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Medicare Fraud Strike Force Charges Individuals, Freezes Assets
Eight Miami-Dade County, Fla., residents have been indicted in connection with an alleged $22 million Medicare fraud scheme operated out of Miami businesses purporting to specialize in home health care services.
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HHS expands funding for Aging and Disability Resource Center Programs (ADRCs). ADRCs provide “one-stop shop” sources of information, one-on-one counseling, and streamlined access to programs and services that can enable people to remain in their own homes and communities.
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Hospitals participating in the Medicare pay-for-reporting program will have from July 1 to Aug. 15 to report whether they participate in a systematic database for cardiac surgery.
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CMS issued new guidance for nursing home surveyors, further defining and clarifying several important dimensions of care to help improve nursing home residents’ quality of life and environment and to de-institutionalize their physical environments.
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Senate Finance Committee Chairman Max Baucus (D-MT) announced an $80 billion commitment from the pharmaceutical industry to reduce Medicare Part D prescription drug costs for seniors as part of health care reform.
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HOSPITAL & HEALTH SYSTEMS NEWS
Lack of access to inpatient beds is the main reason for continued
hospital emergency department crowding, according to a report released
by the Government Accountability Office (GAO).
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Medicare payments to long-term care hospitals in 2010 would increase an
estimated 2.2% instead of the previously proposed 2.8% under a
supplemental proposed rule published in The Federal Register.
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CMS wants Medicare payments to acute-care hospitals to remain flat for 2010.
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The Centers for Medicare & Medicaid Services (CMS) announced the 14 communities around the nation that have been chosen for the Agency’s Care Transitions Project, seeking to eliminate unnecessary hospital readmissions.
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ACE is a new hospital-based demonstration that will test the use of a bundled payment for both hospital and physician services for a select set of inpatient episodes of care to improve the quality of care delivered through Medicare fee-for-service. A bundled payment is a single payment for both Part A and Part B Medicare services furnished during an inpatient stay. The Centers for Medicare and Medicaid Services (CMS) said it has selected sites for the Acute Care Episode (ACE) demonstration.
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For additional Hospital & Health System News click here>
PHYSICIAN NEWS
A new national survey of physician practices finds that physicians on
average are spending the equivalent of three work weeks annually on
administrative tasks required by health plans.
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A plan, goal, objectives, assumptions and principles has been drafted by CMS to transition Medicare Value-Based Purchasing (P4P) For Physicians. Value-based purchasing (VBP) aligns payment more directly to the quality and efficiency of care provided by rewarding providers for their measured performance across the dimensions of quality.
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The National Committee for Quality Assurance (NCQA) launched new nine standards for medical practices, including evidenced-based guidelines for chronic conditions and performance reporting and improvement.
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HOME CARE & POST-ACUTE SERVICES
The American Association of Homes and Services for the Aging (AAHSA),
has been awarded a contract from the Agency for Healthcare Research and
Quality (AHRQ) to investigate the impact of telehealth monitoring for
blood pressure management among older adults.
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AARP endorsed the “Empowered at Home Act” (H.R. 2688) sponsored by
Representatives Frank Pallone (D-NJ) and Diana DeGette (D-CO), which
would provide incentives and greater opportunities for states to expand
access to home and community-based services. “Empowered at Home Act”
would reduce costly Medicaid bias.
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CMS announced it is beginning a supplier awareness and education
campaign ahead of the re-bidding of the initial contracts for the
Medicare competitive bidding program for durable medical equipment,
prosthetics, orthotics and supplies.
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Medicare patients with diabetes, chronic obstructive pulmonary disease,
or congestive heart failure that used home healthcare within 3 months
of being discharged from a hospital cost the program $1.71 billion less
and had 24,000 fewer re-hospitalizations than similar patients that
used other forms of post-acute care over a two-year period.
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The rule calls for payments to Medicare skilled nursing facilities to
be reduced by $390 million in 2010, or 1.2 percent lower than payments
for FY 2009. This adjustment to nursing facility payments is an effort
to rebalance an earlier adjustment to the case-mix indexes (CMIs).
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The Centers for Medicare & Medicaid Services (CMS) issued a
proposed rule to update the Medicare Hospice Wage Index for fiscal year
(FY) 2010 and adds new rules for physicians.
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CMS is rolling-out the patient satisfaction survey designed to measure
the experiences of people receiving home health care from
Medicare-certified home health care agencies. The Consumer Assessment
of Healthcare Providers and Systems (CAHPS) Home Health Care Survey
results will be publicly reported on Home Health Compare once an agency
has four quarters of data, For now, it is voluntary.
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The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), enacted on July 15, 2008, made limited changes to the competitive bidding program for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), including a requirement that the Secretary conduct a second competition to select suppliers for Round 1 in 2009.
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The Medicare Payment Advisory Commission sent Congress its payment recommendations for fiscal year 2010, skilled nursing facilities, inpatient rehabilitation facilities and home health agencies would not receive a payment update.
