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All posts tagged with “Palliative Care Provider News | Operations News | Financial.”
Generative AI is supposed to save doctors from burnout. New data show it needs more training
04/29/24 at 03:00 AMGenerative AI is supposed to save doctors from burnout. New data show it needs more trainingSTAT+; by Casey Ross; 4/25/24After stratospheric levels of hype, early evidence may be bringing generative artificial intelligence down to Earth. A series of recent research papers by academic hospitals has revealed significant limitations of large language models (LLMs) in medical settings, undercutting common industry talking points that they will save time and money, and soon liberate clinicians from the drudgery of documentation.
Relief provisions not enough to mitigate damage of 80/20 policy, providers say
04/29/24 at 03:00 AMRelief provisions not enough to mitigate damage of 80/20 policy, providers say McKnights Home Care; by Adam Healy; 4/24/24 Though newly finalized changes to the Medicaid Access Rule attempted to soften the blow of its controversial 80/20 provision, home care providers remained vehemently opposed to the Centers for Medicare & Medicaid Services’ strict new spending mandate. “Overall, while there are many positive provisions within the final rule as well as mitigations to make the payment adequacy provision less onerous, NAHC remains extremely concerned about the negative consequences of the pass-through policy,” the National Association for Home Care & Hospice said in an analysis for NAHC members released after the rule was published.
Payment cuts are having a compounding, dire effect on the home health industry
04/29/24 at 03:00 AMPayment cuts are having a compounding, dire effect on the home health industry Home Health Care News; by Andrew Donlan; 4/25/24 Home health providers’ fight against cuts to fee-for-service Medicare payment has become a year-by-year battle. But the yearly cuts are compounding, which is exactly what industry advocates are trying to illustrate to Congress prior to the next payment rule proposal. ... Many of the cuts CMS has implemented are permanent, and multiple cuts on top of each other moving forward – plus unsatisfactory adjustments for inflation – are putting significant pressure on providers.
Getting your claims denied? Here are reasons why and what you can do about it
04/29/24 at 03:00 AMGetting your claims denied? Here are reasons why and what you can do about itMedial Economics; by Gretchen Heinen, RN, PHN, BSN and Wael Khouli, MD, MBA; 4/25/24A recent voluntary, national survey by Premier shed new light on denied claims. The survey, conducted from October to December 2023, revealed that nearly 15% of all claims across Medicare Advantage, Medicaid, Commercial, and Managed Medicaid are denied. Of those denied claims, 45% to 60% were overturned, albeit with a costly appeal process sometimes involving multiple appeals. ... With a skillfully crafted appeal letter, a denial can be overturned 50% to 70% of the time. In this article, we will cover denial basics, reasons for claim denials, and actions to take. It is crucial to address all potential reasons for claim denial, including: ...
Palliative care’s value-based future
04/29/24 at 02:00 AMPalliative care’s value-based future Hospice News; by Jim Parker; 4/24/24 Many believe that the fee-for-service model does not sufficiently support a robust palliative care program, meaning that providers must turn to value-based systems for sustainable reimbursement. But primarily, Medicare still reimburses for palliative care through fee-for-service payment programs that cover physician and licensed independent practitioner services. That model does not sufficiently cover the full range of interdisciplinary care, Dr. Julia Friedman, palliative care medical director at Thyme Care, said at the Home Health Care News Cap+Strat Conference.
Commercial Capital Connect unveils $25M financing for home health care & hospice agencies nationwide – revolving credit lines & term loans up to $750K
04/26/24 at 03:00 AMCommercial Capital Connect unveils $25M financing for home health care & hospice agencies nationwide – revolving credit lines & term loans up to $750K Consumer Infoline; 4/25/24Commercial Capital Connect, a leading marketplace for commercial finance solutions, today announced the launch of a $25 million financing program to provide revolving lines of credit and term loans to home health care and hospice agencies across the United States. ... “The home health care and hospice sectors play a vital role in our communities, providing essential services that enable people to receive quality care in the comfort of their homes,” said Cheryl Tibbs, President of Commercial Capital Connect.
