pandemic relief along with its more general allocations to fund the… Read More »4 Vital Health Issues — Not Tied to Covid — That Congress Addressed in Massive Spending Bill
In this Viewpoint for the Journal of the American Medical Association (JAMA), KFF’s Tricia Neuman and co-author Richard G. Frank of Harvard Medical School explain that the looming 2024 insolvency of the Medicare Hospital Insurance Trust Fund cannot be ignored for long.
Chris Riopelle, CEO of Strive Health After an unprecedented year, kidney care providers, including nephrologists, dialysis facilities, and care extenders are expecting 2021 to follow suit. We will see an overhaul in reimbursement and major industry shifts, partly led by CMS, that will require providers… Read More »Why CMS Will Lead the 2021 Kidney Care Revolution
What You Should Know: – Washington, D.C.-based Hurdle raises $5M in seed funding to accelerate its digital mental health platform for people of color. – Hurdle aims to provide an innovative teletherapy solution for employers and insurers; aims to remove barriers to mental health care… Read More »Hurdle Secures $5M for Digital Mental Health Platform for People of Color
Among payment-related policy changes for the home health industry in 2021 is the elimination of traditional Requests for Anticipated Payment (RAPs) — and the introduction of the “no-pay RAP.” While the change is a potentially costly one for home health agencies, they’re not the only… Read More »MACs Report Processing Glitches for No-Pay RAPs
As Joe Biden takes the reins at the White House, pharmaphorum asks experts how his presidential tenure may influence the global healthcare industry. “I think the Biden administration will have only an incremental impact on the healthcare industry as a whole,” said Maxim Jacobs, CFA,… Read More »Biden administration – What can the healthcare industry expect?
At the last minute, President Donald Trump granted pardons to several individuals convicted in huge Medicare swindles that prosecutors alleged often harmed or endangered elderly and infirm patients while fleecing taxpayers. “These aren’t just technical financial crimes. These were major, major crimes,” said Louis Saccoccio,… Read More »Trump’s Pardons Included Health Care Execs Behind Massive Frauds
Anita Baron first noticed something was wrong in August 2018, when she began to drool. Her dentist chalked it up to a problem with her jaw. Then her speech became slurred. She managed to keep her company, which offers financing to small businesses, going, but… Read More »After a Decade of Lobbying, ALS Patients Gain Faster Access to Disability Payments
What You Should Know: – Aledade raises $100 Million in Series D funding to help more primary care practices thrive in value-based care. – The new funding will power the growth of a nationwide network of more than one million patients by further expanding into… Read More »Aledade Secures $100M for Value-Based Primary Care, Reaching $2.1B Valuation
The telehealth company and managed care organization are launching a new HMO plan on the Texas health insurance exchange. The ‘virtual-first’ plan is designed for those who do not qualify for Medicaid or Medicare.
What You Should Know: – Today, CVS Health announced Symphony, a medical alert system designed to keep seniors safe and connected at home. – Symphony consists of a collection of in-home and wearable devices that offer a new at-home experience by connecting a suite of… Read More »CVS Health Launches Senior Medical Alert System, Symphony
Dr. Gary Call, Chief Medical Officer at HMS As healthcare spending continues to rise, so too does the inherent risk for bad actors to take advantage. Today, the United States is estimated to spend nearly 18 percent of its GDP, or $3.6 trillion, on healthcare,… Read More »Provider Strategies for Mitigating Telehealth Fraud & Abuse in 2021
The agency has finalized a rule that allows it to provide immediate Medicare coverage for FDA-approved products that are deemed “breakthrough devices.” The new coverage process would enable seniors to get access to these devices more quickly, but some provider and payer groups are concerned… Read More »New CMS rule to enable immediate coverage for FDA-designated ‘breakthrough’ devices
Medicare Advantage enrollment has grown rapidly over the past decade, and Medicare Advantage plans have taken on a larger role in the Medicare program. More than 24 million Medicare beneficiaries (36%) are enrolled in Medicare Advantage plans in 2020. This data analysis provides updated information… Read More »A Dozen Facts About Medicare Advantage in 2020
In a wide-ranging discussion at J.P. Morgan’s Annual Healthcare Conference, former CMS Administrator Andy Slavitt talked about the future of the ACA, telehealth and Medicare Advantage with a Democrat-led House, Senate and presidency.
