Podcasts about medpac

Let us know what you think about Health Affairs podcasts at communications@healthaffairs.org. If you have 30 minutes to spare, let us know and we'll set up a 30-minute chat for the first 20 listeners that reach out. Coffee will be on us.Health Affairs' Jeff Byers welcomes Farzad Mostashari, founder & CEO of Aledade and the former National Coordinator for Health IT, to the pod to break down insights in the latest MedPAC report, quality measurement reform, and areas of opportunity for value-based care.Health Affairs is hosting an Insider exclusive event on May 29 focusing on the FDA's first 100 days under the second Trump administration featuring moderator Rachel Sachs alongside panelists Richard Hughes IV and Arti Rai.Related Links:Crossing the Chasm: How to Expand Adoption of Value-Based Care (The New England Journal of Medicine)2025 MedPAC Report

Dr. Oz Running Medicare? The Wild Truth Behind His CMS TakeoverBrief DescriptionDr. Mehmet Oz is now leading CMS. Yes, that Dr. Oz. In this episode of Jae's Corner, Jae and Cass break down the surreal appointment, fact-check the fraud claims, decode the political spin, and explain what it really means for Medicare beneficiaries. Cass goes full myth-busting mode—snark included.In This Podcast00:00:00 Dr. Oz Appointed to CMS—What Just Happened?00:01:42 Analyzing the “Stop the Bleeding” Soundbite00:03:15 Medicaid, Immigrants, and the Fear Playbook00:05:10 Breaking Down FMAP and State vs. Federal Dollars00:07:12 Medicare Advantage Rates Rise Despite Cost-Cutting Talk00:09:10 UnitedHealthcare's MA Utilization Shock00:11:00 MedPAC's Truth: MA Costs More Than Original Medicare00:13:00 Why Medicare Advantage Is So Confusing for Users00:15:12 The Geography Trap: Same Person, Different Coverage00:17:30 What Medicare Beneficiaries Need to Know Right Now

In this episode of TCNtalks, Chris Comeaux and Dr. Cordt Kassner, Publisher of Hospice & Palliative Care Today and CEO and Founder of Hospice Analytics, leverage their data and extensive experience to identify key hospice headlines, articles, research, and social media posts that are driving change and transforming end-of-life care and healthcare in America.They share personal experiences with hospice care, emphasizing the importance of social work and discussing the challenges of healthcare reimbursement. The conversation also touches on MedPAC recommendations, new social media trends, and highlights from recent research articles. The hosts explore pressing issues in healthcare, such as workforce challenges, patient demographics, regulatory changes, and the impact of technology.  They address the implications of the aging baby boomer population for healthcare services, the influence of corporate interests on healthcare spending, and the critical role of leadership in navigating these challenges. Their discussion underscores the need for innovative solutions and the role of technology in improving care delivery.  It also emphasizes the importance of preparing for upcoming Medicare and home-based care changes.  The episode concludes with a Masters Class from Chris on what leadership is and why it is so needed during these times.  Join us.Guest: Cordt Kassner, PhD, Publisher of Hospice & Palliative Care Today & CEO and Founder of Hospice AnalyticsHost: Chris Comeaux, President / CEO of TCN / TCGhttps://www.teleioscn.org/tcntalkspodcast/transforming-healthcare-hospice-in-the-news-march-2025Teleios Collaborative Network / https://www.teleioscn.org/tcntalkspodcast

Every Gen X'er listening to this is gonna be singing that Clash song in your head for the rest of the day. So, let's turn our attention to Medicare Advantage policy. And on the show today, I grill the one and only Betsy Seals to find out which policies she thinks are going to stay and which are going to go. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. Obviously, this is very much in the context of a new administration and also just other things that are going on. But today we talk about the following four “stay or go” policy areas. Here's the first policy area we talk about: changes and activities within the Stars program. How will the Medicare Advantage Stars program change or not? Not only with this new administration, but also there are lawsuits and how they will impact the goings-on moving forward. Second policy, will it stay or will it go, that we talk about is risk adjustment and all of the activity in government oversight and focus on recoupment of improper payments as kind of the overarching bucket and what will be the incoming administration's method around risk adjustment. This is certainly on many people's minds. The third “will it stay or will it go” policy that we discuss is the use of AI (artificial intelligence) by Medicare Advantage plans. What does the appropriate oversight of the use in AI look like? Lots of talk about those prior auth AI algorithms and the high levels of denied care. A big topic of everybody's collective mind is looking at how to ensure that oversight is appropriate and that we're using AI for good and that it's not having any adverse impact. So that's the third will it stay or will it go. Fourth, and lastly, the whole agent broker realm—additional CMS and government oversight over misleading or inaccurate information coming from the marketing or the agent broker marketing world. How will that look in 2025 and moving forward? This last one, I'm kind of all over the nuance there after reading posts and comments by Samantha George, and I would recommend following her on LinkedIn would be my suggestion. I am reflecting back on the Ann Kempski episode (EP444), where we talk about the whole, really consider the downstream impact when making any policy changes, because there can be unintended consequences. Now, in a show about carriers—in this case, Medicare Advantage carriers—I'd be pretty tone deaf not to mention the nation's ire at carriers at this exact moment in time, some of it extremely well earned and some of it reflective of an extremely dysfunctional healthcare system. I'd also be tone deaf not to mention the MedPAC (Medicare Payment Advisory Commission) report, which states that Medicare Advantage plans receive payments from CMS that are 122% of spending for similar beneficiaries in traditional Medicare. This translates to an estimated $83 billion in higher spending in 2024. And I would lastly be remiss not to mention how Medicare Advantage plans are most carriers' most profitable service lines, with average earnings of around $1800 per enrollee. All of what I said is not some kind of grand revelation, of course, to most listeners of this show. And it's also not the topic of the conversation today, although some of this did get asked and answered in the earlier shows (EP387, EP375, EP291) with Betsy Seals. One thing I will remind everyone about is that there are regional carriers that are not the big five who may or may not be doing big five types of things. And also, it is actually really difficult to run a Medicare Advantage plan successfully. They call it risk for a reason. One thing I really appreciated about the conversation with Betsy Seals that follows is her advice to contemplate value to the patient and make sure that anybody working on the carrier side, you have enough of a bead on what's actually happening to be able to identify when things are going off the rails, which does not seem to be the case in some instances. This also, by the way, having a bead on what's actually happening on the ground, helps to ensure compliance and that's piece of advice two. Last piece of advice is to learn how to be proactive and not reactive. And this is eminently more possible vis-à-vis data that's available and learning how to use it well. Betsy Seals, my guest today, has had a very busy last couple of years since she was on Relentless Health Value the last time. Betsy is CEO and co-founder of Rebellis Group, a managed care consulting firm focused specifically in Medicare Advantage. Rebellis was actually acquired in February of 2024 and joined as a family of a couple of other consulting firms that now Betsy heads up. So, in short, she's really busy. Also mentioned in this episode are Samantha George; Ann Kempski; Rebellis Group; and Vivian Ho, PhD.   You can learn more at rebellisgroup.com and alerionadvisors.com and by following Betsy on LinkedIn.   Betsy Seals is the CEO of Alerion Advisors, a family of companies dedicated to delivering unparalleled consulting services across the healthcare spectrum. As a parent organization, Alerion Advisors unites three specialized firms—Rebellis Group, Advent Advisory, and Toney Healthcare—to provide health plans and their partners with comprehensive, innovative, and results-driven solutions. With over 25 years of experience in the managed care industry, Betsy is a nationally recognized leader known for her regulatory expertise and strategic insights. Betsy brings to the table a solid mix of leadership and business acumen, as well as regulatory and strategic knowledge within the managed care landscape. Betsy's expertise is focused in the areas of mergers and acquisitions, compliance, sales and marketing, strategy, supplemental benefit landscape, innovative benefit design that address social determinants of health (SDoH), and health plan operations.   05:09 Will the Star Ratings program stay in this new administration? 08:08 How will the lawsuits against CMS policies play out with this new administration? 10:24 Why is it hard for Medicare Advantage plans to survive, let alone thrive? 16:22 How does AI directly impact beneficiary lives? 21:38 What's going on now with the override payments? 27:08 How is non-collaboration going to impact Medicare beneficiaries moving forward? 31:45 Why is it important to become more technologically savvy in compliance?   You can learn more at rebellisgroup.com and alerionadvisors.com and by following Betsy on LinkedIn.   @betsyseals discusses #medicareadvantage policies on our #healthcarepodcast. #healthcare #podcast #changemanagement #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Wendell Potter (Encore! EP384), Dr Scott Conard, Stacey Richter (INBW42), Chris Crawford, Dr Rushika Fernandopulle, Bill Sarraille, Stacey Richter (INBW41), Andreas Mang (Encore! EP419), Dr Komal Bajaj, Cynthia Fisher    

