Healthcare reform

Preparing for the ‘silver tsunami’ across the globe

The United States isn’t the only country experiencing explosive growth within the senior demographic. As the elderly population and the costs of senior care rise across the globe, other countries are weighing the U.S. long-term care experience. How will they handle the need for expanded senior services? Read More »

Preparing for the ‘silver tsunami’ across the globe

The United States isn’t the only country experiencing explosive growth within the senior demographic. As the elderly population and the costs of senior care rise across the globe, other countries are weighing the U.S. long-term care experience. Read More »

Congress introduces Medicare transitions of care legislation

A bipartisan Congressional group introduces the Medicare Transitional Care Act of 2012, moving ahead to formalize reimbursement for care transitions. Read More »

OMB: Medicare providers could see $11 billion in reduced payments in 2013

Medicare providers could be facing a $11 billion reduction in reimbursements if the government's sequestration process goes forward, according to an OMB report released today. Read More »

Largest ACO model project sees significant savings among dual-eligibles

Five years of data from Center for Medicare & Medicaid’s largest experiment in performance-based reimbursement are mixed, but physician groups succeeded in slashing the costs for dual-eligibles. Read More »

UTI payment study reveals big holes in datasets used for performance measures

What started out as a comparative analysis on reimbursement rates related to catheter-based urinary tract infections (CAUTIs) has opened a huge can of worms concerning hospital datasets and their reliability as performance measurements. Read More »

California passes bill restricting emergency room charges for out-of-network patients

California legislature has passed a bill limiting what emergency departments can charge out-of-network payers. Will other states follow? Read More »

Longitudinal care and the LTPAC world

The healthcare system has taken three large steps toward longitudinal care—and toward embracing long-term/post-acute care’s role in that picture. Progress on the Meaningful Use stages and templates for the new Continuity of Care Document were among the highlights. Read More »

IOM report: Healthcare must behave more like a business, reward quality and learn from data

In a milestone report released today, the Institute of Medicine (IOM) analyzes why the U.S. healthcare system needs a new business-based attitude, and why it struggles to learn from its own data. Read More »

AHCA to CMS: Change rule on observation stays, Medicare A-to-B billing

The Centers for Medicare & Medicaid Services' rule on hospital "observation stays" has generated much controversy. The American Health Care Association strikes back with a long list of changes that should be made--and why. Read More »

LTC facilities should prepare now for Social Security payment changeover, Feds say

In March 2013, the majority of nursing home residents will experience a radical change—no more government checks in the mail. Long-term care facilities should start now to educate their staffers and their residents on the new electronic direct deposit system. Read More »

Too little standardization in how states verify Medicaid applicants, GAO report says

When it comes to getting Medicaid assistance for long-term care costs, too many rule variations among the states have created a chaotic system, a GAO report concludes. Read More »

CMS announces final rule delaying ICD-10 to October 2014

The Centers for Medicare & Medicare Services on Friday published a final rule pushing back the compliance deadline for converting to the ICD-10 system of diagnostic and procedural coding to October 1, 2014 from October 1, 2013. Read More »

The carrot or the stick? Paying for nursing home quality

Ohio is the latest state to launch a pay-for-quality program for skilled nursing reimbursement. But with 10 percent of reimbursement riding on passing the quality program, is the test tough enough? Read More »

Aetna buys Coventry Health Care in latest deal to divvy up Medicare/Medicaid expansion market

As Medicare and Medicaid programs grow, the insurance market is spending billions to get a larger slice of the government-backed healthcare markets. Read More »

Healthcare data analytics poised to surge in next four years, study says

Don’t know what data analytics is yet? More hospitals are realizing the potential of data analytics to improve quality and business operations, and the transitions of care initiatives might bring LTC into the analytics mix sooner than you think. Read More »

Ohio program offers hefty incentives for nursing home quality

As reimbursement becomes increasingly tied to clinical quality and performance, Ohio joins the list of states that are trying a bigger carrot instead of the stick. Read More »

AHCA supports CMS’ new program, new laws to fix observation-stay billing problem

The billing differences between inpatient and observation hospitalizations are causing plenty of headaches, but the American Health Care Association believes CMS’ new pilot program is a step in the right direction. Read More »

Hospitalization restriction could cost seniors a bundle for SNF care

A growing number of seniors who have observational hospital stays are getting stuck with the bill for their SNF care. CMS is launching a new pilot to try to iron out the wrinkles in the claims system. Read More »

Today’s seniors see better than their parents

A recent study indicates that today’s seniors have better vision than the elderly of a generation ago. Better vision promotes more independence in performing daily activities. Read More »

Medicare pays $5 million in “questionable” home health claims, OIG study finds

Home healthcare agencies are the focus of $5 million in suspect Medicare claims, according to this week's report from the Office of Inspector General. Read More »

The harmonization of clinical care and technology

In this week's blog, John Derr, RPh, discusses the importance of harmony between clinical design and information technology. Successful implementation of transitions of care and longitudinal health records will require bringing both the clinical side and the technology side into the future together. Read More »

Penalties for readmissions could hit low-income regions below the belt

CMS penalties for readmissions will have disproportionate effects on healthcare facilities in lower-income communities. Read More »

Nursing home cutbacks could tally $65 billion over next decade

The unfortunate overlap of multiple payment-reduction laws and regulations could add up to $65 billion less for skilled nursing home budgets over the next 10 years, according to nationwide data released today. Read More »

CMS set to begin hospital RAC audits in 11 states

The Centers for Medicare & Medicaid Services is finally set to begin a three-year project to reduce fraud and errors by using RACs to check Medicare claims before they move to the payment stage. Read More »

Harvard study: Medicaid expansion could be good for states’ health

As states debate whether to adopt Medicaid expansion or not, the latest public health study from Harvard suggests expansion might be a healthy idea. Read More »

New TN Medicaid program pays seniors to stay home

Tennessee is testing a radical new state Medicaid program: Paying seniors to stay out of nursing homes. Read More »

HHS announces new healthcare fraud initiative

HHS has announced a public-private collaboration aimed at stemming healthcare fraud. Tougher sentences, suspended payments and enhanced screenings are tools now available for enforcement through the Affordable Care Act. Read More »

HHS: Long-term care is the next step in national plan to combat infections

The Department of Health & Human Services has released the LTC chapter in the national plan to reduce infections: C. difficile and urinary tract infections are the first of many high-priority targets. Read More »

AHIP: More companies choosing high-deductible health plans

A low-premium, high-deductible health plan used to be viewed as "the single consumer's plan." Now, high-deductible plans are a favorite of employers, especially for large-group coverage. Read More »