What You Should Know: – Net Health acquires post-acute market analytics platform PointRight to deepen the company’s analytics capabilities, post-acute presence, and support for SNF networks. Net Health, a provider of cloud-based software for specialty medical providers across the continuum of care, today announced that… Read More »Net Health Acquires Post-Acute Analytics Platform PointRight – M&A
This story also ran on U.S. News & World Report. It can be republished for free. Keely Connolly thought she would be safe once the ambulance arrived at Hutchinson Regional Medical Center in Kansas. She was having difficulty breathing because she’d had to miss a… Read More »One Ambulance Ride Leads to Another When Packed Hospitals Cannot Handle Non-Covid Patients
Como jefa de enfermería en uno de los hospitales más concurridos de la red de seguridad de atención médica de Chicago, Raquel Prendkowski ha sido testigo del devastador número de víctimas que COVID-19 ha causado entre los residentes más vulnerables de la ciudad, incluyendo a… Read More »Illinois, primer estado en ofrecer cobertura médica a adultos mayores indocumentados
As a nurse manager for one of Chicago’s busiest safety-net hospitals, Raquel Prendkowski has witnessed covid-19’s devastating toll on many of the city’s most vulnerable residents — including people who lack health insurance because of their immigration status. Some come in so sick they go… Read More »Illinois Is First in the Nation to Extend Health Coverage to Undocumented Seniors
January 14 Web Event: A Shot in the Arm For Long-Term Care Facilities? Early Lessons from the COVID-19 Vaccine Rollout to High Priority Populations
With the pandemic taking a heavy toll among older Americans, the Centers for Disease Control and Prevention and most states have placed a high priority on vaccinating residents and staff of long-term care facilities. People in nursing homes and other long-term care settings account for… Read More »January 14 Web Event: A Shot in the Arm For Long-Term Care Facilities? Early Lessons from the COVID-19 Vaccine Rollout to High Priority Populations
Ted Howard started taking Truvada a few years ago because he wanted to protect himself against HIV, the virus that causes AIDS. But the daily pill was so pricey he was seriously thinking about giving it up. Under his insurance plan, the former flight attendant… Read More »Many Health Plans Now Must Cover Full Cost of Expensive HIV Prevention Drugs
Dr. Paul Hain, Chief Medical Officer of GoHealth Telehealth is Here to Stay in 2021 Prior to the pandemic, telehealth was a limited ad-hoc service with geographic and provider restrictions. However, with both the pandemic restrictions on face to face interactions and a relaxation of… Read More »12 Telehealth & Virtual Care Predictions and Trends for 2021 Roundup
This story also ran on Fortune. It can be republished for free. Sharon Clark is able to get her life-sustaining cancer drug, Pomalyst — priced at more than $18,000 for a 28-day supply — only because of the generosity of patient assistance foundations. Clark, 57,… Read More »Seniors Face Crushing Drug Costs as Congress Stalls on Capping Medicare Out-Of-Pockets
Under the Trump administration, federal health care policymakers have long been vocal about the ability of Medicare Advantage (MA) to lower costs and improve outcomes among vulnerable populations. A recent report from the Washington, D.C.-based Better Medicare Alliance (BMA) and consulting firm Avalere Health is… Read More »MA Beneficiaries See Nearly 20% Fewer Home Health Days Than Traditional Medicare Peers
Teladoc Health and Livongo Merge The combination of Teladoc Health and Livongo creates a global leader in consumer-centered virtual care. The combined company is positioned to execute quantified opportunities to drive revenue synergies of $100 million by the end of the second year following the… Read More »2020’s Top 20 Digital Health M&A Deals Totaled $50B
As we close out the year, we asked several healthcare executives to share their predictions and trends for 2021. Kimberly Powell, Vice President & General Manager, NVIDIA Healthcare Federated Learning: The clinical community will increase their use of federated learning approaches to build robust AI models across various… Read More »30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021
Can’t see the audio player? Click here to listen on SoundCloud. COVID-19 was the dominant — but not the only — health policy story of 2020. In this special year-in-review episode of KHN’s “What the Health?” podcast, panelists look back at some of the biggest non-coronavirus… Read More »KHN’s ‘What the Health?’: 2020 in Review — It Wasn’t All COVID
Catherine Thomas: Co-Founder and VP, Customer Engagement, careMESH Peter Tippett MD, PhD: Founder and CEO, careMESH A recent Advisory Board briefing examined the annual Centers for Medicare & Medicaid Services (CMS) Readmission penalties. Of the 3,080 hospitals CMS evaluated, 83% received a penalty for payments to… Read More »For Better Patient Care Coordination, We Need Seamless Digital Communications
Happy Holidays, Part D readers, and thank you for following along this year as we explored the impact of Medicare Part D and the important role the program plays for seniors and those with disabilities.