R. Tamara Konetzka, PhD, the Louis Block Professor of Public Health Sciences at the University of Chicago, has been studying the intersection of Medicaid home- and community-based services (HCBS) and Medicare. Her research has found that when dual eligibles use Medicaid HCBS they are more likely to use home health versus skilled nursing facilities after hospitalizations. Konetzka also is fascinated by the idea that community-initiated home health serves as a frontier for a long-term care benefit. Other areas of research for Konetzka are Medicare Advantage. She'd like to examine the use of supplemental benefits, but there is not much data available on the use of them. She speculates that the Trump administration will have a hands-off approach to MA and likely will not expand funding for HCBS.Follow us on social media:X (formerly Twitter): @McKHomeCareFacebook: McKnight's Home CareLinkedIn: McKnight's Home CareInstagram: mcknights_homecareFollow University of Chicago on social media:X (formerly Twitter): @UChicagoFacebook: The University of ChicagoLinkedIn: University of ChicagoInstagram: uchicago

In our final episode of season 4, we look ahead to 2025 and beyond, with AMRPA's policy team. Our guests are Kate Beller, President of Government Relations and Policy, Troy Hillman, Director of Quality and Health Policy, and Joe Nahra, Director of Government Relations and Regulatory Policy. Read more about AMRPA's Policy Priorities on our website. This episode is hosted by Patricia Sullivan, AMRPA Director of Content & Marketing.

Join your Health System CXO Podcast host Jackie Kimmell as she discusses the critical topic of site neutrality in healthcare payments, exploring its implications for health systems and the evolving legislative landscape. She highlights the bipartisan momentum towards site neutral payments, the potential cost savings for Medicare, and the importance of understanding these changes for healthcare executives. Key Takeaways1.Site neutrality is a growing concern for healthcare leaders.2.Bipartisan momentum is shifting towards site neutrality in legislation.3.MedPAC has consistently advocated for site neutral payments.4.Potential savings from site neutrality could be significant for Medicare.Welcome to the Health System CXO Podcast, sponsored by The Health Management Academy, featuring content designed for Health System Nurse Executives, Health Equity Officers and Strategy Executives provided by our company SME's - Anne Herleth, Jasmaine McClain, Ph.D. and Jackie Kimmell. Subscribe today and receive the latest insights from the country's leading Health System CXO experts regularly, helping you remain current and guide your health system strategy with thought leadership and success.The Health System CXO Podcast activates health system leaders towards outcomes and scalable solutions you can implement now.About The Health Management Academy:Since 1998, The Health Management Academy has cultivated the premier community of healthcare's most influential changemakers from the top U.S. health systems and innovative industry partners. We power more than 2,000 health system senior executives and 200 industry organizations through exceptional peer groups, original market insights, world-class leadership development programs and novel member alliances. Our industry-leading programs and solutions enable members to facilitate meaningful relationships, navigate strategic transformation and address critical industry issues. To learn more, visit hmacademy.com and follow The Health Management Academy on ...

MedPod Today: the podcast series where MedPage Today reporters share deeper insight into the week's biggest healthcare stories. This week, MedPage Today reporters discussa medical education rundown, the first doctor of chiropractic program, and why MedPAC is questioning the value of 'extra benefits'. Episode produced and hosted by Rachael Robertson. Sound engineering by Greg Laub. Reporting by Rachael Robertson, Sophie Putka, and Cheryl Clark.

  Flip the script from disruption to opportunity! Ted Sims from Integrity Marketing Group joins Sarah to chat about how to prepare for potential Medicare beneficiary shopping as well as how agents can use Integrity tools to streamline work and save time.   Contact the Agent Survival Guide Podcast! Email us ASGPodcast@Ritterim.com or call 1-717-562-7211 and leave a voicemail.   Register for Ted Sims' Plan N for the Win Webinar!   Resources: Ask Integrity Guide: https://learningcenter.tawebhost.com/Integrity-Getting-Started-Ask-Integrity.pdf Learn about Ask Integrity™: https://integrity.com/ask-integrity/  Learn more about PlanEnroll: https://ritterim.com/planenroll/ Integrity Learning Center: https://clients.integrity.com/learning-center Integrity Training Schedule: https://learningcenter.tawebhost.com/MedicareCENTER-Webinar-Schedule.pdf MedicareCENTER:https://integrity.com/medicarecenter/ Not partnered with Integrity? Register here: https://identity.integrity.com/register Staying Motivated Amidst Change & Disruption: https://link.chtbl.com/ASGM20240710 Tech News Roundup: https://link.chtbl.com/ASGF20240927 What to Do if Your Medicare Part D Plans Become Non-Commissionable: https://link.chtbl.com/ASGN20241005   References: Haubensak, Carrie. “2023 Medicare Supplement Loss Ratios by Plan.” CSG Actuarial, CSG Actuarial, csg-actuarial-wordpress.appspot.com/news/2023-medicare-supplement-loss-ratios-by-plan. Accessed 16 Oct. 2024. “2023 Minnesota Statutes.” Revisor.MN.Gov, Minnesota Office of the Revisor of Statutes, www.revisor.mn.gov/statutes/. Accessed 16 Oct. 2024. Feekin, Doug. “Average Medicare Supplement Rate Increases Lower in 2021.” CSG Actuarial, CSG Actuarial, 15 Sept. 2021, www.csgactuarial.com/news/average-medicare-supplement-rate-increases-lower-in-2021/. “Does Your Provider Accept Medicare as Full Payment?” Medicare.Gov, Medicare, www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare. Accessed 16 Oct. 2024. “GA R&R - Guaranteed Issue for Eligible Persons.” Rules.Sos.GA.Gov, State of Georgia, rules.sos.ga.gov/GAC/120-2-8-.12?urlRedirected=yes&data=admin&lookingfor=120-2-8-.12. Accessed 16 Oct. 2024. “Health Care Practitioners Medicare Fee Control Act.” Legis.State.Pa.Us, PA General Assembly, 10 July 1990, www.legis.state.pa.us/WU01/LI/LI/US/PDF/1990/0/0081..PDF. “March 2023 Report to the Congress: Medicare Payment Policy.” MedPAC.Gov, Med Pac, 15 Mar. 2023, www.medpac.gov/document/march-2023-report-to-the-congress-medicare-payment-policy/. “Massachusetts Bulletin for People with Medicare.” Mass.Gov, Commonwealth of Massachusetts, https://www.mass.gov/doc/addendumpdf/download. Accessed 16 Oct. 2024. “Medicare Balance Billing Brochure.” ODH.Ohio.Gov, Ohio Department of Health, odh.ohio.gov/know-our-programs/medicare-balance-billing/resources/medicare-balance-billing-brochure. Accessed 16 Oct. 2024. “Medicare E-Visits.” Medicare.Gov, Medicare, www.medicare.gov/coverage/e-visits-0. Accessed 16 Oct. 2024. “Medicare Participating Physician or Supplier Agreement.” CMS.Gov, Centers for Medicare & Medicaid Services, 1 Nov. 2022, www.cms.gov/medicare/cms-forms/cms-forms/downloads/cms460.pdf. “Medicare Participation Announcement.” CMS.Gov, Centers for Medicare & Medicaid Services, www.cms.gov/files/document/medicare-participation-announcement.pdf. Accessed 16 Oct. 2024. “Medigap Plan N Benefits & Costs 2024.” MedicareSupplement.Com, TZ Insurance Solutions, www.medicaresupplement.com/medigap/plans/n/?force_destination=c3cee4730cf2fe66. Accessed 16 Oct. 2024. “Medicare Supplement Insurance Minimum Standards.” Rules.Sos.Ri.Gov, Rhode Island Department of State, rules.sos.ri.gov/regulations/part/230-20-30-7. Accessed 16 Oct. 2024. “Medicare Supplement Insurance Minimum Standards Regulations.” Dfr.Vermont.Gov, State of Vermont Department of Financial Regulation, dfr.vermont.gov/reg-bul-ord/medicare-supplement-insurance-minimum-standards-regulations. Accessed 16 Oct. 2024. “Medicare Supplement Premium Rates – Looking to the Past and Planning for the Future.” GenRe.Com, Gen Re, 24 Oct. 2023, www.genre.com/us/knowledge/publications/2023/october/medicare-supplement-premium-rates-en. Noga, Russel. “Rate Increase History for Medigap Plans.” Medisupps.Com, Medisupps.com, 10 Jan. 2024, www.medisupps.com/rate-increase-history-for-medigap-plans/. Boccuti, Cristina. “Paying a Visit to the Doctor: Current Financial Protections for Medicare Patients When Receiving Physician Services.” KFF, KFF, 9 Jan. 2017, www.kff.org/medicare/issue-brief/paying-a-visit-to-the-doctor-current-financial-protections-for-medicare-patients-when-receiving-physician-services/. “Revised Questions and Answers Regarding Implementation of Medicare Supplement Plan N Copayment, Deductible and Coinsurance .” CMS.Gov, Centers for Medicare & Medicaid Services, 10 Apr. 2010, www.cms.gov/medicare/health-plans/medigap/medigap-news-email-updates-items/cms1234920. “Supplemental Insurance (Medigap) Plans in Georgia.” Medicare.Gov, Medicare, www.medicare.gov/medigap-supplemental-insurance-plans/#/m/plans?fips=13057&zip=30115&year=2025&lang=en. Accessed 16 Oct. 2024. Fuglesten Biniek, Jeannie, et al. “Traditional Medicare Spending Fell Almost 6% in 2020 as Service Use Declined Early in the COVID-19 Pandemic.” KFF, KFF, 1 June 2022, www.kff.org/medicare/issue-brief/traditional-medicare-spending-fell-almost-6-in-2020-as-service-use-declined-early-in-the-covid-19-pandemic/.   Follow Us on Social! Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim X, https://twitter.com/RitterIM and Youtube, https://www.youtube.com/user/RitterInsurance      Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ Instagram, https://www.instagram.com/thesarahjrueppel/ and Threads, https://www.threads.net/@thesarahjrueppel  Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/

