Tag Archives: Medicare

High costs give palliative care increased industry interest

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http://www.healthcaredive.com/news/palliative-care-healthcare-costs-investment/436065/

While a nascent industry of for-profit companies is eyeing palliative care, some believe a more viable response would be for health systems to build out internal capacities.

Efforts to improve palliative care are growing as both providers and payers struggle to control costs and provide quality end-of-life care. A recent Kaiser Family Foundation report found roughly 25% of Medicare dollars are spent on beneficiaries in the last year of life for services including hospitalization, post-acute care and hospice.

Palliative care is medical care that’s been customized to meet the needs of people with complex and serious illnesses. The goal is to reduce stress and improve the quality of life for both the patient and their family through pain relief, symptom control and help managing care and basic living tasks. “Palliative care teams are able to pull everyone together into the same room — not only the family but also the many different sub-specialists — and actually have a conversation about what is medically appropriate for this patient, so that the care plan becomes rational and appropriate,” says Center to Advance Palliative Care Director Diane Meier.

Today, nearly all hospitals with more than 300 beds and roughly two-thirds of hospitals with more than 50 beds have palliative care teams. While the size of the U.S. palliative care market is hard to pin down, the combined hospice and palliative care market totals $31 billion and is growing at an annual rate of 1.4%, according to research firm IBISWorld.

 

100 things to know about Medicare reimbursement in 2017

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http://www.beckershospitalreview.com/finance/100-things-to-know-about-medicare-reimbursement-2017.html

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Since its launch in 1965, Medicare has been one of the most influential programs for hospitals, health systems and other providers. Medicare has played a prominent part in various reform movements, including the shift from fee-for-service to value-based payment models, and the program’s policies and reimbursement rates have acted as a catalyst for change nationwide.

The following list sheds some light on several facets of Medicare reimbursement, covering everything from the latest update to the Inpatient Prospective Payment System to mandatory bundled payment models.

Top 2017 challenges healthcare executives face

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http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/top-2017-challenges-healthcare-executives-face?cfcache=true&ampGUID=A13E56ED-9529-4BD1-98E9-318F5373C18F&rememberme=1&ts=15022017

Working as a managed care executive in today’s healthcare environment is a demanding role. According to Managed Healthcare Executive’s 2016 State of the Industry Survey, challenges abound. Government requirements and mandates, such as implementing value-based reimbursement, are difficult to meet. Meanwhile, employing new technologies, such as electronic health records and data analytics, is no easy task. Pharmaceutical costs continue to rise dramatically, burdening the entire system.

The survey findings, based on 160 responses, show the biggest challenges that executives at health systems, health plans, pharmacy benefit organizations, and more anticipate next year. Here’s a closer look at the survey results, and what industry experts say organizations can do to overcome them.

Five Quick Ways HHS Secretary Tom Price Could Change The Course Of Health Policy

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http://khn.org/news/five-quick-ways-a-new-hhs-secretary-could-change-the-course-of-health-policy/?utm_campaign=KFF-2017-The-Latest&utm_source=hs_email&utm_medium=email&utm_content=42404172&_hsenc=p2ANqtz–5EWkVt5sjIUe_63Pbf6RTjOO_GqSTuaRBRwH_raPCxqrbMpsVfuUSNHyZm7pv8SbHa4es7RH84q1NOLCwj0m44NZyWQ&_hsmi=42404172

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After a bruising confirmation process, the Senate confirmed Rep. Tom Price, R-Ga., to head up the Department of Health and Human Services, by a 52-to-47 vote.

As secretary, Price will have significant authority to rewrite the rules for the Affordable Care Act, some of which are reportedly nearly ready to be issued.

But there is much more now within Price’s purview, as head of an agency with a budget of more than $1 trillion for the current fiscal year. He can interpret laws in different ways than his predecessors and rewrite regulations and guidance, which is how many important policies are actually carried out.

“Virtually everything people do every day is impacted by the way the Department of Health and Human Services is run,” said Matt Myers, president of the Campaign for Tobacco-Free Kids. HHS responsibilities include food and drug safety, biomedical research, disease prevention and control, as well as oversight over everything from medical laboratories to nursing homes.

Price, a Georgia physician who opposes the Affordable Care Act, abortion and funding for Planned Parenthood, among other things, could have a rapid impact without even a presidential order or an act of Congress.

Some advocates are excited by that possibility. “With Dr. Price taking the helm of American health policy, doctors and patients alike have sound reasons to hope for a welcome and long-overdue change,” Robert Moffit, a senior fellow at the conservative Heritage Foundation, said in a statement when Price’s nomination was announced.

Others are less enthusiastic. Asked about what policies Price might enact, Topher Spiro of the liberal Center for American Progress said at that time: “I don’t know if I want to brainstorm bad ideas for him to do.”

