Government Shutdown 101: How Will it Affect You?

There has been a lot of speculation over the weekend about a possible government shutdown.  The question for healthcare providers remains: what will happen to Medicare, Medicaid, and other ACA related operations if there is a shutdown? Fortunately, funding for Medicare, Medicaid, and the ACA is mandatory and there will be no immediate impact for beneficiaries unless the shutdown continues for weeks.   However, there may be delays for Social Security disability recipients who are applying for Medicare.  There may also be delays in claims processing, audits, and administrative functions.

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Monday Morning Recap

The HMS Healthcare Management Solutions Monday Morning Recap reviews some of the top stories and healthcare highlights you may have missed last week.

The Downside to Healthcare Job Growth

Although most industries are suffering in this economy, the healthcare industry continues to grow.  A new article in the Harvard Business Review suggests the growth is actually a sign of the industry’s inefficiencies.  According to the article, jobs are added faster than demand which leads to overstaffing and lower salaries.  Most of the growth was in non-doctor workers which is believed to contribute to a decline in productivity.

Healthcare is expected to grow in 2014 and experts agree that productivity can be increased if too many jobs aren’t added.  This past year, the healthcare industry began cutting jobs. As of now, the future looks uncertain. In order for the industry to succeed, there needs to be a transformation on both the supply and demand sides; better reimbursement models and a more efficient labor force are recommended.

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Connecticut Premiums under ACA Expected to be Fourth Most Expensive in U.S.

A new report issued by the U.S. Department of Health and Human Services on health insurance premiums ranks Connecticut as the fourth-most expensive in the country.   Officials from Connecticut’s exchange, Access Health state that they cannot verify the figures in the report, although they’re not surprised given that CT currently ranks as the fourth highest in medical costs in the U.S. The average premiums for insurance in Connecticut are estimated to be in the $340-$426 range.

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Getting Paid: Payment Models in Healthcare

In the ever evolving landscape of healthcare, providers are starting to wonder how the transition is going to fare-especially when it comes to getting paid.  Proponents of value-based care say that it will lead to lower costs, better care, and improved patient outcomes although they acknowledge that the conversion may be a difficult one.  Advocates point out that value-based care should be viewed as an opportunity rather than a problem that can lead to lower expenses and better care.  However, not everyone agrees and some argue that the unique nature of each patient complicates the idea of making all of medicine measurable.

It’s important to note that alternative payment models such as “bundled payments,” in which a single payment covers services delivered by multiple providers during a single episode of care, are becoming increasingly common among providers.

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CMS Updates RAI Manual

CMS has released the latest version of the Minimum Data Set 3.0 Resident Assessment Instrument User’s Manual; this version is v1.11 and it goes into effect on October 1st.  The MDS 3.0 will track specific calendar days of therapy and has a co-treatment minutes item.  The new manual also contains coding instructions and examples for the distinct calendar days of therapy requirement.  In Chapter 3, Section K, there are new swallowing and nutrition items, detailing how providers should code the proportion of total calories a resident acquires and gives more detailed instructions on tube feeding.  In sections A, H, M. N and Q the manual includes updated information about coding and transmission policies.

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Medicare Managed Care Plan Beneficial for Residents with Advanced Dementia

A new study analyzing the data of more than 300 nursing home residents has found that residents with advanced dementia on the Medicare managed care plan were less likely to be hospitalized.  They were also more likely to have primary care visits in the nursing home and more nursing home-based nurse practitioner visits.  Researchers believe better care for advanced dementia patients is linked to higher numbers of nurse practitioners a facility has, as well as better reimbursement rates from insurers such as the rates the Medicare managed care plan offers.

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