At the beginning of the month, the Centers for Medicare & Medicaid Services (CMS) released the final rule for the 2021 Medicare Physician Fee Schedule. Since then, the rule has drawn criticism for the payment cuts CMS made to home-based primary care visits, a move… Read More »American Academy of Home Care Medicine Urges CMS to Reconsider Rate Cut for Home-Based Primary Care
In this brief, we analyze third quarter data from 2018 to 2020 to examine how insurance markets performed financially through the end of September. Average margins remained relatively high compared to the same point in recent years, suggesting many insurers remained profitable even as non-COVID-related… Read More »Health Insurer Financial Performance Through September 2020
As the U.S. prepares for nationwide distribution of vaccines to combat COVID-19, some are asking whether people who get the first of two doses will return to complete the series in order to be fully immunized. This analysis draws on Medicare Part D prescription drug… Read More »Who Didn’t Get a Second Shingrix Shot? Implications for Multidose COVID-19 Vaccines
Anne Davis, Director of Quality Programs & Medicare Strategy at HMS A global health crisis has thrust us into a scenario in which lives quite literally depend on the ability to virtually connect. Telehealth has rapidly emerged as a vital tool, enabling continuity of care,… Read More »As Telehealth Surges, Are Seniors Being Left Behind?
Courtney Tesvich, VP of Regulatory at Nextech When 2020 began, no one anticipated that complying with the Merit-based Incentive Payment System (MIPS)—the flagship payment model of the Centers for Medicare & Medicaid Services (CMS) Quality Payment Program (QPP)—would look so different halfway through the year.… Read More »Despite COVID-19: Providers Should Not Lose Sight of MIPS Compliance
New analysis finds stark difference in coverage of breast cancer medicines for seniors in the United States and England
In the United States, seniors and people with disabilities enjoy broad coverage of physician-administered medicines under Medicare Part B because the program relies on market competition to balance access, innovation and cost control. But the same cannot be said for patients in other countries. In… Read More »New analysis finds stark difference in coverage of breast cancer medicines for seniors in the United States and England
What You Should Know: – Cityblock Health, a transformative, value-based healthcare provider focused on improving healthcare outcomes for marginalized communities, today announced a $160M Series C round, bringing its total raised to $300M. – Cityblock is a care delivery trailblazer working to right the injustices… Read More »Cityblock Health Reaches $1B Valuation, Raises $160M to Address Systemic Healthcare Inequity
What You Should Know: – Elation Health, which provides an easy-to-use and affordable clinical technology platform for more than 7 million independent primary care clinicians serving 14M+ patients – including an EHR raises $40M in Series C funding from Al Gore’s sustainable investment firm, Generation… Read More »Elation Health Nabs $40M for Clinical-First Solution to Power Independent Primary Care
The new Geographic Direct Contracting Model aims to improve quality of care and slash costs for Medicare beneficiaries across an entire region. It involves setting up risk-sharing arrangements where participants will be responsible for the total cost of care for beneficiaries in the region.
What You Should Know: – San Francisco-based digital health startup Pair Team emerges out of stealth with $2.7M in seed funding backed by Kleiner Perkins, Craft Ventures, & YC. – Pair Team provides both a remote team and AI that automates workflows, provides infrastructure &… Read More »Pair Team Emerges Out of Stealth with $2.7M to Automate Primary Care Operations
Don Godbee Don Godbee, Mobile Solutions Architect at Stratix Don Godbee Telehealth and virtual care are not brand-new phenomena suddenly cobbled together as a rapid response to the onset of the COVID-19 pandemic, but the average US patient could be forgiven for thinking that it… Read More »Ensuring Telehealth Providers’ Virtual Care Dollars Make Sense
Medicare provides significant health and financial protections to more than 60 million Americans, but there are gaps in coverage and high cost-sharing requirements that can make health care difficult to afford. This report analyzes several policy options that could help make health care more affordable… Read More »Options to Make Medicare More Affordable For Beneficiaries Amid the COVID-19 Pandemic and Beyond
This brief outlines the potential health policy actions that President Biden could take using executive authority, based on campaign pledges, and actions that would reverse or modify regulations or guidance issued by the Trump Administration.