This Day in Legal History: Regents of the University of California v. BakkeOn June 28, 1978, the US Supreme Court delivered a landmark decision in the case of Regents of the University of California v. Bakke, shaping the future of affirmative action in university admissions. The case centered around Allan Bakke, a white applicant who was twice denied admission to the University of California, Davis Medical School, despite having higher test scores than some minority candidates who were admitted under a special admissions program. Bakke argued that he was a victim of racial discrimination.The Court's ruling was complex, resulting in a split opinion. By a narrow 5-4 margin, the Supreme Court held that the university's use of rigid racial quotas, specifically reserving 16 out of 100 seats for minority students, violated the Equal Protection Clause of the Fourteenth Amendment and the Civil Rights Act of 1964. This decision invalidated the quota system used by the university.However, the Court also ruled, in a separate 5-4 vote, that race could be considered as one of many factors in the admissions process. This part of the decision, delivered by Justice Lewis Powell, emphasized that while quotas were unconstitutional, affirmative action programs aimed at increasing diversity and providing opportunities for historically disadvantaged groups could be constitutionally permissible.The Bakke decision was a pivotal moment in the ongoing debate over affirmative action, setting a precedent that continues to influence educational policies and the broader discourse on racial equality in the United States. The case highlighted the delicate balance between prohibiting racial discrimination and promoting diversity and inclusion in higher education.Despite repeated reversals from the Supreme Court, the US Court of Appeals for the Fifth Circuit has continued to push conservative legal boundaries. This term, the Supreme Court reversed or vacated six out of nine Fifth Circuit decisions, yet still made significant rulings in favor of conservative positions, including limiting the Securities and Exchange Commission's (SEC) enforcement power and rejecting a federal bump stock ban. Observers note that while the Supreme Court often overturned Fifth Circuit rulings, it also aligned with the circuit's conservative ideology in key cases.A notable example was the Supreme Court's decision that people subject to civil penalties for alleged securities fraud have a constitutional right to a jury trial, significantly impacting the SEC's adjudication process. Another major case saw the Supreme Court upholding the Fifth Circuit's rejection of the bump stock ban, a regulation initially issued by the Trump administration. The Fifth Circuit also won a case involving incomplete deportation hearing notices, which, though technical, reflected the court's influence. However, the Supreme Court criticized the Fifth Circuit for overreaching, particularly on issues like the abortion pill mifepristone and social media censorship, emphasizing the importance of standing.The Fifth Circuit's decisions are often driven by judges appointed by former President Donald Trump, whose influence reshaped the court. Legal experts suggest that despite some setbacks, the Fifth Circuit's conservative rulings continue to shape national policies, revealing a complex interplay between the circuit and the Supreme Court.Conservatives Gain Despite Fifth Circuit Setbacks at High CourtThe home health industry is preparing to refile its lawsuit against Medicare payment cuts after a recent unfavorable court ruling. William A. Dombi, president of the National Association for Home Care & Hospice (NAHC), stated that the organization will first complete the necessary administrative appeals before returning to court. This legal battle could significantly impact Medicare home health providers and beneficiaries.The US District Court for the District of Columbia dismissed NAHC's initial lawsuit because it was filed before exhausting all administrative remedies. Instead of appealing, NAHC will follow the court's directive and refile the case. Meanwhile, industry groups are lobbying Congress to pass legislation to block a proposed 1.7% cut to home health payments in 2025.The Centers for Medicare & Medicaid Services (CMS) proposed a 2.5% payment increase but also a 3.6% cut due to a “permanent behavior adjustment” and a 0.6% cut for outlier payments. This is the third consecutive year of proposed cuts, which, according to Joanne Cunningham, CEO of the Partnership for Quality Home Healthcare, make it difficult for providers to meet the growing care demands of an aging population. High labor costs and workforce shortages exacerbate these challenges, and Katie Smith Sloan of LeadingAge noted that the cuts make it harder to recruit nurses.Senators Debbie Stabenow and Susan Collins, along with Representatives Terri Sewell and Adrian Smith, have introduced legislation to block the CMS proposal and restrict its authority over payment adjustments based on provider behavior. Dombi emphasized ongoing efforts with lawmakers, indicating that CMS is unlikely to change its stance.The Medicare Payment Advisory Commission (MedPAC) has consistently recommended reductions in home health payments, citing that current payments are significantly higher than costs. Their latest report projects a profit margin of 18% for 2024, arguing that excess payments diminish the value of home health care. However, Dombi countered that MedPAC's estimates don't account for lower payments from private Medicare Advantage plans, which now cover a majority of Medicare beneficiaries.Home Health Agencies to Renew Suit Over Medicare Payment RatesA California federal jury has ordered the National Football League (NFL) to pay over $4.7 billion in damages for overcharging subscribers of its "Sunday Ticket" telecasts. The jury found that the NFL conspired with member teams to inflate the price of "Sunday Ticket" for millions of residential and commercial subscribers. This decision followed more than a decade of litigation. The plaintiffs, who were DirecTV subscribers, argued that the NFL's agreements with broadcast partners allowed DirecTV to charge higher prices by monopolizing distribution. A judge may triple the damages under U.S. antitrust law, potentially bringing the total to over $14 billion. The NFL plans to contest the verdict.NFL hit with $4.7 billion verdict in 'Sunday Ticket' antitrust trial | ReutersThis week's closing theme is by Ludwig van Beethoven, once again, and still a composer of some note.As we close out this week, we turn to the life and music of Ludwig van Beethoven, one of classical music's most iconic figures. On June 28, 1802, Beethoven penned a poignant letter to his friend Franz Wegeler, revealing his deep struggles with his worsening deafness. Despite the profound personal challenge this posed, Beethoven's determination to overcome his condition fueled some of his most extraordinary compositions.In light of this story, our closing theme is Beethoven's "Symphony No. 3 in E-flat major, Op. 55," commonly known as the "Eroica Symphony." This symphony, composed between 1803 and 1804, epitomizes Beethoven's resilience and innovation. Originally dedicated to Napoleon Bonaparte, whom Beethoven admired for his democratic ideals, the dedication was famously retracted when Napoleon declared himself emperor. The "Eroica" is renowned for its emotional depth and groundbreaking structure, marking a significant shift from classical to romantic symphonic form.Beethoven's ability to compose such a powerful and transformative piece while grappling with the despair of impending deafness is a testament to his genius and perseverance. The "Eroica Symphony" not only reflects Beethoven's personal triumphs but also serves as an enduring symbol of human resilience in the face of adversity.As you listen to the stirring movements of this symphony, remember the indomitable spirit of Beethoven. Let his story and music inspire you as we conclude this week, reminding us all of the power of determination and the beauty that can emerge from our greatest challenges. Thank you for joining us, and we look forward to sharing more with you next week.Once again and without further ado, Ludwig van Beethoven's Symphony No. 3 in E-flat major, Op. 55, the “Eroica Symphony” – enjoy! This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.minimumcomp.com/subscribe

Each year the Medicare Payment Advisory Commission, MedPAC, provides Congress a report on the Medicare fee-for-service (FFS) payment systems, the Medicare Advantage (MA) program, and the Medicare prescription drug program (Medicare Part D). Within the MedPAC report is also the often (until now) under-reported Chapter 12.During the next live edition of Talk Ten Tuesdays, Colleen Ejak, Solution Advisor for 3M/Solventum, will report on the particulars from Chapter 12 of this report, including the status of the MA program.Colleen will be sharing specifics from the report regarding MA enrollment trends and updates on risk adjustment reporting and risk-conscious coding practices.The live broadcast will also feature these other instantly recognizable segments:• Dateline Healthcare: Former Centers for Medicare & Medicaid Services (CMS) career professional Stanley Nachimson will report on the latest healthcare news.• Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will report on the latest coding news.• News Desk: Timothy Powell, ICD10monitor national correspondent and regulatory expert, will anchor the Talk Ten Tuesdays News Desk.• Point of View: Angela Comfort, guest cohost of the live broadcast, will report on a subject that has caught her attention.

