Medicaid plans can now pay mental health institutions. Most won’t until 2017

Posted on July 9, 2016 by henrykotula • Posted in Uncategorized • Tagged CMS, EMTALA, Health Policy, Health System, Hospital, Medicaid, Mental Health, Residential Treatment Centers, Substance Abuse • Leave a comment

http://www.modernhealthcare.com/article/20160705/NEWS/160639991

A policy that lifts a 50-year ban on Medicaid pay for mental health institutions kicked in Tuesday, but it may be months before many enrollees can take advantage of the new coverage

Since the creation of Medicaid in 1965, the program has excluded payment for institutions of mental disease (IMDs) for beneficiaries 21 and over. Most residential treatment facilities for mental health and substance-use disorders with more than 16 beds did not qualify for Medicaid reimbursement.

CMS fines, cuts off testing at Theranos, bans Holmes

Posted on July 8, 2016 by henrykotula • Posted in Uncategorized • Tagged Clinical Lab Testing, CMS, CMS Fines, CMS Sanctions, Direct-to-Consumer Lab Testing, Theranos • Leave a comment

CMS fines, cuts off testing at Theranos, bans Holmes

goodbye

The other shoe has dropped for Theranos. Late Thursday night, the embattled diagnostics company disclosed that it is officially being sanctioned by the Centers for Medicare and Medicaid Services.

In a press release issued at 11:35 p.m. Eastern time, the wounded unicorn said CMS has moved to revoke the CLIA certificate for Theranos’ laboratory in Newark, California. Company executives — mainly founder and CEO Elizabeth Holmes — will be barred from owning, operating or directing a clinical lab for two years once the sanctions take effect 60 days from now.

The changing face of healthcare leadership

Posted on July 4, 2016 by henrykotula • Posted in Uncategorized • Tagged CMS, CMS Star Ratings, Consumerism, Customer-Obsessed Business, Diversity, Leadership, M&A, Matrix Leadership, Post Merger Integration, Profitability, Recruiting. Talent Management, Uncomfortable Leadership • Leave a comment

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/changing-face-healthcare-leadership?cfcache=true

Despite all the change health plans are facing today, there’s one key way of measuring leaders’ effectiveness that won’t change: Profitability.

Health plan executives will be evaluated based on the sustainability of their businesses during a time when profit margins are tight. They’ll also be measured based on their ability to retain employees and maintain current local relationships. Health plans will be investing in a lot of new talent. That means that leaders will be measured on their ability to grow their teams, while maintaining deep relationships in the communities where they’re doing business.

Health policy leaders to HHS: More bundled payment models, please

Posted on June 28, 2016 by henrykotula • Posted in Uncategorized • Tagged ACA, ACO, Acute Care Episode Demonstration Project, Bundled Payments, Center for American Progress (CAP), CMS, Health Policy, Health System, HHS, Hospital, Medicare • Leave a comment

http://www.healthcaredive.com/news/health-policy-leaders-to-hhs-more-bundled-payment-models-please/421562/

The Center for American Progress (CAP) and other health policy leaders issued a joint letter to HHS Secretary Sylvia Burwell advocating further advancement in Medicare payment reform.
The signatories seek additional mandatory bundled payment demonstrations, arguing they would show stakeholders — including hospitals, physicians, device manufacturers, skilled nursing facilities, and home healthcare agencies — that aggressive expansion is coming for bundled payments and other payment reforms.
CAP has long advocated for Medicare to expand its most successful bundled payment models, including its Acute Care Episode demonstration project.

Click to access Mandatory-bundled-payment-letter.pdf

Medicare has funding through 2028, trustees say, 2 years less than earlier thought

Posted on June 24, 2016 by henrykotula • Posted in Uncategorized • Tagged ACA, CMS, Health Policy, High Drug Prices, Medicare, Medicare Insurance Trust Fund, Medicare Part D, Medicare Payment Advisory Commission, MedPAC, Per-Medicare Beneficiary Cost, Social Security, Social Security Cost of Living Adjustment, Specialty Drugs • Leave a comment

http://www.healthcarefinancenews.com/news/medicare-has-funding-through-2028-trustees-say-2-years-less-earlier-thought

However, Medicare Trustees said the 2028 date is 11 years longer than they projected in 2009 before the passage of the Affordable Care Act.

