Healthcare, Senior Living, Economics
Late last week, I ran across a number of news posts regarding a proposed class action lawsuit against the hospital/health system giant Advocate Aurora, alleging that the organization used its market mass to limit competition and in return, impose excessively high prices on commercial health plans and their insureds. The suit was filed in Wisconsin (where … Read more
In 2023, regulators re-instituted audits of facilities for inappropriate diagnoses of schizophrenia (justification for anti-psychotic use), plus a five-claim audit of every nursing home. The purpose of the audit was to address a long-standing concern that inappropriate coding was driving higher Medicare reimbursement under PDPM, despite documentation in patient records, not substantiating the level of care … Read more
Senior Housing News and Lument conducted a survey (November of 2023) of senior living organizations and executives regarding their outlook for 2024. They consolidated the responses into a report. That report is available here: 2024-shn-lument-outlooksurveyreport-vf.original The highlights from the report are below. The general consensus of respondents was a positive outlook (87%) for 2024, buffered mostly … Read more
Happy Hump Day! Today’s post is shorter than normal as I have to attend a funeral on behalf of one of my partners (also a very close, close friend). His mom passed away recently, and the service is today. She was a wonderful woman, mom, wife, and grandmother and she will be missed by all who knew … Read more
Over the years I have written many articles about the cost of healthcare and in particular, the cost of senior living and senior healthcare. As the population ages, the demand for senior living and care expands. Per the U.S. Census Bureau, the U.S. population age 65 and over grew nearly five times faster than the … Read more
In 2021, Congress passed the Consolidated Appropriations Act of 2021. Within the Act, a new Medicare provider was created – the Rural Emergency Hospital (REH). The final rule is available here: Rural Emergency Hospital Final Rule REHs were created to improve and increase, access to emergency services and ideally, expanded outpatient services in rural areas. Starting … Read more
Happy First Hump Day of 2024! Short weeks aren’t really deserving of a Hump Day, but it is officially a Wednesday that is not a holiday in a workweek (though I’m sure many are still off from the Christmas/New Year’s season). Thus, no matter deserved or not, it is my first Wednesday Feature and therefore, … Read more
It was only a matter of time before litigation came forward regarding the use of Artificial Intelligence (AI) in primarily, Medicare Advantage plans, where coverage denials/determinations are at issue. This week, a class action suit dropped in the U.S. Circuit Court of Western Kentucky against Humana. A link to the suit is here: https://www.scribd.com/document/692182281/Humana-AI-NaviHealth-MA-lawsuit In … Read more
Yesterday I wrote about MedPAC’s rate recommendations for SNFs for FY 2025. Recall, MedPAC makes these recommendations annually, assuming the full commission votes (in January 2024) for the recommendations as released by draft. The final recommendations go to Congress. Yesterday’s post was the “draft” position for SNFs. Today, I’m including summaries for Home Health, Hospice, … Read more
The Medicare Payment Advisory Commission is (likely) recommending to Congress a series of post-acute rate reductions (Medicare, Fee-for-Service) for federal fiscal year 2025 (beginning October 1, 2024, for most programs, January 1, 2025, for Home Health Agencies). Specifically, the MedPAC recommendations are as follows. Reduce the 2025 payment rate for home health agencies by 7%. … Read more