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New 340B Guidelines Target Program Abuses

November 3, 2017 BY Alanna Moriarty

New 340B Guidelines Target Program Abuses

The Centers for Medicare and Medicaid Services (CMS) announced changes to its 340B Drug Discount Program, effective January 1, 2018. The primary difference in the program is that drug payments to participating hospitals will be cut. Under the original plan, CMS reimbursed hospitals at the average drug cost plus 6 percent. Under new guidelines, hospitals will be reimbursed at 77.5 percent of the average drug price.

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Will HCAHPS Stars Light the Way to Healthcare Transparency?

In July 2016, the Centers for Medicare and Medicaid Services (CMS) introduced a ratings system as part of their Hospital Quality initiative. The aim of the new program is to meet consumer demand for objective, comprehensible data on the performance and care quality of individual hospitals. Hospitals are required by CMS to distribute a patient satisfaction survey called the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The results are then converted into an overall star rating. HCAHPS star ratings make it easier for patients to compare hospitals, as the scores account for procedure data, patient experience, efficiency, and other factors.

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Skilled Nursing Facility Reimbursement: Trouble Ahead?

September 21, 2017 BY Alanna Moriarty

Skilled Nursing Facility Reimbursement: Trouble Ahead?

The American Hospital Association (AHA) is urging CMS to implement an alternate Medicare reimbursement model for skilled nursing facilities (SNFs) before a new clinical groupings model is in place. The current model of Resource Utilization Groups (RUGS) has been criticized as incentivizing the overutilization of resources, as well as demanding reimbursements that exceed actual care costs.

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CMS Proposes Change in HHA Reimbursements

September 13, 2017 BY Alanna Moriarty

Earlier this summer, the Centers for Medicare and Medicaid Services ( CM)S proposed payment updates for various sites of care. One of the most dramatic proposals will affect the home health agency prospective payment system (HHA-PPS). One of the primary differences in the payment update emphasizes a shift away from using therapy services as a replacement for patient acuity. HHAs will now be receiving reimbursements based on patient information and clinical metrics.

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ACA Physician Shortage is Less than Once Feared, but a Real Problem in Some States

A new study appearing in JAMA Internal Medicine suggests that, contrary to initial expectations, the ACA Medicaid expansion did not lead to a significant physician shortage among primary care providers, at least in 10 states surveyed. According to the study, appointment availability increased for Medicaid patients by 5.4 percent from 2012 to 2016, despite a rise in the Medicaid population. While good news, some states faced more serious access barriers than others and the long-term demand for physicians is still projected to outstrip supply.

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