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President Obama is targeting the Medicare home health program for $550 million in cuts in the recently released proposed Federal budget.
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For additional Home Care Trends & News click here>
TECHNOLOGY NEWS
The Recovery Act establishes financial incentives beginning in January
2011 for eligible professionals (EPs) who are meaningful EHR users.
Beginning in 2015, payment adjustments will be imposed on EPs who are
not meaningful EHR users. Read about the differences between incentives
for Medicare and Medicaid.
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CMS will lead the formal rulemaking process for defining “meaningful
use,” a standard that hospitals and office-based physicians must meet
to be eligible for $34 billion in electronic health-record system
subsidy payments under the federal stimulus law, according to
discussions at the HIT Policy Committee meeting.
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H.R. 2068, to be known as the “Medicare Telehealth Enhancement
Act,” is co-sponsored by Bart Stupak (D-MI), Lee Terry (R-NE), and Sam
Johnson (R-TX) amends title XVIII (Medicare) of the Social Security Act
regarding telehealth services. Includes provisions for home health.
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$87 billion in federal dollars has been earmarked by Congressional leaders to help states keep their Medicaid programs fiscally viable. Another $27.1 billion is included for an array of other healthcare provisions. This is part of an $825 billion spending and tax-cuts bill meant to help the economy, according to documents released by the House Appropriations Committee.
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The Telehealth Network Grant Program (TNPG) demonstrates how telehealth programs and networks can improve access to quality healthcare services in underserved rural and urban communities. This program will provide funding for Federal fiscal years 2009 -2011. (TNPG) will be accepting applications until March 6, 2009.
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Cleveland Clinic is partnering with Microsoft HealthVault to enable certain patients to monitor chronic conditions – high blood pressure, diabetes and heart failure – at home. These patients will use high-tech devices, home computers and the Internet to keep Clinic doctors posted on their conditions. The next level – monitoring going direct to physicians and integrated into a consumer record.
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MANAGED CARE NEWS
CMS announced the national average fee-for-service growth rate on which 2010 Medicare Advantage payment rates will be based. The 0.81% growth rate is significantly lower than the 4.24% growth rate in 2009.
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Wellpoint is collaborating with four major independent Blues plans on a cost-transparency program to provide the total estimated cost ranges associated with 39 medical procedures completed at hospitals, outpatient centers and other facilities.
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Beginning in 2010, Medicare Advantage Special Needs Plans (SNPs) that serve Medicare beneficiaries with chronic conditions must meet new guidelines to identify the beneficiary populations eligible for enrollment.
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For additional Managed Care News click here>
MEDICAID NEWS
The Rhode Island Global Compact Waiver established a State-federal compact that provides the State with greater flexibility while assuring federal funding certainty. One of the central goals of the Waiver is to reorient the Medicaid program to reward responsible personal choices, including prevention and wellness. An individually-based system provides comprehensive primary care that facilitates partnerships between beneficiaries, physicians, other healthcare professionals and community providers and, when appropriate, the beneficiary’s family. Further, the Waiver will implement care management instruments across populations, increasing the opportunity for more efficient monitoring of access and quality, and greater use and efficacy of performance-based payment incentives.
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The District of Columbia ranked number one for highest average Medicaid funding per enrollee, based on data from fiscal year (FY) 2005. The average amount spent was $7,941 for each Medicaid beneficiary. The lowest amount of Medicaid funding was found in California with an average of $2,701 per beneficiary.
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State Medicaid programs will spend $1.6 trillion on long-term care expenses over the next twenty years, according to a new study released by America’s Health Insurance Plans (AHIP). When federal matching funds are included, total government expenditures on long-term care will exceed $3.7 trillion.
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For additional Medicaid News click here>
HEALTHCARE STUDIES NEWS
A study by a research team at Beth Israel Deaconess Medical Center
(BIDMC) provides key insights into consumer preferences, suggesting
that patients want full access to all of their medical records, are
willing to make some privacy concessions in the interest of making
their medical records completely transparent, and that, going forward,
fully expect computers will play a major role in their medical care,
even substituting for face-to-face doctor visits.
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The U.S. spent an estimated $1.7 trillion treating patients with one or
more chronic diseases in 2007, about three-quarters of total health
care spending, according to the second annual Almanac of Chronic
Disease, released by the Partnership to Fight Chronic Disease.
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Most Baby Boomers are choosing to “age in place,” but a large and
growing number – more than 1.2 million households are choosing to move
to communities designed to meet their needs, according to a report
released today by the National Association of Home Builders (NAHB) and
the MetLife Mature Market Institute (MMI).
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More than half (54 percent) of U.S. chronically ill patients did not get recommended care, fill prescriptions, or see a doctor when sick because of costs, compared to 7 to 36 percent in other countries. About one-third of U.S. patients – a higher rate than in any other country – experienced poorly coordinated care, such as delays in access to medical records or duplicated tests.
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For additional Healthcare Studies News click here>
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