Healthcare, Senior Living, Economics
On September 30, US District Judge Kathryn Kimball Mizelle from the Middle District of Florida ruled in a landmark decision that the qui tam provision of the federal False Claims Act (FCA) is unconstitutional. This ruling could have significant impact on whistleblower (Qui Tam) actions filed against healthcare providers, particularly home health and hospice (most … Read more
Here’s an oldie but a goodie for today. The House Ways and Means Committee is reportedly considering a markup of legislation this month that would revamp Medicare’s physician payment system. This move could increase the likelihood of incorporating a “doc fix” into a lame duck legislative package. Historic readers and followers of Reg’s Blog will … Read more
Tonight’s presidential debate should be policy focused but likely, won’t be or won’t be with sufficient detail. There are a ton of policy issues that should be discussed. Healthcare policy, in my opinion, should be very much a topic of open and frank discussion. I know I am a geek when it comes to economic … Read more
Nursing assistants are anticipated to experience the largest projected shortfall among all healthcare occupations analyzed, with an expected national shortage exceeding 73,000 assistants by 2028. This projection is based on a report by Mercer, which also predicts a nationwide deficit of over 100,000 healthcare workers by the same year. The demand for nursing assistants is … Read more
Late last year, CMS proposed a final rule to address the issue of coverage denials or service denials via prior authorization on behalf of Medicare Advantage Plans. Between providers and patients, coverage issues have significantly increased as beneficiary participation has increased (today, about 1 in 2 Medicare beneficiaries is in a Medicare Advantage plan). https://rhislop3.com/2023/11/09/cms-offers-fix-to-medicare-advantage-denials/ … Read more
With increasing older adult demand for hospital care, an ongoing wave of nursing home closures is creating post-acute access issues. Since 2020, 774 nursing homes have closed, and only seven new facilities opened in 2024. The primary driver for closure is a nationwide shortage of qualified clinical staff, exacerbated by the COVID pandemic. The pandemic … Read more
Fitch Ratings has completed updates to its ratings criteria for not-for-profit continuing care retirement/life plan communities (CCRCs), enhancing the reflection of the risk profile for these rated entities. These changes come after a period of commentary on a draft released earlier this spring. The criteria modifications aim to more accurately represent the distinct risks associated … Read more
The mandatory Transforming Episode Accountability Model (TEAM) will advance CMS prior work on value-based care models, including bundled care initiatives. The TEAM model (participation) will be mandatory for selected hospitals and participation “optional” for post-acute care providers. Transforming Episode Accountability Model (TEAM) | CMS The Transforming Episode Accountability Model (TEAM) is set to be a … Read more
The healthcare sector has experienced another quarter of record-high distress levels, as indicated by the volume of bankruptcy filings, with the senior living and care sector at the forefront. This bankruptcy trend for senior living remains alarming. In January, I took a look at 2023 bankruptcy levels, the worse year in decades. That post is … Read more
A number of weeks back I looked at what was known and could be divined about Kamala Harris’ health policy. Today, with the election getting close (less than 70 days out), it’s an opportune time to look at Donald Trump’s likely health policy positions. The Harris post is available here: https://rhislop3.com/2024/07/23/kamala-harris-likely-health-policy/ Both candidates have shared … Read more