Healthcare, Senior Living, Economics
Among the many topical areas I watch in health care, I pay particular attention to liability and litigation. As frequent readers/followers know, my firm, H2 Healthcare, LLC, focuses a practice area on clinical compliance and litigation support. My wife and the firm’s Senior Partner is one of the foremost experts (nationally) in litigation support and … Read more
I get asked about value-based care a lot. It is a buzzword or term these days, somewhat driven by the rise in Medicare Advantage enrollment. Frankly, it is a bit of a catch-all concept that has its origins in Medicare and various demonstration projects (e.g., bundled payments) and the implementation of quality measures to “improve … Read more
Since the COVID pandemic, regulatory officials have escalated the review, via various audits, of SNF emergency preparedness. COVID highlighted the sporadic and often, non-existent preparations for disasters (natural and other) and disease outbreaks (pandemic or other) that existed with the SNF industry. In reality, the issues have been present for years but only regionally, highlighted … Read more
A complex area for providers, especially with respect to their compliance programs, are the concepts of fraud and abuse. Central to current requirements for compliance programs, all post-acute providers are REQUIRED to have compliance programs that, Include policies and procedures to define, test for, and mitigate any issues pertaining to fraud and abuse. In this … Read more
Even after all of the years that I have been in health care and particularly, post-acute care, I still field a good number of questions regarding Hospice, the benefit under Medicare, how payments work, and what the generalized payment amounts are. Having started a few hospices in my career, I can attest that done right, … Read more
On November 1, CMS issued the final PPS rule for Home Health (2024). The majority of provisions within this rule, especially those related to payment, take effect on January 1, 2024. The Final Rule as published is available for download here: Home Health 2024 Final Rule In July I wrote a post on the proposed … Read more
An issue that has been tied to AI (artificial intelligence) and specifically, to Medicare Advantage plans, involves coverage denials. I wrote about this in a post earlier this year at https://rhislop3.com/2023/05/01/medicare-advantage-part-d-final-rule/ Coverage denials have been a fairly hot topic around Medicare Advantage plans. The core of the issue is that Medicare Advantage plans are required … Read more
Seema Verma, former CMS head, spoke out yesterday regarding the proposed staffing mandate (hours and type of staff, per resident per day) proposed rule, indicating her opinion that the approach was flawed. A recap article on her comments is here: https://www.mcknights.com/news/former-cms-chief-verma-regulators-over-their-skis-with-staffing-mandate/?utm_source=newsletter&utm_medium=email&utm_campaign=NWLTR_MLT_DAILYUPDATE_110223&hmEmail=IjP1GPaY%2BJ2uvsLxTJ79bVeRWY7ycbnr&sha256email=aa4cb7c695037c31a216b9562788596b6fcd012145d566f31440b6fcd139c8a9 Regular readers know that I have covered various topics on healthcare staffing, particularly as … Read more
Ten days ago, I wrote a post about COVID litigation and how it was not only mounting but also morphing in terms of scope. Cases were predominantly focused on responsibility for infections at the senior living end such as, my ‘family member’ caught COVID at XYZ Manor and died, so therefore XYZ Manor is responsible … Read more
Today’s post is a bit of a hybrid. I’m trying to keep up with a bunch of things ranging from policy to economics (Jerome Powell speech today) to some work stuff so I’m combining two things today that probably, deserve a bit more dissection, but this will do for now. Plus, I’m hopeful that tomorrow … Read more