Hospice News’ Post

"Australia introduced a parallel private pay system in 1997. The evidence from their experiences is clear: a hybrid health care system with a combination of public- and private-pay leads to two-tiered outcomes. Public pay patients waited more than twice as long for their surgeries compared to private pay patients. Not only that, Australia’s public pay patients wait longer than Canada’s public pay patients for the same surgeries.  A recent report found that out-of-pocket payments are becoming a big concern for Australians, especially for people with chronic conditions like cancer. Half of cancer patients paid more than $5000 a year in out-of-pocket medical expenses, and those in the lowest socioeconomic group are 37% more likely to die of their cancer than those in the highest socioeconomic group. Patients aren’t always informed of their publicly-funded treatment options, and often have difficulty assessing what reasonable costs are in the private pay system. In Canada, Saskatchewan has allowed residents to pay out-of-pocket for an MRI since 2016, on the condition that the private facility also performs a publicly-funded scan for each privately-funded one. But from 2015 to 2019, waiting lists for MRIs in Saskatchewan doubled due to increased demand – the result of treating health care as a consumer good. As a result, wait times have actually increased." - Canadian Doctors for Medicare

Overall, a recent study suggests that hospital privatisation "may reduce costs" but "at the expense of quality of care." Key findings reveal that increases in privatisation often result in worse quality of care, with no evidence of unequivocally positive health outcomes. Hospitals transitioning from public to private ownership tend to prioritize higher profits by cutting staff levels and reducing coverage for patients with limited health insurance. Additionally, privatisation is linked to fewer cleaning staff per patient and higher rates of patient infections. Some studies even indicate that higher levels of hospital privatisation lead to increased avoidable deaths. However, in certain cases like Croatia, privatisation has improved patient access through precise appointments and innovative care delivery methods. To learn more about this study, visit the link Canadian Medical Association Royal College of Physicians and Surgeons of Canada, Resident Doctors of Canada, and the Medical Council of Canada #Healthcare #HospitalPrivatisation #PatientCareQuality #HealthOutcomes

Susan Ponder-Stansel spoke at the Elevate Conference earlier this year about how the Medicare fee-for-service models can lead to inadequate support interdisciplinary palliative care. However. programs like Medicare Advantage are focused on integrating palliative care into their models, offering better reimbursement options and shared savings components. You can read the full article below. #AliviaCare #PalliativeCare #Medicare #HospiceNews

A RAND study published in Health Affairs found that hospitals gained $14.6 billion in extra payments in 2019 by billing for higher-intensity care, a practice known as "upcoding." Medicare, Medicaid, and private insurers paid significantly more as hospitals documented patient cases with higher complexity, increasing high-intensity care discharges by 41% from 2011 to 2019—far exceeding the expected 13% rise. Critics argue that this practice inflates healthcare costs, driving up premiums and taxpayer burdens. The American Hospital Association and Federation of American Hospitals challenged the study, citing data limitations and other factors contributing to higher-intensity discharges.

Better primary care and pay for value continues to progress in Medicare thanks to Purva Rawal, Meena Seshamani, Liz F. and team. Nice status check here. What about care for people who carrying insurance through their employer? Slower progress. Given the goal articulated here of having 100% of Medicare in accountable care by 2030, it will be critical for HHS to engage employers as a partner in health system evolution. Put differently, think about a practice that cares for 90% commercial patients ... why would they play in these demos? Changing the delivery system will ultimately require engaging employer sponsored healthcare, so we need to be thinking about this together now. There are many elements to this from a policy perspective - including ensuring that programs such as FEHB are as engaged as Medicare and better connectivity through TEFCA. But maybe most important, creating a locus point within the Federal government where employers can engage to drive more consistency. We're working on all of these questions at Morgan Health, and always looking for like minded organization - let us know what you think.

🚨 Medicare announces emergency funds for doctors affected by Change Healthcare hack 🚨 CMS made available Change Healthcare/Optum Payment Disruption (CHOPD) accelerated payments to Part A providers and advance payments to Part B suppliers experiencing claims disruptions as a result of the Incident. The CHOPD accelerated and advance payments may be granted in amounts representative of up to thirty days (30) of claims payments to eligible providers and suppliers. #healthcare #cyberattack #providers #medicare https://lnkd.in/eNxMzuf8

Prior authorization can significantly impact patient care by causing delays in treatment, restricting access to necessary medications, and creating additional burdens for both patients and healthcare providers. https://lnkd.in/gQY4w8_h #HealthcareAccess #HealthInsurance #Healthcare

With news everyday that health systems are withdrawing from Medicare Advantage (MA contracts), our team at the Healthcare Quality and Outcomes Lab has been studying the relationship between health systems and MA health plans. While health systems may be pulling out of MA contracts due to low reimbursement or administrative burden from claims denial, they may also be launching their own MA plans. In new research published in JAMA Health Forum, we identify that almost 1 in 7 Medicare Advantage beneficiaries are enrolled in MA plans offered by or affiliated with integrated health systems. On average these plans had favorable quality star ratings, but ongoing assessment is needed on the impact for patients. https://lnkd.in/eC8sd4dn

CMS sent out this very important update on Value Based Care Strategy: “March 14: A new CMS blog titled Update on the Medicare Value-Based Care Strategy: Alignment, Growth, Equity" provides a progress report on accomplishments and a look toward the future for CMS’ Value-Based Care Strategy. It also covers CMS’ strategy to move toward value-based payment, a focus on alignment across payers, growth in accountable care, and promoting equity. Among other topics, CMS aims to scale model learnings, support primary care providers in value-based care, improve quality measurement, and improve the flexibility of practitioners to work with community-based organizations to address social needs, while also emphasizing the importance of value-based data transparency and fostering competition within Medicare Advantage.” https://lnkd.in/g3yPh-TN #cms #valuebasedcare #frm #marketaccess #ACO #Medicare #revenuecyclemanagement #OPM #patientadvocate

To stay relevant in the value-based care model, hospices are advised to develop #palliativecare programs that reduce high-cost hospital visits and attract partnerships with Medicare Advantage plans and Accountable Care Organizations, especially as CMS aims for widespread risk-based reimbursement by 2030. https://bit.ly/3YN6FkK