The Administrator for the Centers for Medicare & Medicaid Services (CMS), Dr. Mehmet Oz, spoke to non-profit health system executives, investors, and industry observers this week at the 25th Annual Not-for-Profit Healthcare...more
What do Centene, CVS Health-Aetna and Humana all have in common? (Trying really hard not to start off with a “three health plans walk into a bar” joke…). Well, if you were at the 41st annual J.P. Morgan Healthcare Conference,...more
For those of you who know me, I like to have fun with my Zoom backgrounds – choosing photos of interesting scenery or changing them mid-call to reflect my mood or negotiating strategy. Sitting in front of my computer this...more
1/12/2022
/ Centers for Medicare & Medicaid Services (CMS) ,
Civil Investigation Demand ,
Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
EBITDA ,
False Claims Act (FCA) ,
Healthcare ,
Humana ,
Medicaid ,
Medical Loss Ratio ,
Medicare Advantage ,
Moderna Inc. ,
Pfizer ,
Vaccinations ,
Value-Based Care
CMI, CMMI, and Changing the Consumer Experience in the U.S. and China -
Case Mix Index: Sitting in multiple hospital, payor and physician organization presentations at the J.P. Morgan healthcare conference this year, it is...more
1/17/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
China ,
CMMI ,
Health Care Providers ,
Health Insurance ,
Healthcare Facilities ,
Hospitals ,
Life Sciences ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Outpatient Services ,
Universities ,
Value-Based Care
San Francisco (January 11, 2018) – The final day of the 2018 JP Morgan Healthcare Conference gave us food for thought about the topic of healthcare navigation, as well as updates on the home health sector. Post-acute has...more
1/15/2018
/ Centers for Medicare & Medicaid Services (CMS) ,
Genesis HealthCare ,
Health Care Providers ,
Health Insurance ,
Healthcare Costs ,
Healthcare Workers ,
Home Health Care ,
Hospitals ,
Humana ,
Joint Venture ,
JPMorgan Chase ,
Medicare ,
Mergers ,
Patients ,
Professional Conferences ,
Self-Insured Health Plans ,
Skilled Nursing Facility ,
Telehealth
San Francisco (Monday, January 8, 2018): Outside it was raining heavily today in San Francisco, but inside the 2018 JP Morgan Healthcare Conference the weather was distinctly sunny. Nary a hint of gloom or pessimism was heard...more
1/11/2018
/ Affordable Care Act ,
Artificial Intelligence ,
Catholic Church ,
Centers for Medicare & Medicaid Services (CMS) ,
Health Care Providers ,
Hospitals ,
JPMorgan Chase ,
Medicaid ,
Medicare ,
Professional Conferences ,
Stem cells
Some interesting presentations on the last day of the JPMorgan Healthcare Conference that concentrated on common themes – the increasing importance of ancillary business line to bolster core business revenue and of filling in...more
A new study by Stanford University researchers finds that Medicare Advantage plans pay lower prices than traditional fee-for-service (FFS) Medicare for most types of hospital admissions. According to the study—published...more
Maryland’s Evergreen Health Cooperative has filed for an injunction against the federal government to halt payment by the Consumer Operated and Oriented Plan (co-op) of the $22 million it owes to CareFirst BlueCross...more
On Friday, March 20, 2015, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule which would make significant changes to the federal Medicare and Medicaid Electronic Health Records (“EHR”) Incentive...more
CMS recently released results of Medicare’s value-based payment modifier for 2015. This is the first year in which physicians are subject to adjustments under the payment system and, in this first phase of implementation,...more
Are changes to the landscape of physician hospital ownership ahead?
The Affordable Care Act amended the federal Stark Law to eliminate the “whole hospital exception” that permitted self-referrals provided the referring...more
The Centers for Medicare and Medicaid Services (CMS) has approved Pennsylvania’s demonstration proposal to expand Medicaid to adults with incomes through 133 percent of the federal poverty line. The state is the 28th...more
Another withdrawal from the Medicare Pioneer Accountable Care Organization (ACO) program has occurred. Sharp Healthcare ACO, an affiliate of the Sharp integrated delivery system in San Diego, California, notified the Center...more
The Center for Medicare and Medicaid Services (CMS) recently announced that it will add roughly 4,100 providers to the 2,400 existing providers testing the possible use of Medicare bundled payment contracts. Providers must...more
On July 7, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule updating Medicare’s Home Health Prospective Payment System payment rates for 2015....more
A review of Medicare Part B claims for evaluation and management (E/M) services conducted by the Office of the Inspector General (OIG) has found that the program paid $6.7 billion in improper payments in 2010. This figure...more
Last year, HHS revised policies and definitions surrounding what constitutes certified EHR technology—required for meaningful use incentive program payment eligibility—from the 2011 Edition criteria to the 2014 Edition...more
Last week, the Centers for Medicare and Medicaid Services (CMS) announced that Colorado is joining its Financial Alignment Initiative to pilot a managed fee-for-service model for people enrolled in both Medicare and Medicaid...more
The Centers for Medicare & Medicaid Services (CMS) recently announced that over 500 organizations will begin participating in the Bundled Payments for Care Improvement initiative. The large number of participating...more