Medicare Advantage complaints that the plans don’t want – and the review of systems that wasn’t done
04/25/24 at 03:00 AMMedicare Advantage complaints that the plans don’t want – and the review of systems that wasn’t done RACmonitor, by Ronald Hirsch, MD, FACP, ACPA-C, CHCQM, CHRI; 4/24/24 ... In the past, I have talked about complaining to your regional Centers for Medicare & Medicaid Services (CMS) office about violations of CMS-4201-F, but Dr. [Eddie] Hu described how to do it to actually get action. [Click on the title's link for details] ... Now, why should you take the time to file these complaints? ... Why should you take the time to file these complaints? Because CMS tracks formal complaints, and a lot of complaints can significantly affect their quality bonus – and we know how when their money is at risk, the MA plans suddenly pay attention. ...
Medicare Advantage fight shifts to 340B arena
04/24/24 at 03:00 AMMedicare Advantage fight shifts to 340B arena Modern Healthcare, by Alex Kacik; 4/22/24Hospitals' fight to boost Medicare Advantage reimbursement has extended to plans' pay for 340B drugs. The hospitals’ plea to adjust Medicare Advantage pay stems from regulation aimed at making providers that participate in the drug discount program whole after the Supreme Court reversed 340B rate cuts that were in place from 2018 to 2022.
20M fewer Medicaid enrollees means trouble for providers
04/24/24 at 02:00 AM20M fewer Medicaid enrollees means trouble for providersModern Healthcare, by Nona Tepper; 4/23/24Over the past year, states have removed more than 20 million beneficiaries from Medicaid after suspending eligibility redeterminations during the COVID-19 public health emergency. Thousands of those people are Clinica Family Health patients. The Lafayette, Colorado-based community health center felt the pain of lost reimbursements when patients went from having Medicaid coverage to being uninsured, a fate that has befallen almost one-fourth of these former Medicaid enrollees nationwide, according to KFF. Clinica Family Health responded with cutbacks but is still in the hole.
What home health providers can learn from CMS’ other proposed rules for 2025
04/22/24 at 02:30 AMWhat home health providers can learn from CMS’ other proposed rules for 2025Home Health Care News, by Joyce Famakinwa; 4/19/24... CMS released the 2025 proposed payment rules for hospice and skilled nursing facilities (SNFs) in March. On the hospice side, the proposed rule included a 2.6% increase in the per diem base rate. Aside from the pay raise for hospices, the proposal also included a market basket index update, and notable changes to some of the geographic areas subject to particular indices. “There are rural areas that became urban and urban areas that became rural in the new CBSs — core based statistical areas,” William A. Dombi, president of the National Association for Home Care & Hospice (NAHC), told Home Health Care News.
One-third of West Virginians may soon have a harder time getting health care after lawmakers declined to fully fund Medicaid
04/19/24 at 03:00 AMOne-third of West Virginians may soon have a harder time getting health care after lawmakers declined to fully fund Medicaid Mountain State Spotlight, by Erin Beck; 4/18/24Across West Virginia, it’s already hard for many people to access health care. And unless state lawmakers change the budget they passed last month, it’s about to get even more difficult, especially for people who live in the most rural areas and those considered lower income. Starting in July, at the start of the next fiscal year, West Virginia officials will be forced to dramatically cut the state’s Medicaid budget. Roughly one-third of the state’s population relies on the government health insurance program. ... [Lawmakers] gave the program about $150 million less than was needed.
Mississippi Capitol sees second day of hundreds rallying for ‘full Medicaid expansion now’
04/19/24 at 03:00 AMMississippi Capitol sees second day of hundreds rallying for ‘full Medicaid expansion now’Mississippi Today - Legislature; by Bobby Harrison and Geoff Pender; 4/17/24Hundreds of people rallied at the Mississippi Capitol for a second day Wednesday, urging lawmakers to expand Medicaid to provide health coverage for an estimated 200,000 Mississippians. ... Speakers recounted their struggles with access to affordable health care in Mississippi and chanted for the Legislature to, “Close the coverage gap now,” and for “Full Medicaid expansion now.” ... [Dr. Randy] Easterling recounted a story of two of his friends diagnosed with similar cancers. One was uninsured and self-employed, and did not get early diagnosis or treatment. He’s now in hospice and on death’s door. The other friend, with insurance, received an early diagnosis and treatment and is now cancer free.