This is episode 111, “We Don't Need Medicare Advantage.” Do not miss this episode as host Joe Sparks explains why Medicare Advantage is not needed and is detrimental to Medicare.  Here is the MedPac report that I used as a source: Medicare Payment Policy. (See page XXV and pages 373-374.)  

In this week's podcast Mark Cohen joins me once more for the Top News Stories for the prior month.  This is a new format as Mark has retired from publishing the Hospice News Today as he has transitioned it to Cordt Kassner and the daily publication has been rebranded as Hospice and Palliative Care Today.  You can subscribe for free here:  https://www.hospicepalliativecaretoday.com/With this new format Mark and Chris highlight the top news stories you should not have missed each from their different perspectives Mark as an editor, news aggregator, and longtime marketing Executive focusing on the quantitative data provided by Cordt's team regarding the most clicked on and read stories, and Chris as a C-Suite leader of Hospice and palliative care.Join us as we explore in this episode topics such as rising suicide risk among seniors, HHS Secretary Becerra's testimony, MedPAC's payment policy report, and technical corrections to the CAHPS Hospice Survey.  They also categorize the articles into themes such as mission moments, reimbursement challenges, competition, workforce challenges, patient and family demographics, regulatory and political issues, technology and innovations, and more. Mark also provides a master class on the use of stock photography in hospice marketing. Tune in for a comprehensive analysis that intertwines personal experiences, industry insights, and forward-looking predictions, all contributing to a must-listen episode for healthcare professionals and enthusiasts alike.  You won't want to miss this.  Guest: Mark Cohen, Strategic Communications Consultant/Cohen-Fyfe CommunicationsHost: Chris Comeaux, President / CEO of TCN / TCGwww.teleioscn.orgTeleios Collaborative Network / https://www.teleioscn.org/tcntalkspodcast

Welcome to MattPAC*, a new Accelerators pilot concept! Radiation Oncologist Dr. Matt Spraker aims to introduce important healthcare policy concepts rooted in current events. Each show is designed to be efficient with your time and inspire you to get engaged with #RadOnc advocacy in 30 minutes or less.  In MattPAC #1, Matt covers two current congressional bills that are currently being considered for inclusion into next year's Medicare legislation: HR 2474 and HR3674. These bills seek to link Medicare physician pay to inflation and boost practice expense reimbursement for freestanding practices. The history of Medicare, administration processes, the payment formula, and sites of service are covered for context. Here are some good resources for further reading on these topics:A paper on how Medicare drove hospital desegregation, especially in the south.Power To Heal: Medicare and The Civil Rights RevolutionHow is Medicare Funded?Information about Medicare administration and procedures, WikipediaA lot of info on the RUC, AMAThe medicare physician fee schedule payment formula, MedicalBillersAndCoders.comInteresting write up of history of conversion factors, AMAMedicare payments are not keeping up with inflation, AMAFramework for Rational Medicare, AMAAMA letter to congress about these issues, March 2023AMA commends MedPAC for recognizing challenges of inflationary environment, April 2023HR 2474A Primer On Office Based Specialty Care, USPAUSPA Letter to MedPAC about threats to free standing specialty practices, such as Rad Onc2023 survey of multi-specialty practices regarding Medicare cutsHR 3674The Accelerators Podcast is a production of Photon Media, a division of Cold Light Legacy Company.*MattPAC is not a political action committee, it's just a cute name. If you'd like to support our efforts, please visit the Cold Light Legacy Company to learn more.

Sam is back for the final installment with Michael L. Powe, the Vice president of Reimbursement and Professional Advocacy for the American Academy of Physician Associates. This episode, Sam and Michael discuss modifiers, the MedPAC, 99024 postoperative coding and demonstrating PA value.

The recent collaboration between Henry Schein and Medpod signifies an increased focus on telehealth solutions and the integration of diagnostic technologies. Fast Five hosts Danielle Kirsh and Sean Whooley discuss how the Medpac system serves as a telediagnostic offering and the benefits it offers patients and providers.  Inspire Medical recently appointed a former AppliedVR executive as its chief medical officer. The move highlights the significance of medical leadership in driving strategic decisions. Hear who is taking on the new clinical role and what their career experience is that supports the appointment.  The successful implantation of Anteris Technologies' DurAVR THV in a valve-in-valve procedure showcases a significant milestone in transcatheter heart valve technology for the company. Whooley explains the significance of the implant and what makes it unique compared to other transcatheter aortic heart valves. Augmedics' strategic acquisition of digital health assets from Surgalign signifies a convergence trend of medical devices and digital health solutions. Find out how much Augmedics paid for the assets and how it expands business at the company. Abbott announced that it would withdraw all Trifecta heart valves from the U.S. market more than five months after Abbott and the FDA told health providers that the valves could deteriorate early. Whooley and Kirsh discuss what led to the discontinuance and the company's new focus in the heart valve market.  Check out the show notes for links to the stories we discussed today at MassDevice.com/podcast.

Understanding healthcare spending growth in America is a critical component of any initiative attempting to improve care quality and affordability. This holds true for every person or organization focused on improving healthcare – from policy makers, to traditional healthcare incumbents, new entrants, and the entrepreneurs driving digital health innovation.There are few people who understand healthcare economics in the U.S. as well as Michael Chernew, PhD, who has dedicated his career to studying healthcare spending and how it affects the quality of care and outcomes. Dr. Chernew is the Leonard D. Schaeffer Professor of Health Care Policy, and director of the Healthcare Markets and Regulation Lab in the Department of Health Care Policy at Harvard Medical School. Among many other roles, he is also currently serving as the Chair of the Medicare Payment Advisory Commission (MedPAC), an independent agency that advises Congress on costs, payments and other issues affecting the Medicare program.Dr. Chernew's research examines several areas related to improving the health care system including studies of novel benefit designs, Medicare Advantage, alternative payment models, low value care and the causes and consequences of rising health care spending.In this episode of Healthcare is Hard, Dr. Chernew shares his knowledge with Keith Figlioli in a discussion that touches a broad range of topics around healthcare economics and innovation, including:The false choice between free markets and government intervention. While some people argue for a stronger government role in healthcare, others believe there needs to be better mechanisms to make markets work better. Dr. Chernew says we need to use the power of the markets where we can and sees a lot of potential for innovation to play a role. But he is also skeptical about how much markets can accomplish on their own. He says the most important thing is to recognize that both the government and the markets are flawed, and he talks about the need to understand where flaws exist in order to navigate them.The appetite for disruptive innovation. There are a lot of organizations now that believe they can deliver good population health for less and capture the gains associated with that efficiency. While the effectiveness of these new approaches generally remains to be seen, Dr. Chernew talks about how there are now many mechanisms in place that will allow organizations to accept risk, along with an appetite for innovation that has grown exponentially over the last decade – especially if it can lower spending.Skepticism on the impact of better primary care. There's a common belief that more and better primary care will ultimately save money because everyone would be healthier. This might be true in some places or situations, but Dr. Chernew says he's very skeptical of the assertion that it could scale in the current system. He explains how saving money is typically achieved by eliminating low value care and providing high value care more efficiently, and talks about potential alternatives for expanding primary care as it exists today.The high cost of drugs. There's a lot of disfunction in the drug market in terms of pricing and value, and the way Dr. Chernew explains it, high costs are really financing future innovation. He says there are core debates about how much innovation should be financed, and how much innovation will occur as a result. He talks about options for designing potential structural changes and incentives to address these issues.To hear Keith and Dr. Chernew talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

