CMS proposes changes to Medicare PFS, QPP rule for 2021 | CMS releases final Medicare payment rates for 2021 | WellCare offers free delivery service to MA members
August 5, 2020
Accountable Care SmartBrief
Accountable Care Spotlight
The CMS has unveiled its draft Medicare physician fee schedule and Quality Payment Program rule for 2021, and it includes proposals to broaden the list of telehealth services Medicare can cover, simplify billing and coding requirements for office-based and outpatient evaluation and management visits, and boost payment cuts for certain specialty care providers. The agency also recommends changes to the Medicare Shared Savings Program's quality reporting requirements and quality performance standards, raising the Merit-based Incentive Payment System's performance threshold and postponing implementation of the MIPS Value Pathways program until 2022.
Full Story: Becker's Hospital CFO Report (8/4),  FierceHealthcare (8/4),  Healthcare Finance (8/4) 
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The CMS has released a final rule increasing 2021 Medicare payment rates for skilled nursing facilities, inpatient psychiatric facilities, and hospices. The rules will take effect Oct. 1.
Full Story: Healthcare Finance (8/3),  Becker's Hospital Review (8/3) 
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WellCare Health Plans, a unit of Centene, has partnered with delivery service Shipt to offer free home delivery of groceries and other essential items to around 200,000 Medicare Advantage members across 23 states for the remainder of this year. "We look forward to offering this new benefit as one more way to simplify access to everyday essentials, ensure continuity of care, and help our members stay safe and healthy during this challenging time," said Centene senior vice president Michael Polen.
Full Story: FierceHealthcare (8/3),  Health Payer Intelligence (8/4) 
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Details Matter in Value-Based Contracting
Details really do make a difference. Especially when creating an RFI or RFP. We can help! Save time by downloading Apervita's Buyer's Guide, which provides ready-to-use sample questions for evaluating value-based contract administration solutions.
Insight into Health Care Quality
A study in JAMA Network Open shows that 59.3% of older men and 56.2% of older women were overscreened for colorectal cancer, while 74.1% of older women were overscreened for breast cancer and 45.8% for cervical cancer. Overscreening refers to screening of patients who fall beyond the recommended age ranges for screening, and the findings highlight "the need for additional research to identify risks and benefits of screening in older adults and to determine who may benefit from screening after the recommended upper age limits," researchers wrote.
Full Story: AuntMinnie (free registration) (8/3) 
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About 5% of Medicare patients surveyed had received home-based care from 2011 to 2017, and 75% of beneficiaries in that group were homebound, researchers reported in Health Affairs. "The significant unmet needs of this high-need, high-cost population and the known health and cost benefits of home-based medical care should spur stakeholders to expand the availability of this care," the researchers wrote.
Full Story: HealthLeaders Media (8/3) 
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The Technology Component
President Donald Trump has signed an executive order directing the HHS to issue rules within 60 days ensuring that certain telehealth regulatory changes made during the COVID-19 pandemic will remain in place once the public health emergency ends. The order directs the HHS to develop a payment model that permits rural health care providers to waive some existing Medicare policies and ensure more predictable financial payments, and also directs the HHS, the USDA and the Federal Communications Commission to establish a task force focused on developing broadband infrastructure to support rural telehealth services.
Full Story: The Hill (8/3),  FierceHealthcare (8/3),  Reuters (8/3) 
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Research fellow Ananya Malhotra and her colleagues have developed an artificial intelligence program to identify people at high risk for pancreatic cancer based on symptoms previously associated with pancreatic cancer as well as others that occurred frequently in pancreatic cancer patients' health records. The algorithm predicted pancreatic cancer up to 20 months before diagnosis in a pilot study involving people younger than 60, and it could be used to refine screening protocols.
Full Story: News Medical (8/3) 
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A machine learning tool developed at Massachusetts Institute of Technology analyzes and classifies chest X-rays for signs of lung collapse, an enlarged heart and other conditions and decides whether certain tasks can be handled by the tool or should be handled by an expert. The system was less expensive and more accurate than baselines, but it has not been tested using actual experts.
Full Story: Health IT Analytics (8/4) 
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Population Health and Patients
Research published in Health Affairs found 49% of communities that have a median income less than $35,000 did not have any ICU beds, compared with 3% of communities with a median income of greater than $90,000. Researchers said scarce critical care availability in low-income areas may worsen disparities seen in COVID-19 deaths.
Full Story: STAT (tiered subscription model) (8/3),  Politico (8/3) 
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Researchers found that Alzheimer's disease and dementia incidence rates in the US and Europe dropped by 16% and 13% per decade over the past 25 years, respectively, which may be due to better cardiovascular risk factor control and higher educational attainment. However, the findings in Neurology didn't show reduced Alzheimer's and dementia prevalence in Asia, Africa and South America, which may be caused by elevated smoking rates in those continents.
Full Story: The New York Times (tiered subscription model) (8/3) 
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The coronavirus pandemic has worsened problems caused by health illiteracy in the US, experts say. Nearly 30% of patients in a study found health care providers' instructions difficult to understand, numerous studies have linked low health literacy to negative health outcomes and higher health care usage, and a disproportionate share of patients from groups with notoriously low health literacy are dying of COVID-19.
Full Story: The Washington Post (tiered subscription model) (8/2) 
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Health Insurance and Accountable Care Provider Company News
Zero travel. Zero reasons to delay.
At National Conference on Medicare, Medicaid & Dual Eligibles ONLINE, Sept. 14 through 17, engage with CMS and administration officials, health insurance leadership, and other experts. Register now.
Solutions Provider News
Health insurance providers continue to focus on better care experiences for consumers, even during the most challenging times. Attend AHIP's Consumer Experience & Digital Health Forum and find solutions for your toughest challenges focused on improved access, outcomes, and affordability. You'll engage with experts, innovators, and visionaries who arrive with solutions that continue to transform our health care system. Learn more.
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During these unprecedented times, some things simply can’t be delayed. That includes recruiting health care’s best and brightest. Whether you’re searching for a polished professional or a diamond in the rough, AHIP Career Center helps you find great candidates faster. Now through August 14, save 30% on every job post. Sale ends next week. Use code: DIAMOND30. Start recruiting and saving today.
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