Vesta Healthcare’s Post

Do people living with dementia receive better care from #Medicare Advantage (MA) plans vs. traditional Medicare? Research from #USCSchaeffer Center reveals that diagnosis and care for dementia differs substantially between the two programs. Around the time of diagnosis, traditional Medicare beneficiaries tend to have higher healthcare utilization, including more hospitalizations and outpatient visits. However, within one year of a #dementia diagnosis, Medicare Advantage beneficiaries have a 16% lower mortality risk compared to those in traditional Medicare. While more research is needed to better understand these differences, well-managed care is vital for helping people with dementia maintain quality of life and reduce adverse outcomes, notes the research team including Julie Zissimopoulos, Johanna Thunell and Haley Garland. Read more: https://lnkd.in/g4EzjmsD USC Sol Price School of Public Policy USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences

"Our health care system and our public health care system is woefully, woefully underprepared and underresourced. We've got to change that." - Jim Wessler, CEO, Alzheimer's Association, Massachusetts/New Hampshire Chapter 🚨 This story out of Massachusetts could have come from any state in the union. 🚨 Transforming the healthcare workforce to become more dementia-capable is built into Rippl's mission and drove the launch of Rippl Academy last year. There is so much need for care and support out there and it will take systemic change (like this year's launch of a new dementia care payment model by Centers for Medicare & Medicaid Services) to answer the call. We can and will do better for those #LIVINGwithDementia and their #caregivers. #createarippl #moregooddays More about Rippl Academy here: https://lnkd.in/e3DvNTzp More about the CMS GUIDE model here: https://lnkd.in/grE7BdTS https://lnkd.in/gF9QFSNn

For adults 65 and older, health care spending has been increasing for decades, with per capita spending on aging people growing 4.5% between 2018 and 2020, compared with a 2.6% growth rate from 2016 to 2018. Now one state is making it easier for older adults and others to get care for serious conditions outside of a hospital. This spring, Hawaii became the first state to provide Medicaid coverage for palliative care in non-hospital settings under its state plan amendment. The change has the potential to reduce costs and improve health outcomes and quality of life for patients—and to serve as a model for other states. “In a lot of states, people can access services that fall under the umbrella of palliative care,” said Ella Taggart, a senior research analyst at the National Academy for State Health Policy, but now Hawaii “is able to comprehensively offer … the whole host of [palliative care] services.” Hawaii’s plan allows Medicaid benefits to cover the work of health and social services providers like community health workers, mental health professionals and others. It also defines palliative care as a preventative service, which means that Medicaid will cover comprehensive assessments, such as screening for diseases and psychological, neuropsychological and cognitive testing, to determine their care needs. Learn more here: https://lnkd.in/eW679suz

Key Takeaways (notes) from the Dept of HHS, zoom call, and webinar from CMS administrator and  team this morning. "Affordability is the Guiding Light " ; "North Star is the Consumer"; " Every American must have health care coverage" - CMS Administrator and team Reforms: * Extra help - Drug Law 1/1/24 - * High drug cost – relief – inflation reduction (www.cms.gov) * People with Medicare whole persons - access to behavioral health: Marriage and family therapy and addiction counseling. * New payments for community health integration and payments for psychotherapy - outpatient therapy * Medicare Advantage - remains strong and Thriving; no steering allowed 2024 will maintain the momentum, lower drug cost, transform care, and improve Medicare Advantage. Trust the MEdicare program solvency Increasing coverage - including improving transitions in coverage (Seamless experience) Increasing value; Drive Quality Outcomes;Finalizing consumer protection rules CMS remains committed to Improving access and quality of care to CHIP enrollees. Addressing challenges to the 4 Walls policy (Indian Health Services ) Developed LTC proposal for staffing rule Digital transformation Expanding access to mental health services includes rural health communities. Transparency TCET (Transitional Coverage for Emerging Technologies) From Innovation Center: continue working on health equity, new models include, primary, guide model (dementia), AHEAD (all-payer health equity approaches and development) , transforming maternal health outcomes (supports whole person approach to pregnancy, childbirth and care) Goal - Improve safety, and whole person and increase access to care IBH -integrated services state-based model on integrated whole person care mental health and or substance abuse care CMS cancelled over 2500 unauthorized enrollments and remains committed in 2024 Striving to work against bad actors and fraudulent COVID testing billing Ensure hospice provides quality care, and decrease bad actors AI – focus on integrity and ensure ethical application of this technology OMH (Office of minority health) – sustain the momentum built- Note: May 29 and 30th,  2024 -  Health Equity Recognize and support data, research and analysis to decrease disparities. Health Equity Assistance program continues to provide support with additional tools and resources in 2024 Final rule for prior authorizations will help patients access care in a timely manner (72 hours ; 7 days ) Payors will need to report certain prior auth metrics. Patients will be empowered with access to more of their data. #nationalstakeholdercallwithcmsadministrator#cms#medicare#medicaid#Medicarestrong https://lnkd.in/gY5XFrVj

The importance of developing dementia friendly hospital systems, and staff, can not be emphasized enough. Statistics show that people living with dementia utilize our hospitals more than any other demographic… with environments and staff that are unable to meet their needs. Please support this initiative. @dementiatraining4life

Only 12% of #dementia patients enroll in #hospice. #PalliativeCare is also underutilized: https://lnkd.in/ePBh-3pv Samaritan can support you through this difficult journey; from diagnosis, through primary, #palliative, and #HospiceCare.