Here are five actions the new HHS secretary might take, according to advocates on both sides, that would disrupt health policies currently in force:

The Republican health-care plan the country isn’t debating

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https://www.washingtonpost.com/opinions/the-republican-health-care-plan-the-country-isnt-debating/2017/02/09/919464e2-eee8-11e6-9662-6eedf1627882_story.html?_hsenc=p2ANqtz-_zh-MmG6tEeoYRPpXGnfQ4Br6yG61Zm_BUto5iuDDy7KmrCnce1x4mfC1IJZgA7lEGZpWUtS2wTehJJCZgUSr8nli9FQ&_hsenc=p2ANqtz-_g3ACJaUm5w_DwBb7DyuzIOw5pujA6z1qZbrcFLgKCShQytC1zSXx63-Yuh-gFk2Ivyjf6z-tWrzEpQHRkhxEck_TU4w&_hsmi=42381353&_hsmi=42404172&utm_campaign=KFF-2017-Drew-WashPost-feb10-GOPplans&utm_campaign=KFF-2017-The-Latest&utm_content=42381353&utm_content=42404172&utm_medium=email&utm_medium=email&utm_source=hs_email&utm_source=hs_email&utm_term=.ce2754889c96

With the debate about the Affordable Care Act drawing so much scrutiny, a broader Republican agenda to fundamentally change the federal role in health care is flying under the radar. It’s the most important issue in health care we are not debating.

Many Republicans in Congress want to convert Medicaid to a block-grant program and transform Medicare from a plan that guarantees care into one in which seniors would receive a set amount of money to purchase coverage. Meanwhile, Republicans would replace existing subsidies for premiums under the ACA with less generous tax credits — all while eliminating the expansion of Medicaid that enables states to cover low-income childless adults.

Taken together, these changes would amount to a fundamental rewriting of the health-care role of the federal government. They would end the entitlement nature of Medicaid and Medicare, cap future increases in federal health spending for these programs and shift much more of the risk for health costs in the future to states and consumers.

If Republicans shy away from Medicare for the time being, for fear of angering senior voters, the fulcrum for this policy shift will be the debate about converting the Medicaid program to some form of a block grant, most likely one that would cap spending on a per- enrollee basis. This would be an enormous shift. Medicaid spending exceeds half a trillion dollars , and the program represents more than half of all federal funds spent by states. Medicaid has changed dramatically from its beginnings as a program largely for women and children on welfare. It now has more than 70 million beneficiaries, and its reach is so broad that almost two-thirds of Americans say that they, a family member or a friend have been covered by Medicaid at some point.

Consensus builds that GOP will keep value-based focus for healthcare reimbursement

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http://www.healthcarefinancenews.com/news/insurers-seek-market-stabilization-prior-april-rate-setting-deadline

Health Affairs report suggests new HHS leadership should expand state all-payer models, fine-tune accountable care organizations.

Another report suggest value-based payment models will continue even, if in a different form, under the new administration’s governance of the U.S. Department of Health and Human Services, according to a Health Affairs report.

“The election of Donald Trump might change the strategy of advancing healthcare reform, but the movement toward value-based care both preceded the Affordable Care Act and has bipartisan support,” the authors said.

If Tom Price is confirmed as secretary and Seema Verma administrator of the Centers for Medicare and Medicaid Services Administrator, the agencies will support new value-based payment models said authors David Muhlestein, Natalie Burton and Lia Winfield.

But Price has already voiced his opposition to mandatory models such as bundled payments.

CMS, which has 74 healthcare initiatives and programs in different stages of research, testing, and adoption, recently proposed to make its cardiac care bundle mandatory and said opportunities exist for bundles that consider multiple chronic conditions.

While payment innovation may continue, the agency needs to articulate its overall strategy in four focus areas, the authors said.

The first is the expansion of the population-based model and disease-specific model.

10 Essential Facts About Medicare’s Financial Outlook

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10 Essential Facts About Medicare’s Financial Outlook

Figure 2: The aging of the population and rising health care costs are contributing to the growth in Medicare spending over time

Medicare, the nation’s federal health insurance program for 57 million people age 65 and over and younger people with disabilities, often plays a major role in federal health policy and budget discussions. This was the case in discussions leading up to enactment of the Affordable Care Act (ACA), which, in addition to expanding health insurance coverage, included changes to Medicare that reduced program spending. Medicare is likely to be back on the federal policy agenda as Congress debates repealing and replacing the ACA, and also if policymakers turn their attention to reducing entitlement spending as part of efforts to reduce the growing federal budget deficit and debt.

By many measures, Medicare’s financial status has improved since the ACA passed in 2010, and repealing the ACA’s provisions related to Medicare would increase program spending and worsen the financial outlook for the program. But even if the Medicare savings and revenue provisions in the ACA are retained, Medicare faces long-term financial pressures associated with higher health care costs and an aging population. To sustain Medicare for the long run, policymakers may need to consider additional program changes to modify program revenues, benefits, spending, and financing.

This brief presents 10 facts and figures about Medicare’s financial status today and the outlook for the future.

Premium support is back. What is it?

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Premium support is back. What is it?

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Click to access premium-support.pdf

A number of Republican health care policy proposals that seemed out of favor in the Obama era are now being given new life. One of these involves Medicare, the government health insurance program primarily for older Americans, and is known as premium support.

Right now, the federal government subsidizes Medicare premiums — those of the traditional program, as well as private plan alternatives that participate in Medicare Advantage. The subsidies are established so that they grow at the rate of overall per enrollee Medicare spending. No matter what Medicare costs, older Americans can be sure that the government will cover a certain percentage of it. That’s the main thing that panics fiscal conservatives, because that costs the government more each year.

Premium support could quiet that fear. Subsidies would be calculated so they don’t grow as quickly, thus protecting the federal government (that is, taxpayers) from runaway spending. There are lots of variants, but there are really two principal ideas.