U.S. Representatives Brad Schneider (D-Ill.) and David McKinley (R-W.Va.) introduced the Medicare Sequester COVID Moratorium Act last week. If passed, the bill would extend the temporary suspension of Medicare sequestration payment reductions, giving home health agencies and other providers more financial flexibility headed into an… Read More »House Bill Looks to Keep Medicare Sequestration ‘Holiday’ in Place for Home Health Agencies, Others
Shanti Wilson, Consultant, Freed Associates As if 2020 couldn’t be any more challenging for healthcare providers, new federal rules on interoperability and patient access, granting patients direct access to their healthcare data, begin taking effect this November and continue into 2022. These rules, while ultimately beneficial… Read More »5 Steps for Interoperability Excellence for Healthcare Providers
The home health industry is in a “dynamic state” and evolving into “multiple types of care,” according to the Medicare Payment Advisory Commission (MedPAC). As a result, health care policymakers should start thinking about how to redesign the traditional home health benefit to make it… Read More »MedPAC: ‘Dynamic’ Home Health Industry Is Evolving into ‘Multiple Types of Care’
These FAQs provide the latest guidance on testing and treatment related to COVID-19 for Medicare beneficiaries.
CommonHealth App Connects to 230 Health Systems to Share Health Data – including COVID Test and Vaccine Status
What You Should Know: – CommonHealth has connected to 230 health systems in the United States, allowing patients to gather, manage and share their health and test data, including COVID test and vaccination status. By the end of this month, CommonHealth will connect to more… Read More »CommonHealth App Connects to 230 Health Systems to Share Health Data – including COVID Test and Vaccine Status
Claudia Williams, CEO of Manifest MedEx When doctors know their patients have been to the hospital, they can act fast to provide needed support. Widespread use of hospital event notifications is associated with all kinds of health benefits, including a 10 percent decrease in readmissions… Read More »5 Myth-Busting New Hospital ADT Notification Requirements
As mission-driven organizations, SCAN Group and SCAN Health Plan have leaned into trying to solve some of health care’s biggest problems. In particular, keeping seniors independent and healthy at home has been a major area of focus. SCAN Group is a nonprofit organization focused on… Read More »SCAN Group Takes on Telehealth’s ‘Digital Divide,’ Moves Further into the Home
As Washington policymakers look to make changes to Medicare and our health care system overall, there are right ways and wrong ways to address the challenges that seniors and patients face. Indeed, as part of the 2020 election, voters made it clear what they want… Read More »Final rebate rule represents right way to change Medicare
Last month, the administration released the “Most Favored Nation” (MFN) rule, which allows foreign governments to decide the value of Part B medicines, while also likely limiting seniors’ access to existing medicines and discouraging investments in future treatments and cures. No matter how you look… Read More »No matter how you look at it, the Most Favored Nation rule is bad policy
Science and objective analysis need to be revived.
The US government has introduced a scheme to allow hospitals to reduce the number of inpatients they see through a telehealth platform that would helps deliver acute care at home. The move comes as the number of new cases of COVID-19 have been climbing to… Read More »As COVID-19 cases swell, US extends telehealth to acute care
Elizabeth Bierbower, Former President of Humana’s Group & Specialty Division Healthcare can achieve optimum efficiency when patients are at the center of care. When patients have the necessary information to navigate their care journey, they will choose the path to high-quality care at the lowest… Read More »COVID-19: How Can Payers Prepare for Mandates and Support Pandemic Relief Efforts
Jenifer Leaf Jaeger, MD, MPH, Senior Medical Director, HealthEC Senior isolation is a health risk that affects at least a quarter of seniors over 65. It has become recognized over the past decade as a risk factor for poor aging outcomes including cognitive decline, depression,… Read More »How Care Coordination Technology Addresses Social Isolation in Seniors
If you’ve been watching TV lately, you may have seen actor Danny Glover or Joe Namath, the 77-year-old NFL legend, urging you to call an 800 number to get fabulous extra benefits from Medicare. There are plenty of other Medicare ads, too, many set against… Read More »Medicare Open Enrollment Is Complicated. Here’s How to Get Good Advice.
