Lay-Health Workers Reduce Readmission Rates

A new report from Health Education Research found lay-health workers (LHWs) that addressed social needs affected readmission rates for a high-risk population at a rural community hospital in Kentucky. The study found a nearly 48% relative reduction of 30-day hospital readmissions for those in the program compared to patients that were not part of the program.

Telehealth, Telemedicine Reimbursement Score Big in New Budget Deal

Telehealth and telemedicine reimbursement scored huge successes in the budget deal signed into law by President Donald Trump, with one senator saying the law does more for Medicare coverage of telehealth than any past legislation.

Chronic Care Diagnoses Need Better Patient-Provider Communication

Patient-provider communication following a chronic illness diagnosis needs to strike an important balance of discussing clinical implications and the effect the disease will have on that individual patient’s lifestyle. However, previous patient reports show that providers often miss that mark and that communication can often feel rushed and impersonal, the researchers shared.

CMS Proposes 1.84% Rate Increase for Medicare Advantage Plans, Other Policy Changes

The federal government on Thursday proposed a 1.84% average rate increase for Medicare Advantage plans in 2019, along with other policy tweaks that officials said are designed to strengthen the MA and Medicare Part D programs. CMS says its proposals will “result in a payment increase that promotes stability and insures that resources will be available to support beneficiaries enrolled in private Medicare plans.”

Pharmacist Integration in Med Use Process Yields Positive Results at ACOs

Using pharmacists in accountable care organizations (ACOs) improves medication use by patients. That’s according to a study, “Optimization of Medication Use at Accountable Care Organizations,” which describes how ACOs manage medication use as part of their value-based contracting and care delivery.

UPDATED: Shutdown Nears End After Half of HHS Staff Furloughed

A contingency plan that went into effect during the three-day shutdown provided for CMS to keep operating certain ACA exchange activities, while not affecting Medicare in the short term. Other non-discretionary programs such as Center for Medicare & Medicaid Innovation activities also had continued and states were able fund their Medicaid programs through the second quarter.

Northwestern Memorial Hospital’s Geriatric ER Program Cuts Unnecessary Admissions by 33%

An emergency department program that focused on geriatric transitional care has significantly reduced the risk of unnecessary admissions of geriatric patients, according to a new study. Northwestern Memorial Hospital cut the admissions by 33%, according to researchers from Northwestern University, Mount Sinai Medical Center and St. Joseph’s Regional Medical Center.

CMS Proposes Medicare Advantage Risk Adjustment Increase

Payers in Medicare Advantage (MA) may soon see a change to its risk adjustment model that will take into account mental health, substance use disorder and chronic kidney disease and makes adjustments “to take into account the number of conditions an individual beneficiary may have."

Overview - Care Management Updates:

On November 15, the final rule of the Medicare 2018 Physician Fee Schedule was published. The updates include new billing codes and increased reimbursement for Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs) when certain care management services are furnished. Beginning on January 1, 2018, two new billing codes present RHCs and FQHCs with the opportunity to receive higher reimbursement for providing Chronic Care Management (CCM),...

Congress Delays Decision on CHIP Renewal Until Next Year 

For 20 years, the state-run Children’s Health Insurance Program (CHIP) has provided medical, dental and vision coverage for children in families who earn too much for Medicaid but don’t have or can’t afford private insurance. Now, families will have to wait until next year to find out if funding for the program will continue, New York magazine reports.