Morning Briefing
Summaries of health policy coverage from major news organizations
Home Health Workers Both Happy, Upset At CMS' Payment Changes
Modern Healthcare: Home Health Sector Glad CMS Didn't Finalize Pay Adjustment Method
Home health providers are counting CMS' decision not to finalize methods for keeping the payment system for home health agencies budget neutral as a win, though they're still disappointed that CMS decided to move forward with a 4.36% cut for the third year in its final 2022 payment rule. CMS began the Patient-Driven Groupings Model for home health agencies last year, aiming to cut down on unnecessary therapies and instead emphasize patient characteristics. PDGM also changed the case-mix system and switched to reimbursing agencies based on 30-day periods. (Goldman, 11/4)
In other health industry news —
Axios: Health Insurers Still Aren't That Worried About The Coronavirus
COVID-19 has affected each health insurance company differently, but the industry remains mostly insulated from the virus' growing toll. Most of the big insurers have sidestepped massive coronavirus-related costs so far this year, due in large part to people putting off other care. And the companies that have had to pay more medical claims are raising premiums on employers and consumers, exactly as they said they would. (Herman, 11/5)
Modern Healthcare: Top 8 Healthcare Fraud Cases Related To COVID
Dozens of healthcare workers, executives and medical business owners have faced charges or other consequences for their involvement in fraud schemes related to COVID-19 and abuse of programs designed to facilitate access to medical care during the pandemic. The most recent charges allege a laboratory operator submitted $88 million in fraudulent claims. He and other individuals gained funds they then used to purchase items like exotic automobiles and luxury real estate, according to the U.S. Department of Justice on Thursday. (Devereaux, 11/5)
Modern Healthcare: Digital Health Startup Medallion Raises Another $30M
Digital infrastructure startup Medallion raised $30 million from investors including UnitedHealth Group's venture arm and key figures from Cityblock, Oscar Health and Roivant Sciences, the company announced Wednesday. Medallion, which offers services that automate clinician licensing and insurance network compliance tasks for digital health firms, adds that new Series B money to the $20 million it previously raised sinced its founding in 2019. The San Francisco-based company is valued at $200 million, CEO Derek Lo said. (Tepper, 11/4)
St. Louis Post-Dispatch: Sultan: Child Denied Treatment By UnitedHealth Gets Outside Help — And A Pig
A 10-year-old girl in Arnold will finally get her dream fulfilled of receiving medical treatment for a severe pain disorder. Lyla McCarty has complex regional pain syndrome. Her parents have been battling their insurance company, UnitedHealth Group, for months to get her into an inpatient pain treatment program in Cincinnati. (Sultan, 11/4)
KHN: Few Acute Care Hospitals Escaped Readmissions Penalties
Preventable rehospitalization of the nation’s older adults has proved a persistent health and financial challenge for the U.S., costing Medicare hundreds of millions of dollars each year. Various analyses have found many readmissions within a month of discharge might have been avoided through better care and more attention paid to the patients after they left the hospital. The federal government’s campaign to reduce the frequency of so-called boomerang patients by applying financial disincentives has entered its 10th year with Medicare’s decision to lower payments to 2,499 hospitals throughout the current fiscal year, which began last month and runs through September 2022. (Rau, 11/4)
