Myomo, Inc.’s Post

The Centers for Medicare & Medicaid Services has approved a new #AgeFriendly Hospital Measure that will ensure hospitals better align care with #OlderAdults' goals & preferences. The new measure will require hospitals to report on protocols such as managing medications, assessing social vulnerability, implementing frailty screenings & more. This new measure is based in part on the 4Ms Framework for age-friendly care (What Matters, Medication, Mentation and Mobility) and standards of surgical and emergency department care developed as part of JAHF-funded initiatives. Learn more: bit.ly/CMS_AFMeasure

On Tuesday, the Centers for Medicare & Medicaid Services released its long-awaited report on Shadow Bundles: CY2023/FY2023 National Acute Care Hospital (#ACH) Benchmark Prices to REACH ACOs. The report summarizes Benchmark Prices for a national set of ACHs for various clinical episodes. Example clinical episodes include Inpatient-Acute myocardial infarction, Inpatient-Coronary artery bypass graft, Outpatient-Back & neck except spinal fusion, to name a few. For each clinical episode category, the number of episodes, total spending and spending per episode (benchmark price) are provided. The benchmark prices have been #risk adjusted to account for patient characteristics and comorbidities not under control of a provider, using risk adjustment approaches defined by CMS. Even though ACOs will not be held financially accountable for their Clinical Episodes, these Benchmark Prices provide invaluable information on peer performances and potential targets for your providers. Reach out to our Wakely VBP experts to help digest the Shadow Bundles dataset and how it can be leveraged for your #ACO financial success. To learn more about #ShadowBundles, check out this recent Wakely white paper.

NEW | The Centers for Medicare & Medicaid Services has approved a new #AgeFriendly Hospital Measure that will ensure hospitals better align care with #OlderAdults' goals & preferences. The new measure will require hospitals to report on protocols such as managing medications, assessing social vulnerability, implementing frailty screenings & more. This new measure is based in part on the 4Ms Framework for age-friendly care (What Matters, Medication, Mentation and Mobility) and standards of surgical and emergency department care developed as part of JAHF-funded initiatives. Learn more: bit.ly/CMS_AFMeasure

🏆 All About MVPs 🏆 Since the 2023 Performance Year (PY23), Centers for Medicare & Medicaid Services has implemented a new reporting option for the Merit-Based Incentive Payment System (MIPS) called MIPS Value Pathways (MVPs). Currently, MVPs are optional for eligible clinicians to report, but will become mandatory in years to come. In our latest blog post, we break down: 🔸 What MVPs are and what they offer clinicians 🔸 Why you should begin your transition now and 🔸 Your participation options Learn about MVPs for 2024: https://lnkd.in/gnkaTDTX

Making Care Primary (#MCP) Model -- #CMS is working with State Medicaid Agencies in eight states – Colorado, North Carolina, New Jersey, New Mexico, New York, Minnesota, Massachusetts and Washington – to engage in full care transformation across payers, with plans to engage private payers in the coming months. The MCP Model will provide a pathway for primary care clinicians with varying levels of experience in value-based care to gradually adopt prospective, population-based payments while building infrastructure to improve behavioral health and specialty integration and drive equitable access to care. #vbc, #vbaforvbc, #vba , #valuebasedcare, #alternativepayments, #wholepersoncare, #contractbuilder, #valuebasedinfrastructure, #dataengineering, #datascience, #interoperability, #fhir , #hl7 , #edi , #unstructureddata Rahul Sharma, Lynn Carroll, Deepti Sharma ,CPC CMHP, Mohan Badkundri, Karthik Kanakaraj, Kimberly Shepard, Eric D. Young, John Layne, Carl King, Amol Bapat, MD, FACC, Michael Roach https://lnkd.in/e3mfxX_x

I am happy to share Sellers Dorsey's slide deck summary of the Medicaid managed care rule CMS released on April 22nd. This contains a terrific overview of the rule's impacts on Medicaid financing and how such initiatives will need to be designed in the future. https://lnkd.in/eEPKgkWa

On July 10th, 2024, Centers for Medicare & Medicaid Services (#CMS) published the Proposed Medicare Hospital Outpatient Prospective Payment System (HOPPS) Rule for 2025. CMS is proposing separate payments for higher cost #radiopharmaceuticals. #LifeMolecularImaging firmly supports paying separately for high-cost radiopharmaceuticals, as this would encourage providers to offer these essential procedures without financial constraints. To learn more, visit: https://lnkd.in/g3DnRDXQ #LMI #Medicare #amyloidPET #alzheimersdisease 

Based on the search results provided, there isn't a specific percentage given for Medicaid use in post-acute care in California. However, we can extract some relevant information: Medicare spending on post-acute care accounts for about $60 billion, or 15 percent of total Medicare spending annually. While this figure is for Medicare nationally rather than Medicaid in California specifically, it gives some context on the scale of post-acute care spending. The search results also mention that stroke, hip fracture, and lower extremity joint replacement patients account for approximately 7 percent of Medicare acute discharges and one-quarter of discharges to post-acute care. Again, this is national Medicare data rather than California Medicaid, but it provides insight into the proportion of patients using post-acute care for certain conditions. Without more specific data on Medicaid use for post-acute care in California, it's not possible to provide an exact percentage. To get an accurate figure, you would need to consult California-specific Medicaid data sources or reports that weren't included in these search results.

The April final rule on #supplementalbenefits in #MedicareAdvantage is a big deal requiring immediate action from #healthplans. The Centers for Medicare & Medicaid Services (#CMS) regulations have 3 major components: evidence, eligibility and member awareness. Beginning with the CY2025 bid process, CMS will deny a plan’s bid if it hasn’t demonstrated that its proposed supplemental benefits for the #chronicallyill (#SSBCI) is reasonably expected to improve or maintain the health or overall function of its chronically ill enrollees. CMS is also implementing annual review of SSBCI offerings for compliance. To comply with the final rule, plans must do the following: ▶️ Establish an evidence-based bibliography of clinical literature for each SSBCI offering, showing it can reasonably improve or maintain the health of chronically ill enrollees. All supporting evidence must be published within 10 years of the coverage year. ▶️ Use written, objective criteria to determine an enrollee’s eligibility for SSBCI, ensuring they meet the definition of “chronically ill enrollee” with complex conditions needing intensive care coordination. MAOs must also document when enrollees are deemed ineligible to ensure equitable access to benefits. ▶️ Include an all-channel disclaimer listing the chronic conditions required for eligibility and clarifying that additional criteria may apply. ▶️ Beginning January 1, 2026, MAOs must send mid-year notifications annually each July to each enrollee with unused supplemental benefits. CMS requires the mid-year notice to support #healthequity and inform enrollees about unused supplemental benefits. These new requirements impose huge new operational challenges for plans under tight deadlines. Get cracking now. Full rule: https://lnkd.in/e8GwBmCq