CMS to make Medicare Advantage data available to researchers

Morning eHealth

FDA draws strong, mixed reaction — U.S. Digital Service hands QPP back to CMS

Do Medicare providers located at a Distant Site have to be hospital-based to provide services?

Telehealth Blog

Q: Per Medicare regulations, do the providers at a distant site have to be hospital-based or can they be in a private setting – for example, a group of pulmonologists who want to create a telehealth system on their own? Also, all telehealth services must meet the Medicare established set of criteria for reimbursement. Click here to visit the Medicare Eligibility Analyzer site. To review CCHP information on Medicare, go to: [link]. Medicare

Telehealth Payments Don’t Meet Medicare Requirements

BHM Healthcare Solutions

Payers are rapidly becoming educated in telehealth and are keen on closing telehealth gap, but need to be mindful of Medicare requirements. Almost a third of telemedicine claims sampled by HHS’ Office of Inspector General did not meet Medicare requirements, resulting in an estimated $3.7

Medicare Reimbursement for Remote Monitoring Should Drive Adoption (What a long, strange trip it’s been….)

The cHealth Blog

The Centers for Medicare & Medicaid Services (CMS) released the 2018 Physician Fee Schedule about two weeks ago and there is at least one nugget in there that should speed the adoption of remote patient monitoring.

Racial, ethnic disparities persist in Medicare Advantage


Medicare Advantage plans have been touted as a way to give more control to seniors, but non-minorities may be reaping most of the benefits. A new report finds that minorities enrolled in MA plans are receiving worse clinical care than white patients, following similar studies

Aetna rides Medicare Advantage growth, ACA exit to profitable Q1


Aetna has added 250,000 Medicare Advantage members on its way to a profitable first quarter as it looks to close a deal with CVS Health. The insurer reported $1.2 billion in net income thanks, in part, to an ACA exchange exit

The Patient As Payor: From Rationing Visits Due to Co-Pays to Facing $370K for Healthcare in Retirement

Health Populi

The latest data on health care costs in retirement was published by EBRI earlier this year in their report , Savings Medicare Beneficiaries Need for Health Expenses: Some Couples Could Need as Much as $370,000, Up from $350,000 in 2016.

DOJ investigating Anthem’s Medicare Advantage, Part D plans


The Department of Justice has asked Anthem for more information about its Medicare Advantage and Part D plans as part of an ongoing probe dating back to 2016. Anthem says the inquiry is part of an investigation into other Medicare Advantage health plans, as well as providers and vendors

Elderly Medicare patients less likely to have minimally invasive surgeries


A new study from Johns Hopkins University indicates that not enough Medicare patients undergo minimally invasive surgeries, despite better outcomes, fewer readmissions and lower costs. Researchers said that the findings indicate there is an opportunity for Medicare and other payers to spend healthcare dollars more wisely so that they reward high-value care over low-value care

MedPAC recommends ‘measured approach’ to Medicare telehealth coverage


The Medicare Payment Advisory Commission shied away from recommending policymakers expand telehealth coverage for specific services and instead urged CMS to evaluate cost, access and quality by launching pilot projects through CMMI

Medicare reimbursement caught in the crosshairs of congressional opioid talks


Lawmakers on an influential House committee appear to be looking at Medicare reimbursement as the main culprit of opioid overprescribing. Payment changes for alternative treatments may be in order, and providers say they are "inadequately compensated" for time spent screening patients for addiction or checking drug registries

CMS announces MyHealthEData Initiative and Medicare Blue Button 2.0

Medicine and Technology

Department of Health and Human Services (HHS) – including its Centers for Medicare & Medicaid Services (CMS), Office of the National Coordinator for Health Information Technology (ONC), and National Institutes of Health (NIH) – as well as the U.S. Medicare’s Blue Button 2.0 is a new and secure way for Medicare beneficiaries to access and share their personal health data in a universal digital format. Medicare’s Blue Button 2.0

UnitedHealth reports double-digit revenue boost, backed by Medicare Advantage enrollment


first-quarter revenue increase, beating expectations and adding new beneficiaries to Medicare Advantage plans. Major health insurer UnitedHealth saw a 13.3% The company also reported strong growth in Optum and readjusted its net earnings outlook for the year

JAMA piece urges release of Medicare Advantage encounter data


Despite concerns about the quality of Medicare Advantage encounter data, a new JAMA viewpoint piece argues that it's long past time to make that information available to researchers who want to study the ever-growing privatized Medicare program.

