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Hospital Perspective Surprises Market

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Hip and knee replacements can improve quality of life and provide significant relief for those suffering with severe arthritic conditions. With Americans living longer than ever, total joint replacements represent one of the most commonly performed surgeries in the US, accounting for more than one million procedures annually.This number is expected...
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Coaching & Care Coordination for Chronic Care Management Works

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Patients with multiple chronic conditions have complex needs and are among the most challenging patients for a primary care practice to manage. One solution being adopted by practices to address this challenge is non-face-to-face care coordination—which entails motivating and coaching patients through a comprehensive plan of care covering physical,...
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Most ACOs Would Flee Medicare Program if Pushed to Take on More Risk

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A huge chunk of organizations says they would leave the Medicare Shared Savings Program if they're forced to take on financial risk, which could slow the system's transition to value-based care.  It’s also unclear whether the Centers for Medicare & Medicaid Services (CMS), which oversee the program, will make any new changes. A recent letter from the agency offered a vague response about a possible drop in participation, even as another agency indicated it is reviewing proposed changes to th...
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Reimbursement, Quality Scores & Risk Adjustment Improve HCC Practices

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Hierarchical condition categories (HCCs) reveal the severity, complexity and interaction of member conditions. They are used by the Centers for Medicare and Medicaid Services (CMS) to adjust risk scores that determine payment for Medicare Advantage (MA) beneficiaries. With CMS leading the way, additional government and commercial payers leverage HCCs to drive quality ratings, shared savings, risk scores and payment adjustments for a broad range of value-based contracts and activities. As HCCs ri...
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Administration Unveils ‘American Patients First’ Plan on Drug Costs

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The administration unveiled it’s policy plan to tackle the rising cost of drugs. The " American Patients First " blueprint builds on the administration’s 2019 budget proposal and calls for changes in Medicare Part D alongside a focus on price transparency.  This "American Patients First" policy plan tackles the rising cost of drugs. The President called the proposal "the most sweeping action in history to lower the price of prescription drugs for the American people" at an event to mark the rele...
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Advanced Bill Allowing Veterans to See More Private Health Providers

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A US House of Representatives panel has advanced legislation to allows more veterans to see doctors outside the Veterans Affairs system.  The bill, the VA MISSION Act , passed the House Veterans Affairs Committee 20-2. This bill would allow more veterans to go outside the VA healthcare system and use private-sector doctors when VA medical centers can't provide appointments within a month, when veterans have to drive more than 40 minutes to access care, or when care is determined inadequate by VA...
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Waiver – Medicare Advantage Expands

Recently, the Centers for Medicare & Medicaid Services (CMS) announced a plan to expand products and services covered by Medicare Advantage plans. The department has revised its definition of “primarily health-related” benefits to help Medicare Advantage enrollees lead more independent lives. Some of the new services could include minor home modifications such as grab bars, transportation to and from medical appointments, and home-delivered meals. A prescription is not needed for...
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Medicaid Program Tilting Out of Control From ACA Influence

At least 21,000 Americans have died waiting to enroll in Medicaid, thanks in part to the expansion of the ACA government healthcare program, based on research reported by the Foundation for Government Accountability (FGA). See “ The Medicaid Waiting List Crisis ” report The report focuses primarily on the waiting lists generated by the Home and Community-Based Services (HCBS) waiver program. That program, created in 1981, allows states to extend Medicaid services to individuals in th...
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Administration Pushes Conservative Goals in Health-Care Market Changes

Insurers May Now Charge Higher Premiums to Seniors The administration would like to see the ACA market to reign in some features, such as allowing insurers to charge higher premiums to older people.  Suggested changes include: Allowing insurers to charge older people five times as much as younger people Expanding access to health savings accounts and increasing the amount of money that people can contribute to them Supporting a permanent congressional appropriation for subsidies to insurance com...
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States Evaluate Establishing Their Own Health Insurance Mandates

Congressional Repeal of ACA’s Individual Mandate Leaves A Number of Lawmakers Examining Replacement Measures At least nine states are considering their own versions of a requirement that residents must have health insurance, a move that could accelerate a divide between states trying to shore up the ACA and other states intent on eliminating requirement. Congressional Republicans in December repealed the individual mandate, a pillar of the ACA, as part of their tax overhaul. That cheered t...
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