Insights & Analysis
There’s one constant in healthcare: change. Count on us to break down the trends so you can stay up to date. Follow our take on each piece of this deep, intertwined, and often perplexing industry to find opportunities and practical approaches to move healthcare forward.
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CMS Offers End-to-End Testing of ICD-10 Claims and Beta Software to Support Providers through the ICD-10 Implementation
From July 21 to 25, CMS will conduct end-to-end testing on the International Classification of Disease, Tenth Revision (ICD-10) coding system.
Strategies to Improve Medication Management Communications in SNFs
In this week's edition of McKnight's Long-Term Care News & Assisted Living, Avalere's Anne Tumlinson wrote a guest post discussing ways to improve medication management communications at skilled nursing facilities (SNFs).
Congress Proposes Bill to Expand New Technology Add-On Payments for Antibiotics under Medicare
In the July/August 2013 RPM Report, I co-wrote an article with Avalere's Scott Gottlieb and Lauren Barnes discussing the potential to use the new technology add-on payments (NTAPs), a novel pathway created by Congress in 2001, as a foundation for new policies that support innovation and address public health goals.
March MedPAC Meeting Discussion Highlights CMS’ Interest in Part B Payment Reform
At March's MedPAC meeting, staff discussed improving Medicare spending value by linking Fee-for-Service (FFS) payment to the comparative clinical effectiveness of healthcare therapies.
Nationwide Exchange Enrollment Tracking Toward 5.4M by the End of March
New Avalere analysis finds that exchange enrollment is on track to reach 5.4 million by the end of March when open enrollment is set to end. That number falls short of current Congressional Budget Office (CBO) estimates that six million people will enroll in exchanges in 2014.
MedPAC’s March 2014 Meeting in Brief
MedPAC's latest public meeting was March 6 and 7 and covered topics such as equalizing payments across post-acute settings of care, improving quality measurement, exploring alternative methods to pay for Part B drugs, enhancing delivery of primary care services through payment incentives, and ways to improve payments and care delivery across Medicare fee-for-service (FFS), Medicare Advantage (MA) and Accountable Care Organization (ACOs).
New CPT Codes for Next Generation Sequencing Procedures on the Horizon for 2015
The American Medical Association's (AMA) Current Procedural Terminology (CPT®) Editorial Panel (Panel) announced on March 5 its acceptance of a set of codes that will be used to report testing for large-scale, multianalyte genomic sequencing procedures typically performed using Next Generation Sequencing (NGS) technology.
HHS Notice of Benefit and Payment Parameters for 2015 Final Rule Released
On March 5, CMS released the HHS Notice of Benefit and Payment Parameters for 2015 final rule.
CMS Seeks Stakeholder Input on Possible DMEPOS Payment Methodology Changes
On Feb. 24, CMS released an advance notice of proposed rulemaking and request for comments on two potential methodology changes to adjust Medicare fee schedule payment amounts or other Medicare payment amounts for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).
FDA to Hold Public Hearing on Issues and Challenges Associated with Demographic Subgroup Data
FDA will hold a public hearing on April 1 to receive feedback from key stakeholders on 1) demographic subgroup representation in clinical trials, 2) analysis of demographic subgroup data, and 3) communication of demographic subgroup information to the public.
Duals Demonstrations Pick Up Speed: 4 States Have Launched, 13 to Follow in 2014
The financial alignment demonstrations (FAD), designed to coordinate care for dual eligible beneficiaries, are gaining momentum as states begin implementation and final planning.
President Releases 2015 Fiscal Year Budget
On March 4, President Obama released his budget for the 2015 Fiscal Year (FY). While Congress is unlikely to engage in a serious budget process this year, the president's budget expresses the administration's priorities and stands as a marker of potential healthcare offsets or "savers" for other legislative initiatives, including a repeal of the Sustainable Growth Rate (SGR).
Washington State Accepting Comments on Proposed Review of Six Technologies for Coverage
On Feb. 28, Washington State's Health Care Authority (HCA), which administers the state's Health Technology Assessment (HTA) Program, recommended five technologies to undergo initial review and coverage decisions, and recommended one topic for re-review, beginning in 2015.
Avalere Analysis Finds 2.4 Million to 3.5 Million New Medicaid Enrollees As a Result of the Affordable Care Act
A new analysis from Avalere Health estimates that from October 2013 through January 2014, between 2.4 million and 3.5 million people have newly enrolled in Medicaid as a result of the Affordable Care Act (ACA).
FDA Releases Draft Guidance on New Chemical Entity (NCE) Exclusivity Determinations For Combo Drugs
On Feb. 24, FDA issued draft guidance on exclusivity determinations for certain fixed-combination drug products (FCDs).
OIG Analysis Finds Medicare and Beneficiaries Could Realize Savings from Expansion of DRG Window
On Feb. 19, OIG released a claims analysis of 2011 hospital inpatient Medicare cases, finding that Medicare and its beneficiaries could achieve substantial cost savings by expanding the inpatient hospital Medicare Severity Diagnosis Related Group (DRG) window.
FDA Confirms Widespread Generic-Drug Equivalency Testing Program
FDA has now confirmed that the first widespread generic-drug equivalency testing program was initiated last September (without public notice).
CMS Physician Compare Website Publishes Quality Data for the First Time
On Feb. 21, CMS enhanced the Physician Compare website to include the addition of quality measures to indicate the performance achieved on a set number of specific metrics.
FDA Releases Final Guidance on Pre-Submission Program for Medical Devices
On Feb. 18, FDA released guidance outlining how an applicant can obtain FDA feedback on a potential or planned medical device submission reviewed by the Center for Devices and Radiological Health (CDRH) and the Center for Biologics Evaluation and Research (CBER), including the Pre-Submission (formerly pre-Investigational Device Exemption (pre-IDE)) program.
First Coast Once Again Awarded the Part A/B Medicare Administrative Contract for Jurisdiction N
Last week, CMS awarded First Coast Service Options, Inc. (First Coast) the contract for the administration of Medicare Part A and Part B fee-for-service claims in Jurisdiction N, which encompasses Florida, Puerto Rico, and the U.S. Virgin Islands.