In late 2019, the Centers for Medicare and Medicaid Services finalized the Physician Fee Schedule for this calendar year, which includes several updates and changes to the provision, payment and paperwork related to Medicare Part B Physical Therapy services. These changes included new rules that have already gone into effect earlier this year, and for new initiatives coming in 2021 and 2022. Read Full Post

A growing healthcare trend that will almost certainly ramp up in 2020 is “consumerism,” the concept that patients and their family members are taking even more ownership of care decisions based upon costs and their understanding of the full scope of options available to them based on research and trustworthy sources of information. In response, healthcare providers have been asked to respond with more price transparency and demonstrated quality outcomes. Read Full Post

Kindred Hospital Rehabilitation Services (KHRS) began working with our internal teams and partners in 2014 to prepare for the changes mandated through the IMPACT Act that would ultimately go into effect in 2019. In order to effectively transition from the long-used FIM tool to section GG, the IRF industry required a revised strategy with new tools, resources and training to succeed. In preparation for the changes to the new IRF-PAI system and new requirements, KHRS developed a comprehensive training and implementation plan to ensure a smooth transition for all of our hospital partners. Read Full Post

Trend to Watch: Healthcare Consolidation Aims to Close Gaps and Drive Value-Based Care In 2020, the continued – and growing – trend toward integrated production, including non-traditional partners, is helping to define an age of major transformation across the healthcare industry. While mergers and acquisitions between hospitals, health systems and physician practices may be waning, consolidation among unlikely partners has accelerated. These types of relationships include the ongoing integration between CVS and Aetna and the announced deal between Walmart and Amedysis. Read Full Post

Certificate of Need (CON) is a public policy tool which seeks to slow healthcare cost growth, avoid duplication of programs and services and ensure that new development meets the needs of the community. Nationally, only 12 states have no CON requirements. In Florida, the CON program was enacted in 1973 and applied to the building of new health centers or expansion of certain, complex medical services – including hospitals, nursing facilities, hospices and intermediate care facilities for the developmentally disabled. Read Full Post

On July 31, 2018, the IRF Final Rule was issued by the Centers for Medicare and Medicaid Services, which will take effect FY 2020. In addition to the updates to IRF payment rates and other measures designed to streamline care and reduce inefficiencies, one of the most important takeaways from the Final Rule relates to the removal of the Functional Independence Measure (FIM™) Instrument and Associated Function Modifiers from the IRF-Patient Assessment Instrument (PAI) and Refinements to the Case Mix Classification System. Read Full Post

A corrective statement to clarify Medicare coverage of therapy delivered in a skilled nursing facility or in the home setting was approved recently by a federal court. The statement, to be used as part of the settlement in the Jimmo v. Sebelius case, is designed to clearly explain that therapy to maintain a person's condition or slow down his or her decline is covered under Medicare. Read Full Post

A recent ruling attempts to change the perception that beneficiaries are only eligible for therapy coverage if their health is improving. The ruling is related to a 2013 settlement that established that improvement is not one of the criteria for coverage.

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As part of the Affordable Care Act, in recent years Medicare and Medicaid have worked with federal government agencies, states, patient organizations and others to identify and prevent health conditions that have caused long-term care residents to be unnecessarily hospitalized. As a result, we have seen a significant decline in avoidable hospitalizations over the last several years, according to analysis released by CMS.

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The Centers for Medicare and Medicaid Services finalized a major new rule approximately one month ago to make significant changes to improve patient care and safety. The new rule’s compliance obligations, which will be implemented in three phases that begin this year and extend through 2019, represent the largest update the industry has seen since 1991. The “megarule" as some in the industry are calling it sets high standards for care and targets infections, hospital readmissions, staffing practices and resident safety among other areas.

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