MedPAC, a group advising Congress on Medicare issues, held a vote on 3 recommendations to reduce prices for accelerated approval drugs covered under Medicare Part B; David Balat, Healthcare Policy Director for the Texas Public Policy Foundation, says vague language surrounding the 340B program allows it to be misused; Patients Rising Now submits comments on CMS' Medicare Drug Price Negotiation Program Guidance; The Safe Step Act is reintroduced in the House; and Shannon Sharp is our patient correspondent from Alabama's 2nd Congressional District who discusses copay accumulator programs. MedPAC Webpage: April 2023 Public Meeting Wilcox: MedPAC's Part B Recommendations Threaten Patient Access to Care Patients Rising Now: Medicare Drug Price Negotiation Program Guidance Memo News Release: Physicians Wenstrup, Ruiz Lead Reintroduction of Safe Step Act to Improve Patient Access to Treatments X-Linked Hypophosphatemia and Copay Accumulators X-Linked Hypophosphatemia Robbed by Copay Accumulator practice  

AI is having its moment in all industries, including healthcare. In this episode, hear how AI-driven tools can help oncologists treat patients. Navid Alipour, CEO of CureMatch, talks about the role of AI in care and how it helps doctors do their jobs.  And Terry and Bob dive into the latest healthcare headlines, including Mark Cuban's Cost Plus Drugs' expansion into brand name medications, how a MedPAC decision could threaten patient access to Part B accelerated approval drugs, and ProPublica's report on insurance claims being denied without being read.  Don't forget to register for the 2023 We the Patients Fly-In! Additional Links: Wendell Potter Need help? The successful patient is one who can get what they need when they need it. We all know insurance slows us down, so why not take matters into your own hands? Our Navigator is an online tool that allows you to search a massive network of health-related resources using your zip code so you get local results. Get proactive and become a more successful patient right now at the Patients Rising Helpline. Have a question or comment about the show, or want to suggest a show topic or share your story as a patient correspondent? Drop us a line: podcast@patientsrising.org The views and opinions expressed herein are those of the guest(s)/ author(s) and do not reflect the official policy or position of Patients Rising, nor do the views and opinions stated on this show reflect the opinions of a guest's current or previous employers.  

Kelly Maynard, President of the Little Hercules Foundation, discusses the growing trend of alternative funding vendors and how their practices are leaving patients to foot the bill; Dr. Mark Lopatin, a rheumatologist, underscores the burdens of prior authorization on both patients and providers; MedPAC has a public meeting to address payments for Part B; and Rachael Novick, a patient from Ohio's 10th Congressional District, shares how prior authorization and step therpay changed her life for the worse. Patients Rising Podcast: Have Health Plans Abandoned Rare Disease Patients? Fierce Healthcare News Article: CMS finalizes changes to Medicare Advantage star ratings, prior authorization reforms Patients Rising Stories: Psoriasis, Step Therapy, Community, Advocacy  

In this Episode, Jennifer Kennedy talks to Katie Wehri as they walk through NAHC's Hospice and Palliative Care Report from December, giving everyone a list of what needs to be on providers' radar in 2023. From VBID, Hospice Cap and MedPAC recommendation, Telehealth recertification through 2024, and Hospice fraud.  Register Now! This two-and-a-half-day workshop will focus on giving you all the tools you need for operational excellence with a goal of patient-centered care. This is a hands-on, skill-based workshop that is focused in on the Hospice industry and has a tailored approach to increasing agency success. Learn more about Age-Friendly Health Care Connect with us - LinkedIn, Twitter, YouTube, Facebook Leave us a Google Review Subscribe to our emails Visit our website

In this episode, Melissa Brown, breaks down the concerning information in the MEDPACs report that was just released. 

Gas prices are heading straight to the stratosphere. Inflation is the elephant in the room. And there's a growing concern in Medicare when it comes to physician payments. Here's why: Medicare cuts are pending, including the PAYGO 4 percent, starting in 2023.What's more, deductions from reinstated sequestrations are on the rise. There's also an expected lowering of the 2023 conversion factor, the possible ending of the public health emergency (PHE) windfall of telehealth payment parity, as well as MedPac saying that a physician raise generally is not necessary. So, the burning question: where is all the money going from Medicare? For an exclusive backgrounder on this timely and worrisome topic, register now to listen to the next live edition of Talk Ten Tuesdays. That's when nationally recognized physician coder, auditor, and consultant Terry Fletcher will have insight and perspective on the potential impact on your practice, moving forward. The live broadcast will also feature these other segments:Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC will report on the latest coding news.Mental Health Report: Internationally recognized and award-winning psychiatrist H. Steven Moffic, MD, will begin a new series on mental health. His focus this Tuesday will be on PTSD, a particularly relevant segment given that June is PTSD Awareness Month.News Desk: Timothy Powell, CPA, a consultant with Besler, will anchor the Talk-Ten-Tuesdays News Desk.Journaling John: John Zelem, MD, FACS, founder and CEO for Streamline Solutions Consulting, will continue with his second journal entry in this new segment.TalkBack: Erica Remer,MD, founder and president of Erica Remer, MD, Inc. and Talk-Ten-Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.Sitting in for executive producer and program host Chuck Buck will be Dennis Jones.

In this Money Tree Series Episode #2, Coach JPMD discusses 3 things healthcare providers should know about Medicare Advantage payments from the Center for Medicare and Medicaid Services (CMS).  Private companies contract with CMS to provide medical services for patients enrolled in Medicare. These companies are entrusted with hundreds of millions of taxpayer dollars and healthcare providers have the opportunity to care for patients and generate a good revenue stream in this practice niche. Coach JPMD uses information gathered from MedPAC and has created a free link to the resource document.  Enjoying the podcast?  Please consider leaving a short review on Apple Podcasts/iTunes.  It only takes a minute, and ratings and reviews are extremely helpful in getting the word out about the show and are greatly appreciated by me! Keep Practicing Impossible!Show Notes

Lawmakers are lining up to decide what Medicare will pay for after the COVID-19 public health emergency (PHE) is over – and they are looking confident that they have the votes to include it in a must-pass piece of legislation this year.Congress also seems to be on board with a plan to allow millions of Medicare patients to continue to video-chat with their physicians once the PHE is over. The Medicare advisory committee, MedPAC, has recommended a cautious approach, however, that would temporarily cover some telehealth services for all beneficiaries, but revert to lower reimbursement rates post-crisis for virtual appointments compared to in-person. There's also concern that a rapid expansion could prompt more fraudulent billings: the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) estimates that $4.5 billion in telehealth-related fraud was lost last year, which is why Part B evaluation and management (E&M) services provided during the PHE is on the current OIG 2021 Work Plan.Nationally recognized physician auditor, educator, and coder Terry Fletcher will report on this developing story during the next live edition of Talk Ten Tuesdays.The live broadcast will also feature these other segments:Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will have the Talk Ten Tuesdays Coding Report, along with the broadcast's weekly Listeners Survey.RegWatch: Stanley Nachimson, former Centers for Medicare & Medicaid Services (CMS) career professional-turned-well-known healthcare IT authority, will report on the latest regulatory news coming out of Washington.News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc., and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.

There is a lot of avoidable waste in the basic delivery of care, but this waste is actually an asset for alternative payment models (APMs). Unlike the fee-for-service model that discourages eliminating waste and low-value care because it loses money, APMs can get paid to eliminate that same waste and improve healthcare quality, says health economist @Michael_Chernew, PhD, professor of #healthcare policy at @harvardmed school, and chair of MEDPAC @medicarepayment. In a timely interview with APG President and CEO @DonCrane, Professor Chernew talks about the premise of his recent JAMA article, “A Path Forward for Alternative Payment: Build a Portfolio Not a Garden.” @AmerPhysGrps #Medicare #valuebasedcare  

William Morice II, M.D., Ph.D., chair of the Department of Laboratory Medicine and Pathology at Mayo Clinic and president of Mayo Clinic Laboratories, joins the "Answers From the Lab" podcast for his weekly leadership update. In this episode, Dr. Morice and Bobbi Pritt, M.D. discuss a recent report to Congress that outlined potential laboratory fee reimbursement changes, and what that could mean for labs going forward.

