Following July 1, 2022, most group health plans and issuers of group or individual health insurance across the country are required to disclose pricing information of negotiated rates for healthcare services between insurer and provider under the new Federal Price Transparency Rule (The Rule). The stated purpose of The Rule is to “empowering consumers with the necessary…
Background: The Center for Medicare & Medicaid Services’ Center for Medicare & Medicaid Innovation tests service delivery models designed to improve care quality and patient outcomes while reducing or maintaining program costs. Historically, Innovation Center models were not explicitly designed to serve underserved populations, and most evaluations have not focused on health equity-related outcomes. In…
A Medicare Advantage bundled payment model for hip and knee replacements offered by Humana (NYSE: HUM) was associated with reduced skilled nursing facility use. These bundled payments were also linked to reduced spending overall for lower extremity joint replacements (LEJR) – while maintaining quality of care, according to a study published in JAMA Network. Of…
It’s no secret that something needs to be done in order to curb the unsustainable increase in Medicare spending. In 2021, overall Medicare cost grew 8.4%, or 21% of total national health expenditure, greatly exceeding the pace of economic expansion and in turn threatening the long-term financial viability of the program. The Centers for Medicare & Medicaid…
To advance its goal of having 100% of people in traditional Medicare in an accountable care relationship in seven years, the Centers for Medicare and Medicaid Services has announced three initiatives in the Medicare Shared Savings Program and the ACO REACH and Kidney Care Choices models. More than 700,000 healthcare providers and organizations will participate…
Skilled nursing providers are facing an extremely challenging operating environment, but they must keep adapting and innovating as the shift toward value-based care continues across the U.S. health care system. And in fact, providers have tremendous opportunities to seize. “Value-based care through the population health management model is the most exciting thing I’ve had the…
The proposed changes in the Medicare Physician Fee Schedule (PFS) for calendar year (CY) 2023 may offer incentives for provider groups to consider alternative payment models. Still, the policies will likely require more apparent benefits to significantly impact the shift to value-based care. The CY 2023 PFS proposed rule included changes to the Medicare Shared…
The CMS outlined potential guidance last week on issues like healthcare equity and climate change in its final inpatient payment rule as the federal government heightens its healthcare oversight on social issues. In the report, the CMS released comments that it received after soliciting public input during its proposed rule in April. The feedback on…
While the Centers for Medicare & Medicaid Services (CMS) proposes to make some of the most significant changes to its accountable care organization (ACO) model since it was finalized in 2011, it doesn’t appear that such updates will have a lasting impact on the broader skilled nursing industry. If anything, only operators with their own…
The American Medical Association has criticized the new Medicare payment schedule proposed rule released last week by the Centers for Medicare and Medicaid Services, saying it fails to account for inflation in practice costs and “COVID-19-related challenges to practice sustainability.” The proposed 2023 Physician Fee Schedule (PFS) conversion factor is $33.08, a decrease of $1.53…