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OIG recommends Medicare improve rate setting for clinical diagnostic tests for future public health emergencies
For future public health emergencies, the Centers for Medicare & Medicaid Services should improve how it sets Medicare rates for clinical diagnostic laboratory tests under the Clinical Laboratory Fee Schedule and communicates with stakeholders involved in setting the rates, the Department of Health and Human Services’ Office of Inspector General advised last week.
CMS finalizes rule for 2025 Medicare Advantage, prescription drug plans
The Centers for Medicare & Medicaid Services April 4 finalized changes to the Medicare Advantage and prescription drug programs for contract year 2025 intended to improve access to behavioral health care; cap and standardize MA plan compensation to brokers, including prohibiting volume-based bonuses for enrollment into certain plans; limit the distribution of personal beneficiary data by third-party marketing organizations; ensure that MA plans offer appropriate supplemental benefits; streamline enrollment for individuals dually eligible for Medicare and Medicaid; and annually review MA utilization management policies for health equity considerations.
Report examines impact of COVID-19 on rural hospitals
Almost half of rural hospitals had negative total margins in 2022 and negative patient care margins both before and after the COVID-19 pandemic, according to a report prepared for the AHA by faculty at the Virginia Commonwealth University College of Health Professions.
Assessing the Impact of COVID-19 on Rural Hospitals
The purpose of this research is to examine the impact of the COVID-19 pandemic on rural hospital financial performance.
Navigating Value-based Payment
In the 14 years since passage of the Affordable Care Act (ACA) and 9 years since the passage of the Medicare Access and CHIP Reauthorization Act (MACRA), there have been numerous programs developed by Medicare, states and commercial payers to support the movement to outcomes or value-based reimbursement.
Capitated and Global Budget Models
At the upstream end of the value-based payment spectrum, organizations can assume full risk for a population through capitated payments, global budgets, and provider led insurance plans.
Current and Emerging Payment Models
Health care is currently in the middle of a transition from a system of payment based on the volume of services provided (fee-for-service) to payment based on the value of those services (value-based care and alternative payment models).
Bundled and Episode-Based Payment Models
Growing in popularity, bundled payment programs generally provide a single, comprehensive payment that covers all of the services involved in a patient's episode of care.
Accountable Care Organizations
What are Accountable Care Organizations? What are ACOs? An ACO is a group of clinicians, hospitals and other health care providers who come together voluntarily to give coordinated high-quality care a designated group of patients.
The 340B Drug Pricing Program
For more than 30 years, the 340B Drug Pricing Program has provided financial help to hospitals serving vulnerable communities to manage rising prescription drug costs. Despite significant oversight from HRSA and the program’s proven record of decreasing government spending and expanding access to patient care, some want to scale it back or drastically reduce the benefits that eligible hospitals and their patients receive from the program.