Timely updates about the healthcare industry

insurance open enrollment

CMS looks ahead to 2017 open enrollment

Healthcare leaders have now had a chance to evaluate the most recent open enrollment period and identify steps for improving next year’s processes. While the general trends show that consumers are getting the hang of using insurance exchanges, advocates continue to push for greater transparency and more features that will make it easier to comparison shop. Read more

physician quality

Simpler physician quality measures on the way

As Medicare, Medicaid and commercial payers have shifted toward alternative payment models in recent years, their varying standards for judging value have been a headache for healthcare providers. Outcomes that one payer deemed acceptable may not have passed the bar for another payer—resulting in confusion and increased administrative time for providers. Read more

the future of healthcare

4 trends for 2016: Experts emphasize value-based care, data-driven decisions

As the healthcare industry looks ahead at what 2016 will bring, a number of common topics are appearing on the experts’ lists and projections. Read more

SNFs must focus on star ratings to prep for 2017

CMS’s final bundled payment model for hip and knee replacement surgeries makes one thing clear for SNFs: A quality rating of at least three stars is more crucial than ever, especially given the changes going into effect in a little over a year. Read more

patient voices in value-based reimbursement

Will “value to the patient” one day be a part of billing? 

In the shift to value-based payments, are patients’ voices being heard? The Center for Medicare & Medicaid Innovation (CMMI), along with other payers, has been busy for some time now developing and testing new alternative payment models (APMs), all in an effort to better align payments with value. But in the midst of this change, some are wondering if the patient’s perspective is being given enough weight in the equation. Read more

The gray area of payer consolidation

Since news broke this summer of the proposed mergers between four insurance giants, voices representing payers, providers and consumers have sounded out about the benefits and drawbacks that such major consolidations would have on the insurance industry, and healthcare as a whole. In the most recent developments, the American Medical Association (AMA) has sent a letter to the Department of Justice objecting to these acquisitions, while a consumer group has also voiced its opposition. Read more

Coverage lapses are common for buyers on insurance exchanges

As open enrollment season gets underway, providers must work hard to ensure they’re ready for the changes ahead. (Need a guide for your own preparations? Click here for our flipbook.) Patients, of course, are weighing their options. Those purchasing their own health insurance policies from a state or federal exchange are making careful choices. But if this year’s cohort of buyers is like last year’s, a significant portion of them may lose or drop their coverage before the end of 2016. Data continues to show the importance of thorough communication and financial counseling with this at-risk group.    Read more

Providers report positive impacts from ACA

As the dust continues to settle in the aftermath of the passage of the Affordable Care Act (ACA), data shows that healthcare providers in both ambulatory and acute settings have seen positive impacts from the law. Voters across the political spectrum now point to high drug costs as their biggest healthcare concern, indicating that the ACA will likely play a smaller role in the 2016 presidential election, and giving providers confidence that the benefits they’ve seen thus far are likely to remain. Read more

ICD-10: Ready to flip the switch?

With very little time remaining until October 1, healthcare providers are anxiously awaiting the change to ICD-10. The vast majority of providers have likely taken some steps to prepare, but as Robert Tennant, an adviser for the Medical Group Management Association, told Modern Healthcare, October 1 will be “like the garbage disposal. You’re flipping a switch and hoping a fork isn’t in there.” Read more

SNFs and the 3-Day Stay

The recent recommendation from the Medicare Payment Advisory Commission (MedPAC) that the “three-day stay” rule be relaxed is welcome news for many skilled nursing facilities (SNFs). Not only did the commission recommend that up to two outpatient observation days be counted toward the three-day requirement, it also asked Congress to mandate that hospitals communicate better with patients about their status as an outpatient or inpatient and how it might impact their benefits in a skilled nursing facility. (To be clear, the three-day rule is not to be confused with the two-midnight rule, to which CMS has recently proposed changes.)

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