Medicare Advantage Transparency Efforts Could Impact Hospices

In case you missed it, Hospice News has launched a new specialty publication for palliative care professionals. You can subscribe to Palliative Care News here: Subscribe today! Recent efforts to increase transparency within Medicare Advantage may impact hospice reimbursement. The U.S. Centers for Medicare & Medicaid Services (CMS) recently released a Request for Information (RFI) on ways […]

How CMS’ 2024 Risk Adjustment Rules May Affect Palliative Care Companies

Depending on how stakeholders play their cards, the U.S. Centers for Medicare & Medicaid Services’ (CMS) updated risk adjustment policy could lead to tightened belts — or a golden opportunity — for palliative care providers in Medicare Advantage. Much of the palliative care delivered to U.S. patients is now reimbursed through risk-based models like Medicare […]

Health Plan Participation in Hospice VBID to Shrink in 2024

Health plan participation in the hospice component of the value-based insurance design model (VBID) will fall in 2024. For calendar year 2024, 13 Medicare Advantage Organizations (MAOs) will participate in the program’s hospice component, providing coverage through 78 health plans in 19 states. In 2023, 15 MAOs participated in hospice VBID, including 119 health plans […]

Why MA Plans Are Investing in Palliative Care as a Supplemental Benefit

Increasingly, Medicare Advantage (MA) plans have found real value in offering community-based palliative care as a supplemental benefit. Since 2018, the U.S. Centers for Medicare & Medicaid Services (CMS) has allowed MA health plans to cover new supplemental benefits for eligible patients. This flexibility has allowed insurance companies to offer assistance beyond what is available […]

CMS Unveils Dementia-Focused Payment Model with Interdisciplinary Care Approach

The U.S. Centers for Medicare & Medicaid Services (CMS) has unveiled a new payment model demonstration geared toward dementia-related illnesses, which are becoming more prevalent among hospice patients. The Guiding an Improved Dementia Experience (GUIDE) Model is designed to improve the quality of life for dementia patients and their caregivers by addressing behavioral health and […]

Defining the Undefined Scope of Palliative Care Payment, Services

Breaking down the payment barriers that impede access to palliative care will take building up a reimbursement structure that more narrowly defines service scope and sets specific parameters for quality. The nation’s fragmented payment structures for palliative care reimbursement create opportunities for regulators to examine the facets of these different models across varied geographic areas […]

The Forces Fueling the Palliative Care Market

Evolving demographic and economic forces have placed palliative care among the nation’s fastest growing health care sectors. Interest in the palliative care market has spiked in recent years, partly due to the value proposition these services offer to patients, families, providers and payers alike, according to Fred Bentley, managing director at health care consulting firm […]

How Palliative Care Fits in to CMMI’s Enhancing Oncology Model

A new cancer-focused payment model demonstration from the Center for Medicare & Medicaid Innovation (CMMI) could create opportunities for palliative care providers. The goals of the Enhancing Oncology Model (EOM), which went live on July 1, are to improve quality and reduce the cost of cancer care with augmented care coordination. While documents on the […]

Medicare Advantage Crackdown Could Dampen Palliative Care Growth

Federal regulators are cracking down on the private insurers that administer Medicare Advantage (MA) plans. In turn, that could dampen the growth of palliative care supplemental benefits in MA moving forward. Despite palliative care’s ability to lower health care spending and improve patient outcomes, it remains an underutilized service. That’s partly because providers are forced […]

SCAN CEO Jain: Don’t Glorify Fee-for-Service to Improve Medicare Advantage

When stakeholders consider ways to improve Medicare Advantage, they should take care not to romanticize fee-for-service Medicare in the process, SCAN Health Plan CEO Dr. Sachin Jain cautions. Medicare Advantage (MA) is a growing force in health care. More MA plans emerge each year and the size of their beneficiary populations continues to grow. While […]