Join Health Affairs Insider.June is shaping to be a busy month in the health policy space. Two major events happened this week alone.First, the Affordable Care Act (ACA) survived its latest legal challenge in the Supreme Court. After facing many court challenges, the 2010 policy is still the law of the land.Also, the Medicare Payment Advisory Commission (MedPAC) sent a report to Congress on Tuesday making many recommendations to revamp Medicare payments. It's recommendations are not binding but the group is influential in the health policy community. In the report, the advisory group called for streamlining alternative payment models (APMs) and changing how Medicare Advantage benchmarks are calculated.On this episode of Health Affairs This Week, Senior Editors Leslie Erdelack and Jessica Bylander discuss the recent Supreme Court decision and try and demystify what MedPAC is and highlight some of the agency's recommendations from the recent report. Related Links: MedPAC June 2021 Report Affordable Care Act Survives Latest Supreme Court Challenge (The New York Times) LIVE with Liz Fowler, Director Of The Center for Medicare & Medicaid Innovation (A Health Podyssey) Private Equity Investments In Health Care: An Overview Of Hospital And Health System Leveraged Buyouts, 2003-17 (Health Affairs) Understanding Private Equity Investment In Hospitals (A Health Podyssey) Subscribe: RSS | Apple Podcasts | Spotify | Castro | Stitcher | Deezer | Overcast

In this episode, we sit down with Mark Miller, Executive Vice President of Health Care at Arnold Ventures and the Former Executive Director of MedPAC. We'll explore how Mark defined the position of executive director at MedPAC, significantly influenced federal health policy at MedPAC, his current influence at Arnold Ventures, and a discussion of his purpose and agenda.

Host JC Scott speaks with Amy Bricker, Senior Vice President of Health Services Supply Chain at Express Scripts and previous commissioner for MedPac. November is National Diabetes Month, and the discussion this week revolves around how PBMs help keep the costs of insulin down and improve patient care. Getting Support for Diabetes in AmericaList prices for insulin have not gone down, leaving some diabetes patients with high costs for the live-saving medicine, either as high insurance co-pays or deductibles or the high cost of insulin itself. While there have been some improvements in delivery technology and formulations, Bricker points out that these innovations don't justify the high prices pharmaceutical companies continue to charge. To some extent, the lack of competition in the market is causing this, which is why PBMs are so important.How Express Scripts is HelpingLast year Express Scripts saw a 5% decrease in spending from those enrolled in their clinical solution, thanks in part to discounts but more critically through leveraging formularies, utilization, and diabetes care value program that ensures patients get complete care, communicated in ways that work best for them.The Effects of Coupon and Discount ProgramsBricker argues that well-intentioned programs like 340B are out of control and no longer helping patients. She believes this and other coupon programs require major reform or even elimination, because they operate in the background and disrupt formularies.CMS Part D Senior Savings ModelThe Centers for Medicare & Medicaid Services established a voluntary Part D plan that limits insulin's cost share to $35 a month per beneficiary. Approximately a third of Medicare beneficiaries are affected by diabetes and companies such as Express Scripts and Cigna will participate in this program. While Medicare Part D definitely needs reform, steps such as these are a great starting point and crucial to those within the program.What Does the Future Look Like?Bricker says we need to encourage manufacturers to lower prices, but that needs to be encouraged by legislation or regulation — while always keeping the patient top of mind. She advocates for Part D reform to establish more programs like the #35/month cost share.You can subscribe to The Pharmacy Benefit on Spotify, Google Podcasts, Apple Podcasts, and all other major platforms.

In this episode of the MatrixCare Podcast, Navin Gupta, SVP of the Home and Hospice Division at MatrixCare, sits down with Bill Dombi, President of the National Association for Home Care & Hospice (NAHC) to discuss the future of health care and more specifically, home care. With reimbursement changes, Navin and Bill explore how Medicare payments will be impacted going forward and what leaders should pay attention to. Listen in as they talk about how providers leverage solutions like telehealth and remote patient monitoring (RPM) during COVID-19 to solve issues such as isolation and more; creating an experience that is both high-touch and high-tech. Show resources Learn more about MatrixCare solutions at https://www.matrixcare.com/ Read the transcript of today’s episode. For more information on NAHC, please visit https://www.nahc.org/ Connect with our host and guest on LinkedIn: Navin Gupta Bill Dombi Review the questions we discussed Many of us in healthcare/senior care have had a pivotal moment where we decided this was the career for us. Share with us your journey in healthcare and home care specifically to NAHC. What do you see as the major positive and negative forces/dynamics that have emerged from the Covid-19 pandemic? The level of interest around the use of technology has increased – particularly remote patient monitoring (RPM) and telehealth – where is Congress headed in the use of RPM and telehealth? Will the policy changes that occurred as part of the Covid-19 response be made permanent? What is the outlook for Medicare payments in the future as we continue and then hopefully emerge from the stresses of the pandemic? Hospice –Medicare Advantage (MA) carve in – what should leaders pay attention to here and what does the pathway look like? What should we expect in the near-term relative to legislative and regulatory action on the carve-in? What do you see as the respective roles of HHAs and hospices in palliative care? What will it take from Washington to make community-based palliative care a reality? There is talk about finding a way for care at home to be used as a substitute for care in nursing facilities. What would it take to create a true SNF at home option? Is there interest in Washington in such a concept? MedPAC has issued recommendations to Congress on some matters that directly would affect home health and hospice, for example, a post-acute care unified payment model, rate cuts, and a reduction of the hospice cap. What is the outlook for these matters? The content in this presentation is for informational purposes only and is provided “as-is.” Information and views expressed herein, may change without notice. Given the fluidity of the current regulatory environment due to the pandemic, we encourage you to seek as appropriate, regulatory and legal advice on any of the matters covered in t

This month's episode: MedPAC public meeting Disclosures of affiliation implementation of Phase I Various settlements and audits Thank you for joining me on 10-Minute Check Up! Please note the podcast is for informational purposes and is not intended to provide legal advice. The opinions expressed during the 10-Minute Check Up are my own and should not be attributed to any other individual or organization.

Warner Thomas is president and CEO of Ochsner Health based in New Orleans, Louisiana, and he recently completed a six-year term on MedPAC. He has been with Ochsner for over 20 years, previously serving as president and COO. Between hurricane Katrina, the COVID-19 pandemic, and sitting at the table for discussions about Medicare and other federal healthcare policies, Thomas has comprehensive perspective on how the healthcare system became what it is today, and has a clear point of view for the future of healthcare. In this conversation for the Art of Change, Thomas talks with Jarrard Inc. partner and chief development officer Anne Hancock Toomey about that point of view. They discuss the importance of scale, the role of mergers and acquisitions, the value of a strong digital footprint, and the mindset of hospital and health system CEOs today.

Not all news is negative news—even in the healthcare sector. Premium increases and doctor shortages and pandemic scares are the current fair for most American medical executives. It's enough to make a hospital honcho hang his or her head in despair. However, every now then, some dim ray of light shines through the darkness, a small sign that there may be some good news on the horizon for America's hospitals.

written post at https://healthy-skeptic.com/2020/03/18/more-from-medpacs-annual-report-to-congress-2/

written post at https://healthy-skeptic.com/2020/03/17/medpac-report-to-congress-3/

written post at https://healthy-skeptic.com/2020/03/19/the-rest-of-the-medpac-report-to-congress/

On this episode of the ASC Podcast with John Goehle, we have a special roundtable discussion with the staff of AHS about current regulatory issues, activities and observations including discussions about education programs, life safety issues, challenges for owners new to the ASC world and benefits of computerizing credentialing and employee files. We also follow-up on our discussion of the March 2019 MedPac Report, talk about the new AAAHC Advanced Orthopedic Certification and update you on upcoming activities in the ASC world.   Visit the ASC Podcast with John Goehle Website   Support the ASC Podcast with John Goehle by becoming a patron member. Get AEU Credits for Listening to the Podcast!   Purchase John’s Books Go to the ASC Podcast Store

On this episode of the ASC Podcast with John Goehle, We review the March 2019 MedPac Report, provide Clarification on some pharmacy issues, discuss ACLS and BLS requirements, Remind listeners about upcoming Medicare Quality Reporting Deadlines, discuss ASC Startup Challenges, review Infection Preventionist Requirements, and do a focus segment on Malignant Hypothermia.      Visit the ASC Podcast with John Goehle Website   Support the ASC Podcast with John Goehle by becoming a patron member. Get AEU Credits for Listening to the Podcast!   Purchase John’s Books Go to the ASC Podcast Store

The Medicare Payment Advisory Commission (MedPAC) recently published a presentation titled Evaluating an episode-based payment system for post-acute carethat explains the committee's thinking about a bundled payment model for post-acute care. Soon after, Becker's highlighted 5 key points from the presentation. We spoke with Bruce Greenstein to get his insight on the post-acute care landscape and, more specifically, the potential value of bundling post-acute care services. Greenstein is the Executive Vice President and Chief Strategy & Innovation Officer at LHC Group, as well as the former Chief Technology Officer of the US Department of Health & Human Services. Check out the full post with quotes here.