Most ACOs would flee Medicare program if pushed to take on more risk


A substantial number of providers plan to leave their ACO program if the Medicare agency doesn't allow them to remain in non-risk-based tracks, according to a new survey. But the CMS has given confusing signs on whether it will act on the concerns

Medicare advisers mull altering bonus payments for ACOs


The main Medicare payment advisers to Congress have mulled a proposal to solidify and expand an incentive payment for accountable care organizations (ACOs), which could lead organizations to take on more risk. This week, MedPAC proposed a 5% increase to bonus payments for advance alternative payment models under MACRA

New 'Medicare Extra' plan would carve out role for private health insurers


A left-leaning think tank is proposing a plan for universal health coverage that sounds similar to “Medicare-for-all” but is actually friendlier to private insurers. The Center for American Progress' new plan would widen access to a Medicare-based public insurance program but also give consumers the option of keeping their employer-sponsored insurance plan or opting for a privatized Medicare plan

CMS to release Medicare Advantage encounter data as part of new data-driven strategy


CMS is making good on its promise to release encounter data that it collects from Medicare Advantage plans. The agency was scheduled to release the data last year, but concerns over accuracy caused them to pull back, disappointing researchers. CMS also announced that it will publicly release data for Medicaid and CHIP plans next year

Democrats skeptical of Medicare payment reform efforts amid proposed funding cuts


A top administrator at the Medicare agency says the White House is committed to driving the market toward value-based care. Democrats, however, are skeptical in light of recent steps taken by the administration, including proposed cuts to the Medicare program

CMS floats proposal tying medical records sharing to Medicare participation


Buried underneath changes to the Meaningful Use program, a newly proposed hospital payment rule includes the possibility of more stringent requirements that would require providers to share data to participate in the Medicare program. Experts said the agency could also leverage that approach to give TEFCA more teeth

CMS hints at Blue Button 2.0 mandates for Medicare Advantage plans in 2020


In an announcement outlining Medicare Advantage rate hikes, CMS said it is considering rulemaking that would require MA plans to connect with Blue Button 2.0 beginning in 2020. The notice comes a month after Seema Verma announced the new initiative and said the agency would "re-examine" its relationship with insurers

AHIP: CMS must fix flaw in Medicare Advantage rate formula


As Medicare Advantage grows in popularity, America’s Health Insurance Plans says it is vital that the Centers for Medicare & Medicaid Services fix the flaws in its funding formula to maintain the program’s stability. AHIP’s assessment rests on a new legal analysis that shows CMS calculates current benchmarks for Medicare Advantage using data from patients who are not eligible to participate in the program

Report: Medicare beneficiaries are often confused about enrollment deadlines, struggle to pay


Medicare beneficiaries find enrollment in some of its programs, including Part B, confusing and may struggle to pay for medication and other healthcare needs, according to a new report. The Medicare Rights Center says its data can guide policymakers looking to improve Medicare's programs

American Hospital Association balks at proposal to slash Medicare payments to standalone emergency departments


The AHA argues that proposed rules to reduce payment for standalone emergency departments are "unfounded and arbitrary," but the Medicare Payment Advisory Committee says freestanding emergency departments can drive up health costs

CBO: Medicare spending expected to reach $1.2T in the next decade


Starting next year, annual Medicare spending is expected to grow by an average of 7% over the next decade, exceeding $1.2 trillion by 2028, according to the CBO. Healthcare costs overall are projected to grow faster than the economy

MACRA: Medicare’s Opportunity to Finally Embrace Connected Health Technology


The nation’s healthcare system is in the middle of a major transition – one that, if done well, will have an incredible impact on the lives of millions Americans who rely on Medicare. For a long time, Medicare has had a reputation for being bureaucratic, lethargic, wasteful, and outdated. Further, the Center for Medicare and Medicaid Services (CMS), which administers Medicare, has been slow to incorporate advances in advanced health technology in the program.