‘Explosive’ Healthcare Spending at End of Life Uncommon

Posted on June 20, 2016 by henrykotula • Posted in Uncategorized • Tagged CMS, End of Life Healthcare, Health Policy, Medicare, Out of Pocket Expenses, US Healthcare Spending • Leave a comment

http://www.healthleadersmedia.com/finance/explosive-healthcare-spending-end-life-uncommon?spMailingID=9084486&spUserID=MTMyMzQyMDQxMTkyS0&spJobID=941950601&spReportId=OTQxOTUwNjAxS0

A study of spending patterns finds end-of-life healthcare spending begins far earlier than the last few months of a patient’s life. Nearly half the Medicare patients studied had high spending throughout the entire final year of life.

Pressure Mounts to Risk-Adjust for Poverty

Posted on June 20, 2016 by henrykotula • Posted in Uncategorized • Tagged CMS, Cost of Treating Economically Disadvantaged Patients, Health Policy, Health System, Hospital, Medicare Readmission Penalties, Proverty, Risk Adjustment, The Disease of Poverty • Leave a comment

http://www.healthleadersmedia.com/finance/pressure-mounts-risk-adjust-poverty?spMailingID=9084486&spUserID=MTMyMzQyMDQxMTkyS0&spJobID=941950601&spReportId=OTQxOTUwNjAxS0#

Hospital associations and trade groups are lobbying federal officials to account for how “the disease of poverty” impacts the health of patients—and costs hospitals.

Healthcare CEO gets 10 years for fraud that led to 2 patient deaths

Posted on June 17, 2016 by henrykotula • Posted in Uncategorized • Tagged CEO, CMS, DOJ, Fraud and Abuse, Malpractice, Medicaid, Medicare, Non-Physician Employees, Portable Diagnostic Service Providers, Prison Conviction • Leave a comment

http://www.beckershospitalreview.com/legal-regulatory-issues/healthcare-ceo-gets-10-years-for-fraud-that-led-to-2-patient-deaths.html

Hospitals moving slowly toward value-based pay, Health Catalyst survey says

Posted on June 14, 2016 by henrykotula • Posted in Uncategorized • Tagged ACA, Access to Capital, CMS, Culture, Fee for Service, Health System, Hospital, Population Health, Risk-based Contracts, Value Based Health Care, Value Based Reimbursement • Leave a comment

http://www.healthcarefinancenews.com/news/hospitals-moving-slowly-toward-value-based-pay-health-catalyst-survey-says

The majority of health systems have either zero or less than 10 percent of their care tied to the type of risk-based contracts.

Walgreens terminates partnership with Theranos

Posted on June 13, 2016 by henrykotula • Posted in Uncategorized • Tagged CMS, Direct-to-Consumer Lab Testing, Retail Health Clinics, Theranos, Walgreens • Leave a comment

http://www.beckershospitalreview.com/hospital-management-administration/walgreens-terminates-partnership-with-theranos.html

http://www.npr.org/sections/thetwo-way/2016/06/13/481888422/walgreens-cuts-ties-with-blood-test-company-theranos

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HENRY KOTULA

A Healthcare Leadership Blog

Tag Archives: CMS

Medicaid plans can now pay mental health institutions. Most won’t until 2017

CMS fines, cuts off testing at Theranos, bans Holmes

The changing face of healthcare leadership

Health policy leaders to HHS: More bundled payment models, please

‘Explosive’ Healthcare Spending at End of Life Uncommon

A study of spending patterns finds end-of-life healthcare spending begins far earlier than the last few months of a patient’s life. Nearly half the Medicare patients studied had high spending throughout the entire final year of life.

Pressure Mounts to Risk-Adjust for Poverty

Hospital associations and trade groups are lobbying federal officials to account for how “the disease of poverty” impacts the health of patients—and costs hospitals.

Healthcare CEO gets 10 years for fraud that led to 2 patient deaths

Hospitals moving slowly toward value-based pay, Health Catalyst survey says

The majority of health systems have either zero or less than 10 percent of their care tied to the type of risk-based contracts.

Walgreens terminates partnership with Theranos

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However, Medicare Trustees said the 2028 date is 11 years longer than they projected in 2009 before the passage of the Affordable Care Act.

Share this:

A study of spending patterns finds end-of-life healthcare spending begins far earlier than the last few months of a patient’s life. Nearly half the Medicare patients studied had high spending throughout the entire final year of life.

Share this:

Hospital associations and trade groups are lobbying federal officials to account for how “the disease of poverty” impacts the health of patients—and costs hospitals.

Share this:

Share this:

The majority of health systems have either zero or less than 10 percent of their care tied to the type of risk-based contracts.

Share this:

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