In this episode, John reviews what happened in the world of health care this past week, specifically the results of a study published on March 11 in the JAMA Internal Medicine on Home Health and how it can provide a significant amount of savings when compared to other discharge locations. Home health care agencies save Medicare millions of dollars compared with skilled nursing facilities, despite higher readmission rates, according to the study. Researchers used Medicare claims data from 2010 through 2016 to compare the results of more than 17 million hospitalizations, where 39% were discharged to home health and 61% to skilled nursing. This massive study—17 million cases over a seven-year period—demonstrates the enormous potential value home health care can bring to Medicare and other payers. About Darwin Research Group Darwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin’s client list includes forward-thinking biopharmaceutical and medical device companies, as well as health care providers, private equity, and venture capital firms. The company was founded in 2010 as Darwin Advisory Partners, LLC and is headquartered in Scottsdale, Ariz. with a satellite office in Princeton, N.J.

The latest policy news from Director of Policy and Advocacy Alex Bardakh, including a look back at another successful Hill Day. * AMDA-On-The-Hill podcasts are not eligible for CMD credits Questions? Email Alex at abardakh@paltc.org Related Resources: MACRA, MIPS and APMS: Current Requirements and Proposed Changes Advanced Care Planning Series Guide to PA/LTC Coding, Reimbursement, and Documentation

MedPAC eyes 'incident to' billing.  (http://bit.ly/2AbQBP3) Stepdown to oral ciprofloxacin looks safe in gram-negative bloodstream infections. (http://bit.ly/2CKC0wx) Nasal cannula device may be an option for severe COPD. (http://bit.ly/2IX5aZR) Brexanolone injection quickly improves postpartum depression. (http://bit.ly/2CLuLVs)

Suzanne dials up her "guru" on provider payment- Bob Berenson of the Urban Institute. Bob draws on his 20 years experience as an internal medicine doctor, before moving to policy work with CMS and MedPAC, to answer Suzanne's questions about the prevalence of mis- and missed- diagnoses in health care, as well as other root causes of the estimated $750 billion spent on unnecessary or inappropriate care each year. He previews part of his presentation for CPR's upcoming Virtual Summit by exploring the Institute of Medicine's report on this critical area that is top of mind for many employer-purchasers. https://www.urban.org/research/publication/doing-better-doing-less-approaches-tackle-overuse-services

Telemedicine, considered to be an electronic lifeline for rural healthcare, is a rapidly growing sector of health care in the United States that has recently gone through a significant expansion. Returning to Monitor Mondays to provide an update to his October 2017 report on the CHRONIC Act and MedPac's report on Telemedicine, is attorney Dale C. Van Demark, a partner at McDermott Will & Emery in Washington, D.C. The episode rundown also includes: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO for Nancy Beckley and Associates, returns to report on all the latest hot topics and the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility. 340B Update: Monitor Mondays national correspondent Timothy Powell, CPA, reports on the status of the controversial 340B drug program. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer continues to report on the vexing issue of Medicare Advantage. Spencer is a senior healthcare consultant for DoctorsManagement. Monitor with us™

Dan Kirkpatrick, Founder and Managing Partner of Partners in Improvement, works with physician practices, particularly emergency medicine groups, to improve their operational efficiency, financial standing and leadership. We discuss a range of topics including the foundation of a successful medical practice, deficits in clinician training in terms of healthcare business expertise, MedPAC and MIPS, and the future of the hospital.

Listen NowThis past November 16 CMS published the agency's final 2018 MACRA (Medicare Access and CHIP Reauthorization Act) rule (at 661 federal register pages).  MACRA, authorized in 2015, formulates how approximately 1.5 million Medicare Part B physicians and other eligible clinicians are reimbursed.  Annual MACRA proposed and final rule making is closely monitored since the law's MIPS (Merit-Based Incentive Payment System) and Advanced Payment Model (APM) pathway are the two formulas CMS uses to annually update Fee for Service Medicare Spending (Part A and Part B) and how eligible clinicians under Medicare Advantage (Part C) can participate in MACRA's payment updates or rewards.    During this 24 minute conversation Ms. O'Brien discusses the MIPS two threshold exclusions, MIPS quality and cost components, the composite performance score (CPS), the Advanced APM (AAPM) pathway, the anticipated 2018 Medicare Advantage (MA) AAPM demonstration and criticisms of MACRA implementation, specifically MedPAC's.  Ms. Kristen O'Brien serves as Counsel at the law firm, Olsson, Frank and Weeda (OFW), in their Health Industry and Regulatory Practice.  Prior to OFW, she served as Senior Legislative Counsel with the American Medical Association and prior still worked in private practice.   Ms. O'Brien's experience also includes serving as professional staff for the Senate Finance Committee under Former Committee Chair, Senator Max Baucus (D-MT), where she worked on health and environmental issues as well as financial reform.  Ms. O'Brien received her J.D. cum laude from Georgetown University Law Center and her undergraduate from Cornell University that included study at the London School of Economics.The 2018 final MACRA rule is at: https://www.federalregister.gov/documents/2017/11/16/2017-24067/medicare-program-cy-2018-updates-to-the-quality-payment-program-and-quality-payment-program-extreme. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

For many healthcare professionals, Dr. Mary Naylor and her transformative Transitional Care Model (fondly referred to as the “Naylor Model”), have become synonymous with care transitions and readmission prevention.  Adapted from a care transitions program for low birth weight infants, Dr. Naylor created one of the most influential models for caring for high-risk older adults.  With amazing results in hundreds of healthcare organizations across the country, it has become one of the standards for managing a high-risk patient population.  Now chair of the Care Culture and Decision-Making Collaborative through the National Academy of Medicine, Dr. Naylor continues to shape the future of healthcare through policy initiatives and research, including her recent 6-year term on MedPAC.

MedPAC recently released it's new report to Congress. In the chapter on Hospice, one of the issues they bring up is live discharge. Hear Judi and Jennnifer discuss some of the reasons for the focus on live discharges and offer insight and tips into proper compliance. 

