Healthcare Delivery Development & Redesign

New paper highlights seven ways stakeholders can help alleviate medical debt without unintended consequences

As efforts continued at the beginning of 2022 to implement the No Surprises Act aimed at preventing surprise medical bills that patients are often unable to pay, the Kaiser Family Foundation published a report that estimates nearly one in 10 adults have medical debt, and that Americans’ total medical debt could be as high as $195 billion. About a week later the nation’s top three debt collection firms announced planned changes to medical debt practices designed to reduce the strain of medical debt on patients, and appease a Consumer Financial Protection Bureau that has made credit reporting and medical debt a priority. Less than a month later, the Biden Administration announced several initiatives aimed at alleviating issues related to medical debt for Americans.

Read More

CMS Finalizes Policy to Use Hospital Negotiated Charge Data to Set Payment Rates

This week, our In Focus section reviews the policy changes included in the Centers for Medicare & Medicaid Services (CMS) Fiscal Year (FY) 2021 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care Hospital (LTCH) Final Rule (CMS-1735-F). This year’s IPPS Final Rule includes several important policy changes that will change hospitals’ administrative procedures and may alter hospitals’ Medicare margins, beginning as soon as October 1, 2020.

Read More

HMA Announces Cancellation of 2020 Annual Conference

Health Management Associates has made the decision to cancel its October 2020 conference on Trends in Publicly Sponsored Healthcare, given continuing developments concerning COVID-19 and out of an abundance of caution for the safety of attendees, speakers, and staff. Full refunds will be made to registered attendees and sponsors.

Read More

Early Bird Registration Expires July 29 for HMA Conference, October 26-27 in Chicago

Be sure to register soon for HMA’s conference on What’s Next for Medicaid, Medicare, and Publicly Sponsored Healthcare: How Payers, Providers, and States Are Navigating a Future of Opportunity and Uncertainty, October 26-27, at the Fairmont Chicago, Millennium Park. The Early Bird registration rate of $1595 per person expires on July 29.  After that, the rate is $1795.

Read More

Proposed Medicare Payment and Policy Changes for Fiscal Year 2021 for Hospice, Inpatient Psychiatric Facilities, and Skilled Nursing Facilities

Recently, the Centers for Medicare & Medicaid Services (CMS) issued proposed rules to update the Medicare payment rates and implement other policy changes for three types of Part A providers: hospice, inpatient psychiatric facilities (IPFs), and skilled nursing facilities (SNFs). CMS is publishing these proposed rules in accordance with existing statutory and regulatory requirements to update Medicare payment policies for these providers on an annual basis. This brief summarizes the proposed payment rates and key policy changes for each of these provider types.

Read More

Medicare and Medicaid Telehealth Coverage in Response to COVID-19

Telehealth service expansions by Medicare and most Medicaid programs aim to rapidly increase access to care and reduce transmission, but also provide a natural experiment for policymakers.

This week, our In Focus section examines the extensive scope of flexibilities Federal and State governments have made to Medicare and Medicaid telehealth coverage in response to the COVID-19 national emergency. In March and April 2020, federal and state policymakers responded to the COVID-19 emergency by temporarily and aggressively expanding the definition of and reimbursement for telehealth services—moves intended to improve access to care and reduce virus transmission. Under the Medicare and Medicaid programs, these temporary expansions have been rapid and historic in scope, and will have substantial implications for patients, providers, payers, and federal/state financing. For policymakers, this temporary expansion may serve as a natural experiment for assessing which forms of telehealth services successfully expand access to care and should become permanent healthcare policy.

Read More

Life Plan Communities and Value-Based Payments

This week, our In Focus section reviews value-based payment (VBP) opportunities for long-term care providers. HMA Principal Dana McHugh authored the article, “Life Plan Communities and Value-Based Payments: Aligning Incentives So Everyone Benefits”, for LeadingAge national magazine, discussing how life plan communities can establish value-based payment arrangements with managed care organizations (MCOs) to maximize value and add additional revenue streams.

Read More

California Releases Medicaid Delivery System Waiver Proposal

This week, our In Focus section reviews the California Advancing and Innovating Medi-Cal (CalAIM) proposal, issued by the California Department of Health Care Services (DHCS) on October 28, 2019. CalAIM would implement broad delivery system, program, and payment reform for the state’s Medicaid program. The proposal includes efforts to address social determinants of health and other policy priorities such as homelessness, lack of access to behavioral health care, children with complex medical conditions, justice-involved populations, and aging individuals. According to DHCS, the three key goals of the proposal are to:

Read More