Home care sees largest price jump in history, BLS report finds
04/18/24 at 03:00 AMHome care sees largest price jump in history, BLS report finds McKnights Home Care, by Adam Healy; 4/15/24The cost of home care rose faster than ever in the last year, far outpacing inflation across every other healthcare spending category, according to the Bureau of Labor Statistics’ latest Consumer Price Index report. Home care costs rose 14.2% between March 2023 and March 2024 — its most rapid growth since BLS began tracking data for the segment in 2005, according to the CPI. ... During the same period, standard inflation for all medical care services was 2.1%. The costs of hospital services — outpatient hospital services (8.3%), general hospital services (7.5%) and inpatient hospital services (6.9%) — saw the next-highest inflation rates since March 2023, eclipsed only by home care services. Meanwhile, prices for nursing home and adult day service rose by about 3.9%.Editor's Note: This article did not report cost changes for hospice care.
CMMI’s proposed TEAM Model offers another risk-based opportunity for home health providers
04/17/24 at 03:00 AMCMMI’s proposed TEAM Model offers another risk-based opportunity for home health providers Home Helath Care News, by Andrew Donlan; 4/15/24Last week, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced a new proposed model that will undoubtedly affect home health providers, and also allow them the opportunity to get more involved in value-based care initiatives. The Transforming Episode Accountability Model (TEAM), which would eventually be mandatory if finalized, would have selected acute care hospitals put under full responsibility for the cost – and quality – of care from surgery up until the first 30 days after hospital discharge.
‘Are nursing homes our only option?’ These centers offer older adults an alternative.
04/16/24 at 03:00 AM‘Are nursing homes our only option?’ These centers offer older adults an alternative. Rhode Island Current, by Anna Claire Vollers; 4/12/24PACE centers attract bipartisan interest and, in some states, scrutiny. ... PACE (Program of All-Inclusive Care for the Elderly) centers provide government-funded medical care and social services to people older than 55 whose complex medical needs qualify them for nursing home care, but who can live at home with the right sort of help. ... Nationally, PACE centers are owned by a variety of health care organizations, including nonprofits, for-profit companies, large health care systems and religious organizations. ... [The] explosive growth has come with challenges ...
AHA seeks federal probe of MultiPlan, insurers
04/15/24 at 03:00 AMAHA seeks federal probe of MultiPlan, insurers Modern Healthcare, by Michael McAuliff; 4/9/24 The American Hospital Association wants the Labor Department to investigate the analytics company MultiPlan and its large insurer clients to determine whether they engage in business practices that disadvantage patients and providers. According to a New York Times investigation published Sunday, MultiPlan and customers such as UnitedHealth Group subsidiary UnitedHealthcare, CVS Health subsidiary Aetna and Cigna boost their finances by dispensing low payments to out-of-network providers and burdening patients with large bills.
AMA, AHIP, NAACOS outline value-based care best practices
04/15/24 at 02:00 AMAMA, AHIP, NAACOS outline value-based care best practices Modern Healthcare, by Nona Tepper; 4/10/24 Health insurers, physicians and accountable care organizations issued recommendations Wednesday outlining what they see as the best ways to boost value-based care initiatives. The report from the health insurance trade group AHIP, the American Medical Association and the National Association of ACOs focuses on total-cost-of-care contracts, ACOs that typically span three to five years and have demonstrated success improving quality and reducing costs, according to the organizations.
Providers still navigating Change outage as systems are restored
04/12/24 at 03:00 AMProviders still navigating Change outage as systems are restored Modern Healthcare, by Lauren Berryman; 4/10/24 Providers are seeing some improvements following the Change Healthcare cyberattack nearly two months ago, but not necessarily because they are reconnecting to restored systems. Hospitals and medical groups are submitting claims to payers through alternate vendors, allowing them to generate cash. But the level of claims and payments moving among healthcare organizations that had heavily relied on Change Healthcare is still far from normal.
Report: How MA Plan design affects utilization, health equity
04/12/24 at 03:00 AMHow MA Plan design affects utilization, health equity MedCity News, by Marissa Pescia; 4/8/24 A new study found that enrollees with zero-premium MA plans are three times as likely to be non-White compared to other MA enrollees and traditional Medicare enrollees. ... The study was published by Harvard Medical School and Inovalon, a provider of cloud-based software solutions. It used Inovalon’s Medical Outcomes Research for Effectiveness and Economics Registry dataset, which “tracks demographic characteristics and outcomes for about 30% of all MA members at any given point in time,” according to the report.