Several of you have requested a recap of the recent CMS article on the CY 2025 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule (CMS 1809-P). Key Takeaways from the CY 2025 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule (CMS 1809-P): Payment Rate Updates: CMS proposes updating OPPS and ASC payment rates by 2.6% for hospitals and ASCs that meet applicable quality reporting requirements. This update is based on a projected hospital market basket increase of 3.0%, reduced by a 0.4 percentage point productivity adjustment (CMS.gov, eCQI Resource Center). Intensive Outpatient Program (IOP): The proposed rule updates Medicare payment rates for IOP services provided in hospital outpatient departments and Community Mental Health Centers (CMHCs). The existing rate structure, with different rates for three services per day and four or more services per day, will be maintained (CMS.gov, eCQI Resource Center). Partial Hospitalization Program (PHP): Similar to IOP, the rule proposes maintaining the current rate structure for PHP services, with two separate APCs based on the number of services provided per day. Payment rates will be based on CY 2023 claims data and the latest available cost information (CMS.gov, eCQI Resource Center). Access to Non-Opioid Treatments for Pain Relief: CMS proposes implementing additional payments for certain non-opioid pain treatments in hospital outpatient and ASC settings from January 1, 2025, through December 31, 2027. This initiative is part of the effort to expand access to non-opioid alternatives for pain management (CMS.gov, eCQI Resource Center). Behavioral Health and Health Equity: The proposed rule includes measures to address health disparities and expand access to behavioral health care. This aligns with the administration’s goals of promoting safe, effective, and patient-centered care, informed by lessons learned from the COVID-19 pandemic (CMS.gov, eCQI Resource Center). Refinement of Definitions and Policies: CMS is proposing to narrow the definition of "custody" to facilitate Medicare access for individuals on parole, probation, or home detention. This change aims to remove barriers to healthcare access for recently released individuals and those under supervision (CMS.gov). Comment Period and Final Rule: The proposed rule was published on July 10, 2024, with a 60-day comment period ending on September 9, 2024. The final rule is expected to be issued in early November (CMS.gov, eCQI Resource Center). These proposed changes reflect CMS’s ongoing efforts to update and refine Medicare payment systems, ensuring they remain equitable and effective in delivering healthcare services. Healthcare providers should prepare for these updates and consider the potential impacts on their operations and reimbursement strategies.

The Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system will be revised for calendar year 2024. The final rule with comment period describes changes to the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. The Hospital Outpatient Quality Reporting (OQR) Program, the ASC Quality Reporting (ASCQR) Program, and the Rural Emergency Hospital Quality Reporting (REHQR) Program will also be updated and refined. Starting January 1, 2024, a payment for certain intensive outpatient services under Medicare will be established. Additionally, hospitals will be required to make their standard charge information public and enforce hospital price transparency. The community mental health center (CMHC) Conditions of Participation (CoPs) will be updated to provide requirements for furnishing intensive outpatient (IOP) services, and personnel qualifications for mental health counselors (MHCs) and marriage and family therapists (MFTs) will be established. The annual IPPS rulemakings will no longer include discussion of the inpatient prospective payment system (IPPS) Medicare Code Editor (MCE) starting with the fiscal year (FY) 2025 rulemaking. Finally, there will be a technical correction to the Rural Emergency Hospital (REH) CoPs under the standard for the designation and certification of REHs. To be assured consideration, comments must be received at one of the addresses provided by January 1, 2024. Effective date for the provisions of this rule is January 1, 2024. cms.gov mlmatters.gov

Navigating the healthcare system after a stroke can be overwhelming for individuals and their loved ones. In early 2024, the Center for Medicare and Medicaid Services (CMS) introduced a new model for post-acute care called Principal Illness Navigation (PIN). PIN aims to provide individuals with chronic health conditions with holistic support and access to timely and coordinated care as they go through their journey towards recovery. Check out our article about how PIN for stroke survivors can help reduce healthcare disparities and improve patient outcomes at https://lnkd.in/gHa8tjRG

While we know that the Medicare Care Choices Model hit on every deliverable with every subpopulation studied, it is important to look at the numbers. For the 7,263 enrollees in MCCM, Medicare expenditures were reduced by $7,604 per enrollee - a 13% reduction in cost. Hospital admissions fell by 26% and ED visits by 12%. MCCM enrollees were 18% more likely to enter hospice and they had an average length of stay of 42 days compared to 19. They were able to have 183 days at home compared to 178. Racial and ethnic disparities in hospice utilization were also reduced. While there were many limitations to MCCM, the lessons learned should spur more research and modeling. CMS: Concurrent Hospice Care Improves Quality, Reduces Costs - Hospice News https://okt.to/JPBK6t