Listen NowUnitedHealth Group and other major health care insurers' participation in state health insurance marketplaces has caused increasing concern Affordable Care Act-created state marketplaces are becoming unstable.  Moreover, this means health care insurance consumers will have little or possibly no choice in selecting an insurance provider.  For example, in 2016 30 percent of counties throughout the US had only two insurers participating in state marketplaces (10 percent of counties had one). Beyond consumer choice, the absence of marketplace competitors threatens premium affordability.   Creating new and stable insurance marketplaces, that is by definition challenging to accomplish, has been made additionally difficult by Congressional Republican opposition to the ACA's risk corridor program, that along with risk adjustment and reinsurance, is designed to mitigate unavoidable plan financial losses in trying to appropriately price premiums for a population with an unknown health history.             During this 25 minute conversation Professor Hoadley discusses contributing factors to state marketplace instability andmoreover four methods by which the insurance marketplaces can be stabilized: a "fall back plan;" state participation requirements; extending risk corridors and reinsurance; and, methods to improve marketplace enrollment. Dr. Jack Hoadley is a Research Professor at Georgetown University's Health Policy Institute where he studies health financing topics including drug pricing, out-of-pocket costs and the dynamics of insurance making decisions.   In 2015 Professor Hoadley was reappointed to a second, three-year term as a Medicare Payment Advisory Commissioner (MedPAC) member.  Prior to his work at Georgetown, Dr. Hoadley held staff positions at DHHS, i.e., within the Assistant Secretary for Planning and Evaluation (ASPE) office, at MedPAC, the Physician Payment Review Commission and at the National Health Policy Forum.   Professor Hoadley has published widely on health care financing and pharmaco-economics topics and has provided testimony to numerous federal Congressional and other government panels.  He earned his Ph.D. in political science. Jack Hoadley and Sabrina Corlette's August 2016 paper, "Strategies to Stabalize the Affordable Care Act Marketplaces: Lessons from Medicare," is at: http://www.rwjf.org/en/library/research/2016/08/strategies-to-stabilize-the-affordable-care-act-marketplaces.html. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowMeasuring health care quality and outcomes effectively and efficiently remains a daunting task.  Quality measures are largely seen as too process versus outcome focused, substantially irrelevant to patients and insufficiently aligned between and among payers.  Measuring care or care quality, ironically, can and does detract from actual care delivery, can have no relationship to spending efficiency and on its own is costly.  A recent article published in Health Affairs found physician practices spent over $15 billion in 2014 in reporting quality measures.  Concerning the Medicare program's quality measurement activities, MedPAC in a 2014 report to the Congress went so far as to state, "Medicare's current quality measurement approach as gone off the rails." During this 23 minute conversation Dr. Burstin briefly describes the work of the National Quality Forum (NQF), the work done by the CMS-led Core Measure Collaborative, quality measurement under the CMS proposed MACRA (Medicare Access and CHIP Reauthorization Act) rule, risk adjusting measures for socio-demographic factors, the role of PREMS and PROMS or patient reported experience and outcome measures and correlating care quality and spending or measuring for healthcare value.  Dr. Helen Burstin is the Chief Scientific Officer at the NQF.  Prior to serving in her current position, Dr. Burstin was NQF's Senior Vice President for Performance Measurement.  Prior to NQF Dr. Burstin was the Director of the Center for Primary Care at the DHHS Agency for Healthcare Research and Quality (AHRQ).  Prior to AHRQ, Dr. Burstin was an Assistant Professor at Harvard Medical School and the Director of Quality Measurement at the Brigham and Woman's Hospital in Boston.  Dr. Burstin has published more than 80 articles and book chapters on quality, safety and disparities.  She was recently selected as a 2015-2016 Baldridge Executive Fellow.  She currently is also is a Professorial Lecturer in the Department of Health and Policy and a Clinical Associate Professor of Medicine at George Washington University and serves as a preceptor in internal medicine.For information concerning NQF go to: http://www.qualityforum.org/Home.aspx This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowThis past July CMS announced a proposed demonstration that would either reduce or increase a Medicare home health agency's reimbursement based on quality performance.   With a rapidly aging and growing Medicare population home health utilization and costs have risen significantly over the past decade.  Per MedPAC, between 2000 and 2012 total Medicare home health spending increased 64 percent.  However, home health agency quality performance has been limited.  For example, again per MedPAC, less than half of all Medicare home health patients in 2013 showed improvement in medication management and only 65 percent showed improvement in pain management.    During this 22 minute discussion Ms. Mason explains the several, if not numerous reasons, why CMS announced this demonstration, how it will work, e.g., how quality will be measured or what quality metrics will be used, what are the specific financial incentives, in what states the demo will be conducted, when it will begin and for how long, and what are some of the perceived pros and cons of the demonstration as proposed.   Sherill Mason is currently Principal, Mason Advisers, where she provides strategic planning, program development and operations analysis for post acute care providers including senior living and nursing home facilities, home health, hospice, long term acute care hospitals, in patient rehabilitation facilities, and long term care pharmacy.  Previously, Sherill she served as a Vice Presient to the Marwood Group, a healthcare industry consultant, as Senior Vice President at Sunrise Senior Living and as a Director at KPMG.   Among other current professional activities Sherill currently is a Guest Lecturer at the University of Pennsylvania School of Nursing.  She received her RN diploma and training at the Englewood Hospital School Nursing and a BA in American Studies from Eckerd College.  For information regarding CMS's proposed value-based home health demonstration go to: https://www.cms.gov/center/provider-Type/home-Health-Agency-HHA-Center.html This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Eric Dick, MMA's manager of state legislative affairs, provides information on and reasons to join MEDPAC, the MMA's political action committee.

Listen NowSince the 1970s Medicare beneficiaries have had the option of receiving their Medicare benefits via private health insurance plans.  Today 27% of Medicare beneficiaries, or 13.3 million seniors, are enrolled in these private plans.  MA program growth in the past few years has been rapid, enrollment almost tripled between 2003 and 2012 and the program is estimated to add another 1.5 million beneficiaries this year.  Medicare, which pays MA plans a capitated rate rather than on a FFS basis, reimbursed MA plans $136b. in 2012.  The program has not been without controversy largely due to payments or over payments made to MA-participating plans.   For example, just prior to the 2010 passage of the Affordable Care Act the CBO estimated equalizing payments between Medicare Advantage programs and the traditional fee for service Medicare program would generate $170 billion in savings over the ten year budget window.   Despite ACA reforms to MA, MedPAC (the Medicare Payment Advisory Commission) estimated in 2013 overall payments to plans will equal $6 billion more for MA enrollees than would have been paid to cover the same enrollees in Medicare fee for service.  Dr. Biles begins this 27-minute interview by explaining how private insurance plans participte in the MA program including how they bid for services against county benchmark rates.  He explains why MA participation has nearly tripled over the past decade, what MA payment and quality incentive reforms were included in the Affordable Care Act including the star bonus program, MA risk adjustment, the quality of care provided by MA plans and possible future reforms to the MA program are also all discussed.       Since 2000 Dr. Brian Biles has been a Professor in the Health Policy Department at The George Washingtion University and is also a Senior Vice President at the Commonwealth Foundation. Previously Dr. Biles served for seven years as staff director of the House Ways and Means Subcommittee on Health, served later as Deputy Assistant Secretary for Health at the Department of Health and Human Services in the Clinton Administration and also served as Deputy Secretary for Maryland's Department of Health and Mental Hygiene.  Among other professional activities, Dr. Biles chairs the Medical Administrators Conference and is a Fellow of the New York Academy of Medicine and an Invited Lecturer at the Kennedy School of Government at Harvard University.  Dr. Biles received his Doctor of Medicine and Bachelor of Arts with honors from the University of Kansas and he holds a masters degree in public health from Johns Hopkins University. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowIn 1997 the Congress reformed how it pays physicians under Medicare.  The new formula was termed the "sustainable growth rate" (SGR).   The impetus for the reform was to control better Medicare cost growth.   (Medicare physician payments now exceed $100 billion annually).   Largely because of the concern physicians would limit seeing Medicare patients if their Medicare reimbursement rates were cut, the Congress has not enforced the SGR since 2002.   Despite the realization the SGR is unalterably broken, the Congress has been unable or unwilling to amend the law.  Though the upaid SGR tab is presently $138 billion this amount is substantially less than previous calculations that approached  $300 billion (due to a recent decline in Medicare utilization).  With debt and deficit reduction talks expected to re-emerge over the next few months will the Congress finally find the wherewithal to fix the docs?    The podcast begins with Dr. Berenson addressing the genesis of the SGR and then proceeding to explain why Congress has routinely ignored enforcing the SGR since 2002.  The discussion proceeds to explain why/how doing away with the SGR would currently cost $138 billion.   What effect the SGR has (still) had and what recent MedPAC and a bipartisan House proposal (Reps. Schwartz and Heck) call for in creating a new payment method while offsetting the accumulated $138 billion.  Dr. Berenson next discusses his recent Congressional testimony where he identified ways to improve or mend Medicare fee for service payments, e.g., reducing distortions in, or improving the accuracy of, physician service relative value units (RVUs), improving payment for evaluation and management services.  He argues in sum for global payment or partial capitation.  Dr. Berenson concludes by noting current Congressional bi-partisan support for SGR reform though noting reform proposals would have to identify some mechanism/s to control for volume growth and an indication that quality and efficiency would be improved.           Dr. Robert Berenson is currently a Fellow at the Urban Institute where his research work concerns health care policy, particularly Medicare.  From 1998-2000, Dr. Berenson was in charge of Medicare payment policy and private health plan contracting in the Centers for Medicare and Medicaid Services (CMS). Previously, he served as an Assistant Director of the Carter White House Domestic Policy Staff.  Dr. Berenson became a Commissioner of the Medicare Payment Advisory Commission (MedPAC) in 2009 and in 2010 became MedPAC's Vice Chair.  Dr. Berenson is a board-certified internist, for the last twelve years practicing in Washington, D.C.  He is Fellow of the American College of Physicians and the author of numerous research publications.  He is a graduate of the Mount Sinai School of Medicine and on the faculty at the George Washington University Schools of Medicine and Public Health and the Fuqua School of Business at Duke.Dr. Berenson's February 2013 Energy and Commerce Committee testimony can be found at:  http://democrats.energycommerce.house.gov/sites/default/files/documents/Testimony-Berenson-Health-SGR-Medicare-Payment-2013-2-14.pdfDr. Berenson's (et al.) March 2013 Urban Institute paper, "Can Medicare Be Preserved While Reducing the Deficit?" is available at:http://www.rwjf.org/en/research-publications/find-rwjf-research/2013/03/can-medicare-be-preserved-while-reducing-the-deficit-.html This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com