Tagged with Healthcare Reform

New Final Rule Targets Pass-Through Payments

CMS’ newest Medicaid managed care final rule will prevent increases in pass-through payments as well as the addition of new pass-through payments beyond those in place when the pass-through payment transition periods were established.

PA – New Global Capitation Model for Rural Hospitals

CMS has announced a new global capitation model for rural hospitals in Pennsylvania. Under the new model participating critical access hospitals and acute care hospitals will receive all-payer global budgets for a fixed amount of money that is set in advance and funded by all participating insurers, to cover inpatient and outpatient services.

UnitedHealth Group to Buy Outpatient Surgery Chain for $2.3 Billion

UnitedHealth Group has announced plans for its health services unit, Optum, to acquire Surgical Care Affiliates (SCA). Under the acquisition, Optum would add to its footprint SCA 205 surgical facilities, which SCA operates in partnership with thousands of surgeons in 33 states.

Study Finds New Payment Models May Potentially Reduce Health Care Disparities

A new study from Harvard Medical School claiming to have found “meaningful” improvements in quality, outcomes, and spending for all patients in the Alternative Quality Contract (AQC) between suggests binding insurers’ physician payments to quality metrics can narrow disparities between low- and higher-income patients.

CMS Releases Third Innovation Center Report to Congress

As mandated by section 1115A(g) of the Social Security Act, the CMS Innovation Center recently released its third Report to Congress. The report highlights activities between October 1, 2014 and September 30, 2016, but also highlights a number of important activities started during that time period that were announced between September 30, 2016 and December 31, 2016.

ACA Repeal Efforts Begin, while Sign-Ups Continue to Rise

As senate and legislative efforts to repeal the Affordable Care Act (ACA) pick-up, the American Medical Association sent a letter to congressional leaders called on lawmakers to outline plans to replace the ACA before they repeal the law. Despite these efforts, it was recently announced that 8.8 million U.S. residents have signed up for health plans through the federal exchange.

NJ – OIG Report Reveals Improper Medicaid Payments

A report released by the HHS Office of Inspector General (OIG) states, over a four-year span, New Jersey has received an estimated $95 million in improper Medicaid payments. According to the report, “The deficiencies occurred because the state … did not adequately monitor [its] partial care services program to ensure that providers complied with [the program’s] requirements.”

NY – New Law Grants Clinicians Access to Patient Data for Minors

New York based clinicians participating in the regional health information organization serving the western part of the state, HEALTHeLINK, are now able to access health data for patients who are between 10 and 17 years old with parents or legal guardians signed consent.

Another Step Toward Value-Based Reimbursement

CMS Acting Administrator Andy Slavitt is urging healthcare and political leaders to continue value-based care progress made under the Affordable Care Act, including value-based care progress after MACRA implementation through universal coverage, the CMS Innovation Center, interoperable health IT, and patient-centered care.

‘Simple Choice Plans’ to Make First Appearance in 2017 Marketplace Enrollment

Continuing efforts to make picking a plan easier, the federal government is encouraging insurers to offer “simple choice plans” as an option when the 2017 open Enrollment starts in November. The six new standardized plan designs aim to eliminate many of the moving parts that have plagued consumers trying to make comparisons between similar plans.

Study Finds Average Deductible for Employer-Sponsored Health Plans Rises 12% in 2016

A new Kaiser/HRET survey reveals the average deductible for employer-sponsored health plans has risen 12% this year to $1,478 annually, and has exceeded $2,000 at small businesses. The analysis illustrates the shift between plan types, showing 29% of all employees are now in high-deductible plans compared to 20% in 2014, while those employees in higher cost PPO plans have gone down from 58% in 2014to 48% in 2016.

Some US Residents will Take Significant Hit Following Premium Hikes

U.S. residents paying the full costs of their health insurance premiums could be hit especially hard by premium rate hikes for the 2017 coverage year. Individuals who do not receive subsidies under the Affordable Care Act must pay the full costs of health plans they purchase through the exchanges, according to a new report from Kaiser Health News/NPR’s “Shots.”

Imaging 3.0: Early Steps

ACR’s Imaging 3.0™ “provides concrete steps to allow all radiologists to take a leadership role in shaping America’s future health care system.” We highlight efforts underway at NYU Langone Medical Center which may provide examples for others to follow.

CDS Update: Action Required Now

The requirement for all physicians ordering advanced imaging to first consult a CDS has been moved to January 2018. But this delay only recognizes the many practical issues that must be resolved to assure widespread use of CDS and avoid penalties to radiology reimbursement.

Healthcare Exchanges Evolve with Narrow Networks

Narrow networks are steadily becoming the primary way for insurance companies to be profitable on the exchanges. These plans are half of all Marketplace offers in the first two years, and nearly 90% of consumers had the option of buying such a plan.

Population Health Starts with Whole Person Care

Creating population health strategies that focus on whole-person care for large populations can be challenging. But as the industry shifts toward patient-centered care, learning how to increase patient engagement and eventually cut healthcare costs will be crucial.