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CMS to make Medicare Advantage data available to researchers
Morning eHealth
APRIL 27, 2018
FDA draws strong, mixed reaction — U.S. Digital Service hands QPP back to CMS
Medicare Related Topics 
Do Medicare providers located at a Distant Site have to be hospital-based to provide services?
Telehealth Blog
MAY 24, 2018
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
Trending Sources
Telehealth Payments Don’t Meet Medicare Requirements
BHM Healthcare Solutions
MAY 1, 2018
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
NOVEMBER 16, 2017
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
FierceHealthIT
APRIL 12, 2018
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
FierceHealthIT
MAY 1, 2018
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
MARCH 27, 2018
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
FierceHealthIT
APRIL 26, 2018
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
FierceHealthIT
MARCH 6, 2018
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
FierceHealthIT
MARCH 15, 2018
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
FierceHealthIT
APRIL 12, 2018
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
MARCH 6, 2018
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
FierceHealthIT
APRIL 17, 2018
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
FierceHealthIT
FEBRUARY 21, 2018
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
FierceHealthIT
MAY 2, 2018
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
FierceHealthIT
APRIL 9, 2018
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
FierceHealthIT
FEBRUARY 22, 2018
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
FierceHealthIT
APRIL 26, 2018
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
FierceHealthIT
MARCH 23, 2018
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
FierceHealthIT
APRIL 25, 2018
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
FierceHealthIT
APRIL 3, 2018
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
FierceHealthIT
MARCH 16, 2018
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
FierceHealthIT
MARCH 16, 2018
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
FierceHealthIT
APRIL 5, 2018
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
FierceHealthIT
APRIL 17, 2018
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
ConnectedHealth
MARCH 17, 2017
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
FierceHealthIT
MAY 4, 2018
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
APRIL 16, 2018
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
FierceHealthIT
APRIL 15, 2018
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
FierceHealthIT
MAY 18, 2018
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
FierceHealthIT
MAY 14, 2018
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
FierceHealthIT
APRIL 3, 2018
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
FierceHealthIT
MARCH 28, 2018
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
FierceHealthIT
MARCH 7, 2018
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
FierceHealthIT
MARCH 21, 2018
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
JANUARY 31, 2018
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
FierceHealthIT
APRIL 19, 2018
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'
FierceHealthIT
MAY 8, 2018
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
FierceHealthIT
MARCH 29, 2018
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
FierceHealthIT
APRIL 6, 2018
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
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