Vasilios Nassiopoulos, VP of Platform Strategy and Innovation, Hayes Razor-thin operational margins coupled with substantial and ongoing losses related to COVID-19 are culminating in a perfect storm of bottom-line issues for U.S. hospitals and health systems. A study commissioned by the American Hospital Association (AHA) found that… Read More »Hospital Sustainability Demands that Revenue Integrity Move Front and Center
What You Should Know: – Central Logic has acquired Omaha-based Ensocare, which automates the referral process for patients from hospital to post-acute care (PAC) when they are being discharged. – This acquisition means that Central Logic’s technology solution will now expand its reach across the… Read More »M&A: Central Logic Acquires Patient Care Transition Platform Ensocare
NEW YORK — Mike Angevine lives in constant pain. For a decade the 37-year-old has relied on opioids to manage his chronic pancreatitis, a disease with no known cure. But in January, Angevine’s pharmacy on Long Island ran out of oxymorphone and he couldn’t find… Read More »Patients Struggle to Find Prescription Opioids After NY Tax Drives Out Suppliers
Prasad Dindigal, Vice President, Healthcare & Life Sciences, EXL. Over the past few months, primarily as a result of the COVID-19 pandemic, telehealth has gone from a “nice-to-have” to a “must-have” for healthcare providers. The surge of COVID-19 patients in the spring, coupled with “stay-at-home”… Read More »8 Ways Advanced Analytics Can Help You Decide If Telehealth Should Be Temporary or Permanent
What You Should Know: – The American Medical Association (AMA) published an update to the Current Procedural Terminology (CPT®) code set that includes new vaccine-specific codes to report immunizations for the novel coronavirus (SARS-CoV-2). – The new Category I CPT codes and long descriptors for… Read More »AMA Unveils 2 Vaccine-Specific CPT Codes for Coronavirus Immunizations
Of his many plans to expand insurance coverage, President-elect Joe Biden’s simplest strategy is lowering the eligibility age for Medicare from 65 to 60. But the plan is sure to face long odds, even if the Democrats can snag control of the Senate in January… Read More »Biden Plan to Lower Medicare Eligibility Age to 60 Faces Hostility From Hospitals
Sacramento.- Cuando la Corte Suprema de los Estados Unidos esté escuchando el martes 10 un caso que podría decidir el destino de la Ley de Cuidado de Salud a Bajo Precio (ACA), California liderará la defensa de la ley federal que impacta en casi todos… Read More »Fiscal general de California: los jueces deben ver que ACA es “indispensable”
‘Our Work Begins with Getting COVID Under Control’: What a Biden Administration Means for Home-Based Care
After one of the closest and most hotly contested campaigns in modern history, President-Elect Joe Biden addressed the nation on Saturday from an outdoor platform in Wilmington, Delaware. While it’s far too early to say what the first 100 days of a Biden administration will… Read More »‘Our Work Begins with Getting COVID Under Control’: What a Biden Administration Means for Home-Based Care
SACRAMENTO — When the U.S. Supreme Court hears a case Tuesday that could decide the fate of the Affordable Care Act, California will be leading the defense to uphold the federal law that touches nearly every aspect of the country’s health care system. It’s usually… Read More »Justices Bound to See ACA as ‘Indispensable,’ Says Californian Leading Defense
Former Vice President Joe Biden secured the 270 electoral votes needed to capture the White House on Saturday, major news organizations projected, after election officials in a handful of swing states spent days in round-the-clock counting of millions of mail-in ballots and early votes. The… Read More »Biden Wins, but His Health Agenda Dims With GOP Likely to Hold Senate
California’s annual health insurance enrollment season for individuals and families kicks off this week against a dramatic backdrop: the hotly contested presidential election; a pandemic raging out of control in much of the U.S.; and, on Nov. 10, a Supreme Court hearing of a case… Read More »It’s Open Enrollment. Here’s What You Need to Know
Poor, elderly individuals who may qualify for both Medicaid (for being poor) and Medicare (for being elderly, blind, disabled or have ESRD). In these cases, Medicaid serves as a supplemental insurer, covering Medicare coinsurance and deductibles. The generosity of this supplemental coverage for so-called ‘dual-eligibles’… Read More »Dual Eligibles’ Medicaid Policy Database
Nearly half the nation’s hospitals, many of which are still wrestling with the financial fallout of the unexpected coronavirus, will get lower payments for all Medicare patients because of their history of readmitting patients, federal records show. The penalties are the ninth annual round of… Read More »Medicare Fines Half of Hospitals for Readmitting Too Many Patients
The U.S. Centers for Medicare & Medicaid Services (CMS) released its final home health payment rule for CY 2021 on Thursday, with essentially no changes to the Patient-Driven Groupings Model (PDGM) or its controversial behavioral adjustment. In addition to doubling down on PDGM, boosting the… Read More »Late RAPs Could Trigger Immediate 20% Payment Reduction in 2021
