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Medicare Reimbursement Policy Changes Under the 21st Century Cures Act

July 5, 2017


The 21st Century Cures Act (CCA) has been proclaimed by some policymakers to be “the most important legislation” Congress passed in 2016.  Among many important provisions relating to precision medicine, drug innovation, telemedicine and mental health reform, the CCA also includes several potentially high-impact Medicare reimbursement policy changes set to take effect starting this year and into 2019.  Those policy changes include site-neutral payment exceptions, adjustments to the penalty calculation formula under the Hospital Readmissions Reduction Program, new codes to bridge outpatient and inpatient surgical procedures, and suspension of the 25 Percent Rule for long-term care hospitals.


CMS Actuary and Congressional Budget Office Differ on Predictions for Costs and Uninsured for the AHCA

June 28, 2017


The Centers for Medicare and Medicaid Services (CMS) Office of the Actuary has estimated that the House-passed American Health Care Act (AHCA) would reduce insurance coverage by 13 million people by 2026—10 million less than the Congressional Budget Office's (CBO's) prediction.


How Physician Compare’s New Five-Star Ratings Will Impact Clinicians and Healthcare Organizations

June 21, 2017


In late 2017, the Centers for Medicare and Medicaid Services (CMS) will implement a new benchmark and five-star quality rating system for clinicians and group practices on Physician Compare, the website mandated by the Affordable Care Act (ACA) to help patients, families and caregivers make more informed choices regarding healthcare services.  The changes will ramp up the level of information readily available to patients and others about individual clinician and group practice performance on clinical quality measures, and push healthcare providers into a new phase of accelerated transparency.  Healthcare consumer sites such as Healthgrades and Vitals are likely to incorporate the information into their own portals.


CHRONIC Care Act Proposes Big Boost in Home, Telehealth Services

June 14, 2017


On May 18th, the Senate Finance Committee unanimously approved a bill designed to improve care for Medicare beneficiaries with chronic conditions.  The Creating High-Quality Results and Outcomes Necessary to Improve CHRONIC Care Act (CCA) of 2017 would increase access to telehealth services for Medicare beneficiaries with chronic illnesses—including those in Medicare Advantage (MA) plans—as well as provide more incentives for enrollees to receive care through accountable care organizations (ACOs).


MiraMed Global Services Approved as a QCDR for 2017

June 1, 2017


MiraMed is pleased to announce that for the second year in a row it has been approved as a Qualified Clinical Data Registry (QCDR) for the 2017 reporting year via its company-developed MiraMed QCDR.


Cybersecurity News and Best Practices for Healthcare Providers

May 31, 2017


Do the names WannaCrypt or WannaCry mean anything to you? They well might, by now. In a global cyberattack that began on May 12, 2017, this aggressive form of ransomware infected more than 300,000 Windows PCs in 150 countries across Europe, Latin America and Asia.


Studies Shed Light on Provider Readiness for Value-Based Care

May 24, 2017


The shift from traditional fee-for-service (FFS) models to value-based payments is of growing concern to all healthcare providers.  Various types of value-based models are described in the news on a regular basis, with no shortage of opinions as to how quickly this transition will occur and frequent calls to action by those who would like to help you prepare.  For organizations who want to be at the forefront of this transition, it can be difficult to determine the appropriate level of urgency.


Survey Debunks Perception That Medicaid Offers Lesser Levels of Care

May 17, 2017


Healthcare in America is expensive. The share of the U.S. economy devoted to healthcare spending is currently 17.5 percent, and the Centers for Medicare & Medicaid Services (CMS) projects it will reach 19.6 percent by 2024.  Estimates put total U.S. spending on healthcare at more than $5.4 trillion by that point, with both the private and public sectors each contributing approximately 50 percent of costs.  While spending for both sectors may be equal, according to The Commonwealth Fund, Medicaid patients may be receiving better care on some measures than private sector patients.


Attitudes About Aging and End-of-Life Care: Kaiser Survey

May 10, 2017


U.S. Census Bureau projections indicate that Americans 65 and older will make up 24 percent of the U.S. population by 2060.  A majority of adults in the U.S. say that the government is “not too prepared” or “not at all prepared” to deal with the aging population, according to a recent survey conducted by the Kaiser Family Foundation in partnership with The Economist.  This study covered views and experiences related to aging and end-of-life medical care in the U.S., Italy, Japan and Brazil, among a nationally representative sample of adults ages 18 and older.


