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.

Medicare Pays Primary Care Doctors More for Managing Chronic Conditions

To attract more doctors to primary care, the Centers for Medicare & Medicaid Services has taken a two-pronged approach to reform Medicare payment systems for those physicians: paying more for managing care for patients with chronic conditions.

More Billing Codes, Demonstrations Help Bridge Physician Payment Gap

A new Robert Wood Johnson Foundation (RWJF) report analyzed how CMS has expanded billing codes and demonstrations focused on supporting primary care. The report said primary care providers (PCPs) involved in CMS demonstrations are getting higher monthly payments.

How Public Health Agencies Can Navigate HIPAA to Integrate Data-Driven Chronic Disease Interventions

Utilizing data housed in EHR systems has become a critical function for public health agencies looking to make an impact on pockets of chronic disease within a community or state. As those agencies explore opportunities to integrate high-quality patient data into outreach efforts, they also have to navigate longstanding privacy requirements outlined under HIPAA.