The ongoing expansion of Medicare Advantage (MA), a federal minimum-wage hike and additional support for front-line health care workers during the COVID-19 public health emergency. These are just a few of the industry-shaping topics that home health insiders are following going into Election Day this… Read More »Perspectives: Home Health Insiders Sound Off on the 2020 Election
Democrats are favored to win both chambers of Congress after years of campaign-trail promises about health care. But with a pandemic, a more conservative Supreme Court and lingering disagreements between progressives and moderates, it could be difficult for Democrats to turn those promises into law.… Read More »If They Sweep on Election Day, Dems Still Face a Challenge Meeting Health Promises
If they’ve been listening to President Donald Trump, seniors may be expecting a $200 debit card in the mail any day now to help them pay for prescription drugs. He promised as much this month, saying his administration soon will mail the drug cards to… Read More »A $200 Debit Card Won’t Do Much for Seniors’ Drug Costs
The Oncology Care Model is slated to end soon. Specifically, the last set of six-month episodes would initiate no later than December 31, 2020 and thus all episodes will be completed in June 30, 2021. Nevertheless, CMS is proposing a successor to the Oncology Care… Read More »The Oncology Care Model is dead. Long Live the Oncology Care First Model.
For 2021, the average Medicare beneficiary has access to 33 Medicare Advantage plans, the largest number of options available in the last decade, and can choose from plans offered by eight firms. Among the majority of Medicare Advantage plans that cover prescription drugs, 54 percent… Read More »Medicare Advantage 2021 Spotlight: First Look
This issue brief provides an overview of the Medicare Part D prescription drug benefit plan landscape for 2021, with a focus on stand-alone drug plans. It includes national and state-level data on plan availability, premiums, benefit design, cost sharing, information about premium-free plans for low-income… Read More »Medicare Part D: A First Look at Medicare Prescription Drug Plans in 2021
CMS’ interim rule states that Medicare will cover Covid-19 vaccines approved by the FDA, including those receiving emergency use authorization, in a reversal from its usual policy. The vaccine will be made available at no cost to Medicare beneficiaries.
Vanessa Kuhn, Director of Health Policy, PatientPing The Centers for Medicare and Medicaid Innovation (CMMI) created the Direct Contracting Model to expand opportunities for more diverse providers and healthcare organizations to participate in value-based care arrangements for Medicare fee-for-service (FFS) beneficiaries. The goal of the… Read More »CMS Direct Contracting Model Options for Value-Based Care
This analysis shows that more than half of Medicare beneficiaries do not compare coverage options annually during the open enrollment period, despite the fact that Medicare Advantage and Part D plans often change from one year to the next, which could lead to unexpected and… Read More »More Than Half of All People on Medicare Do Not Compare Their Coverage Options Annually
It’s a tried-and-true campaign strategy. Candidates go on the attack, claiming their opponent will do harm to Medicare. After all, people 65 and older are good about making it to the polls on Election Day. These voters are also generally motivated to protect the federal… Read More »Arguing to Undo the ACA. Harming Medicare. Do They Go Hand in Hand?
What You Should Know: – Doctor On Demand and CareLinx, one of the largest professional networks for in-home care, have announced a collaboration to bring in-home virtual care services to CareLinx clients. – At a time when seniors have been encouraged to stay home to… Read More »CareLinx, Doctor on Demand Partner to Bring In-Home Virtual Care to Seniors
The partnership will combine in-home caretakers with Doctor on Demand’s telehealth services. Some of CareLinx users will be able to access virtual visits for free.
This analysis examines the extent to which non-pediatric physicians have opted out of the Medicare program. The analysis finds that few physicians have opted out of Medicare, with the share of opt-out physicians varying by specialty.
If Joe Biden wins the presidency in November, health is likely to play a high-profile role in his agenda. Just probably not in the way he or anyone else might have predicted. Barring something truly unforeseen, it’s fairly certain that on Jan. 20 the U.S.… Read More »Biden’s Big Health Agenda Won’t Be Easy to Achieve
As the 2020 Election Day approaches, many candidates continue to focus on health care issues, including on the public health and economic response to COVID-19, the future of the Affordable Care Act, health care costs and abortion. To help reporters understand and cover these issues,… Read More »Health Policy Resources for Covering the 2020 Elections
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