A Snapshot of Risk Management in 2017: 20 Top Concerns for Hospitals

May 3, 2017


Healthcare’s frenetic pace of change—catalyzed by the Affordable Care Act, and more recently, by efforts to repeal and replace that landmark legislation—have expanded the scope and complexity of regulatory compliance and the importance of comprehensive risk management efforts on the part of hospitals and healthcare systems.  However, the barrage of competing demands in the current environment makes it a challenge for healthcare organizations to know where to focus their time and resources.


The Administrative Burden of EHRs Opens Doors to Medical Scribes

April 26, 2017


A physician's responsibility is to provide the best possible care for sick patients.  A key for delivering quality healthcare is open communication between the physician and patient to discuss issues and develop a care plan.  Today, providing quality care is becoming more difficult due to increasing patient loads and administrative challenges.  This dilemma has become a catalyst for the growth of medical scribes (often referred to as scribes).


CMS Aims to Simplify with Proposed Inpatient Payment Rule

April 19, 2017


On April 14, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would update 2018 Medicare inpatient payment and polices.  The proposed rule aims to relieve regulatory burdens for providers; supports the patient-doctor relationship in healthcare; and promotes transparency, flexibility and innovation in the delivery of care.  The proposed rule would apply to about 3,330 acute care hospitals and 420 long-term care hospitals, and would affect discharges occurring on or after October 1, 2017.  The rule will be published in the Federal Register April 28, and comments will be accepted through June 13.


Patient Satisfaction is The Next Competitive Battleground

April 12, 2017


Patient satisfaction and the patient experience have always been important to providers.  In today’s era of value-based care reimbursement models, it has become one of the top three priorities facing healthcare executives, according to a 2013 study conducted by HealthLeaders Media.


The MACRA MIPS Composite Score: A Guide for Providers

April 5, 2017


The Medicare Access & Chip Reauthorization Act of 2015 (MACRA) marked the end of Medicare payment’s fee-for-service model and the beginning of a performance-based payment system, the Quality Payment Program (QPP).  Understanding how participation in the QPP will impact payments begins with understanding the scoring system.


CMS Delays Bundled Payment Programs

March 29, 2017


As noted in our eAlert issued March 16, 2016, bundled payments have long been a part of the healthcare reform debate as a strategy for reducing healthcare costs, but while there has been significant discussion and research relating to alternative payment methods, most healthcare spending is still based on a fee-for-service framework.  Despite recent efforts to measure and provide financial incentives for quality, this system rewards volume, rather than value, for the most part, creating a system where patients and families struggle to navigate across fragmented care silos, and providers must work to maximize utilization to survive.


An Overview of the American Health Care Act

March 22, 2017


The House proposal to “repeal and replace” the Affordable Care Act (ACA), the landmark and controversial legislation that is a signature of President Barack Obama’s administration, indicates that the nation’s healthcare system could be heading for yet another upheaval.  March 21, 2017 marked the seventh anniversary of the ACA.  Although there is still a high degree of uncertainty regarding what the final repeal-and-replace legislation will look like, or when it will appear, any changes to the ACA will have important implications for hospitals, health systems, healthcare professionals and patients.


Growing Medical Debt Requires New Collection Approaches

March 15, 2017


The Affordable Care Act (ACA) and new payment models such as high deductible health plans are contributing to a growth in patient liability.  This emerging trend has put pressure on providers to collect more from patients while better managing their financial relationship.


11 Building Blocks of a Solid Safety Culture

March 8, 2017


The fact that 125,000 fewer patients died due to hospital-acquired conditions in 2010-2015, resulting in a cost savings of more than $28 billion, shows healthcare’s capacity to make strides in improving safety.  But despite encouraging results like these, hospitals and health systems still face a daunting array of hurdles, ranging from the growth of antibiotic resistance to new diseases and outbreaks to sepsis prevention.


ACOs: Who Will Lead the Way?

March 1, 2017


We are in the midst of a period that economists call “creative destruction” of our fragmented fee-for-service healthcare delivery system.  The hope is that it will evolve into a higher-quality, more productive system with strong incentives for efficient, coordinated care.  In any case, the transformation will have profound implications regarding hospitals’ ability to maintain their dominant role in the healthcare system.


Understanding OIG Compliance

February 22, 2017


On October 15, 1976, President Ford signed into law legislation creating an Office of Inspector General (OIG) at the Department of Health, Education and Welfare (HEW).  HEW OIG would become HHS-OIG in 1980 when the Department was redesignated as the Department of Health and Human Services (HHS).


Coalition Targets Root Causes of Health Disparities

February 15, 2017


The notion that healthcare needs are human needs is gaining ground within the healthcare sector.  So is the view of hospitals as important economic anchors that must address these human factors as well as the medical needs of the communities they serve, because the two sets of needs are inextricably linked.


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