Editor’s Picks: New Bundled Payment Model

Hold on to your hats, folks! The winds of new regulations are blowing in fast.

This week was all about new regulations, as we clue in our readers to the newest bundled payment initiative coming down the pipe from the Centers for Medicare & Medicaid Services. At the same time, home health industry groups were still up in arms about the pre-claim review.

Here in the newsroom, we were tracking down the latest huge Medicare fraud involving home health. It’s a doozy.


Most Read

Home Health Agencies Implicated in $1 Billion Medicare Fraud—The Department of Justice has brought charges against the owner of 30 Miami-area health care facilities in the largest single Medicare fraud scheme ever, totaling more than $1 billion. The charges come on the heels of another enormous bust that involved home health companies in more than $900 million in Medicare fraud across various scams.

NAHC: Pre-Claim Review Makes No Sense, Goes Too Far—Days away from the August 1 start of the pre-claim review demonstration in Illinois, industry groups are pushing back yet again. The National Association for Home Care & Hospice (NAHC) recently submitted harsh comments to the Office of Management & Budget (OMB) over the pre-claim pilot program by the Centers for Medicare & Medicaid Services (CMS), criticizing the added administrative burden the demonstration will add and even questioning its legality.


CMS Unveils Bundled Payment for Heart Conditions, Femur Fractures—Home health agencies already are becoming more enmeshed with hospitals and other providers through new payment models, and that’s set to accelerate thanks to a program announced Monday. A newly proposed bundled payment model could mean closer hospital and home health coordination for patients with certain heart conditions, as well as those recovering from hip and femur fractures.

Top Policy Recommendations for Aging in Place—Nearly all Americans want to age in place, but policies and payment mechanisms often get in the way of seniors getting the care they need at home. While the home health care industry has seen an onslaught of new regulations over the past few years, not all of these are helpful to expanding care to more Americans at home. Industry experts recently discussed policy recommendations at the d.health Executive Summit in New York City.

Around the Web

3 Ways to Work From Home and Be a Caregiver, Too—While it’s cheaper and more pleasant to age in place at home, family members of loved ones in need of care often find themselves in a complex health care system without much direction. Fortunately, family caregivers can make it work by finding the right resources, the right help and managing their own time.

Can This Brain Exercise Put Off Dementia?—A new, 10-year study showed that speed training—computer exercises that get users to visually process information more quickly—beat out memory and reasoning exercises, two other popular brain-training techniques when it comes to reducing the chances of dementia, The Wall Street Journal writes. The study is believed to be the first to demonstrate that a behavioral intervention can reduce the incidence of dementia.

Amy’s Adds

Illinois House Candidate Walks in the Shoes of a Home Healthcare Worker—State Representative candidate Marsha Griffin spent the day walking in the shoes of a local home health care worker to see firsthand how a new overtime policy is affecting them. The worker, Jeff Pool, used to work up to 48 hours a week caring for a SIU student. Now a state policy that started in May restricts Poole to working 40 hours a week, WSIU, an NPR public broadcasting station, reported.

Healthy Mind, Healthy Body: Changing Health Care, Especially at Home—Today, the major health care players—including home care companies, medical systems like the VA, managed care organizations, Medicare, Medicaid and government health agencies—are all moving toward an integrated view of physical and behavioral health, in which metal disorders are being screen for early and treated aggressively, The Huffington Post writes.

Written by Amy Baxter

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