Trump likely to target Medicare in quest for lower drug prices


The Trump administration is likely eyeing reforms to Medicare as a way to lower drug prices, which have skyrocketed in recent years. The president is planning on announcing new initiatives to combat rising prices next week, and proposals are likely to be based off of Trump's 2019 budget, which included major changes to Medicare Part B

How Walmart Could Bolster Healthcare in the Community

Health Populi

Here’s one description about the chain’s plans to use $200 mm to expand in Florida (THINK: the state will be home to 4,5 million people age 65 and over in 2020, potential candidates for Humana’s Medicare programs. Walmart has been a health/care destination for many years.

OIG identifies $3.7M in improper Medicare telehealth payments, which could lead to more scrutiny for providers


Medicare paid out $3.7 million in improper payments for telehealth services during a two-year period, according to the Office of Inspector General, most of which were linked to beneficiaries that received services at nonrural sites. The report is likely to add to scrutiny of telehealth claims

Healthcare Roundup—Alaska out of Medicaid funds; groups warn SNAP cuts will hit Medicare, Medicaid


Plus, more than a dozen groups are warning that cuts to SNAP will lead to higher Medicare and Medicaid costs Maine Gov. Paul LePage continues to drag his feet on Medicaid expansion, while Alaska also struggles with Medicaid funds.

Alex Azar to resurrect Medicare Part B price bidding program


Fresh off Trump's speech on lowering drug prices, HHS Secretary Alex Azar has announced the agency is planning on looking back at an old Bush-era program

CMS boosts Medicare Advantage rates, adjusts risk score calculations despite concerns


Medicare Advantage plans are getting a significant payment boost next year, even as CMS moves forward with changes to risk score calculations by relying more on encounter data. The total payment and policy changes are expected to save the government almost $300 million a year

Medicare readmission rates offer incomplete picture of hospital quality


The authors of the study pointed to an imbalance between 30-day readmissions among Medicare patients and overall quality, concluding that broadening the scope of the program would eliminate penalties for 40% of hospitals Condition-specific readmission rates do not offer a fair proxy for overall hospital quality, according to a new analysis of federal data.

Report: Axing protected drug classes in Medicare Part D may not substantially lower spending


Eliminating the protected classes of medications for Medicare Part D plans could give insurers more leverage to negotiate rebates but may have a limited financial payoff, according to a new analysis

Farzad Mostashari: CMS should look to Medicare Advantage to improve accountable care


To help meet that goal and support accountable care organizations, he should look to Medicare Advantage for inspiration, say Farzad Mostashari, M.D., HHS Secretary Alex Azar has made it clear that the transition to value-based care is one of his priorities. and Travis Broome

Heart-Love – Omron’s Holy Grail of Blood Pressure Tracking on the Wrist

Health Populi

It’s February 1st, which marks the first of 28 days of American Heart Month – a time to get real, embrace, learn about, and engage with heart health. Heart disease kills 610,000 people in the U.S. every year, equal to 1 in 4 deaths in America.

Democrat's Medicare buy-in could be a double-edged sword for hospitals and providers


Democratic lawmakers are taking another crack at a public option, this time in the form of a Medicare buy-in for employers and individuals on ACA exchanges. While more coverage options might be good for consumers, providers could feel a financial pinch

Centers for Medicare & Medicaid Services to consider future policies through 'rural lens'


The strategy, which highlights tactics such as improving access to telemedicine, is meant to avoid unintended consequences of policy and program implementation in rural health settings, officials said

Republicans and Democrats concerned over proposed changes to Medicare Advantage, Part D plans


Lawmakers on two House committees have concerns about the Medicare agency's 2019 advanced notice for changes to MA and Part D plans. Those concerns include payment reductions to PACE programs and lack of information for seniors regarding cost plan transitions

Medicare panel votes to cut payments to freestanding emergency departments


The American Hospital Association urged the panel not to recommend the payment reduction. Here's how much of a cut standalone emergency departments could sustain