Insurers’ response to the Change breach failed providers
04/10/24 at 02:30 AMInsurers’ response to the Change breach failed providers Modern Healthcare, by Chip Kahn and Dr. Bruce Siegel; 4/8/24 ... The Feb. 21 attack on Change Healthcare, a subsidiary of UnitedHealth Group’s Optum unit, severed the electronic ties that connect patients, providers and insurance companies. The attack robbed patients of the certainty they could seek and receive care, and it robbed physicians, pharmacists and hospitals of the resources necessary for patient care. ... Overlooked in this crisis, is that insurance companies failed to act decisively and collectively to protect patients and providers. ... Here’s what should have happened immediately when the threat facing patient care became painfully obvious.
Medicaid expansion and palliative care for advanced-stage liver cancer
04/09/24 at 03:00 AMMedicaid expansion and palliative care for advanced-stage liver cancer Journal of Gastrointestinal Surgery; by Henrique A Lima, Parit Mavani, Muhammad Musaab Munir, Yutaka Endo, Selamawit Woldesenbet, Muhammad Muntazir Mehdi Khan, Karol Rawicz-Pruszyński, Usama Waqar, Erryk Katayama, Vivian Resende, Mujtaba Khalil, Timothy M Pawlik; dated 4/24/28 (for print) Conclusion: The implementation of ME [Medicaid expansion] contributed to increased rates of palliative treatment for patients residing in ME states after expansion. However, racial disparities persist even after ME, resulting in inequitable access to palliative care.
Hospitals cash in on a private equity-backed trend: Concierge physician care
04/09/24 at 03:00 AMHospitals cash in on a private equity-backed trend: Concierge physician care KFF Health News, by Phil Galewitz; 4/1/24 Nonprofit hospitals created largely to serve the poor are adding concierge physician practices, charging patients annual membership fees of $2,000 or more for easier access to their doctors. It’s a trend that began decades ago with physician practices. Thousands of doctors have shifted to the concierge model, in which they can increase their income while decreasing their patient load. ...
CMS: Contract Year 2025 Medicare Advantage and Part D Final Rule (CMS-4205-F)
04/08/24 at 03:00 AMCMS: Contract Year 2025 Medicare Advantage and Part D Final Rule (CMS-4205-F)CMS, Medicare Part D, Policy; 4/4/24On April 4, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that revises the Medicare Advantage Program, Medicare Prescription Drug Benefit Program (Medicare Part D), Medicare Cost Plan Program, Programs of All-Inclusive Care for the Elderly (PACE), and Health Information Technology Standards and Implementation Specifications. Additionally, this final rule addresses several key provisions that remain from the CY 2024 Medicare Advantage and Part D proposed rule, CMS-4201-P, published on December 14, 2022. ... This fact sheet discusses the major provisions of the 2025 final rule which can be downloaded here: https://www.federalregister.gov/public-inspection/2024-07105/medicare-program-medicare-advantage-and-the-medicare-prescription-drug-benefit-program-for-contract
Medicare Program; FY 2025 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program Requirements
04/08/24 at 03:00 AMMedicare Program; FY 2025 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program Requirements Federal Register; A Proposed Rule by the Centers for Medicare & Medicaid Services on 4/4/24This document has a comment period that ends in 53 days, 5/28/24.This proposed rule would update the hospice wage index, payment rates, and aggregate cap amount for Fiscal Year (FY) 2025. This rule proposes changes to the Hospice Quality Reporting Program. This rule also proposes to adopt the most recent Office of Management and Budget statistical area delineations, which would change the hospice wage index. This rule proposes to clarify current policy related to the “election statement” and the “notice of election”, as well as to add clarifying language regarding hospice certification. Finally, this rulemaking solicits comments regarding potential implementation of a separate payment mechanism to account for high intensity palliative care services.
Telehealth effective in supporting rural caregivers
04/08/24 at 03:00 AMTelehealth effective in supporting rural caregivers Hospice News, by Jim Parker; 4/3/24Palliative care delivered via telehealth is effective at improving access to caregiver support. Moreover, these services can also be cost-effective, recent research has found. ... “[Technology-enhanced transitional palliative care] is a feasible, low cost and sustainable strategy to enhance [family caregiver] support in rural areas,” researches indicated in the study. “Potential reimbursement mechanisms are available to offset the costs to the health system for providing transitional palliative care to caregivers of patients recently hospitalized.”