MedPAC Report: Private Equity and Medicare

In March 2020, the chairman of the Committee on Ways and Means asked MedPAC to examine the role that private equity (PE) plays in the Medicare program. One type of PE activity that has drawn growing attention in recent years involves investment firms that purchase companies and then try to improve their operational and financial performance so they can later be sold for a substantial profit. These types of acquisitions have become increasingly common in many parts of the economy, including the health care sector. The advantages and disadvantages of PE investment in health care have long been a topic of debate.

MedPAC: CMMI Should Consider a ‘Smaller, More Harmonized’ Portfolio of Alternative Payment Models

To reduce redundancies and confusion in the Medicare system, health care policymakers should consider implementing “a smaller, more harmonized” portfolio of alternative payment models (APMs). That’s according to the Medicare Payment Advisory Commission (MedPAC), which released its regular June report to Congress on Tuesday. “In many cases, providers participate in multiple [alternative payment models] simultaneously, and Medicare beneficiaries are attributed to multiple models at the same time,” the report notes. “This overlapping participation can have unintended consequences.”

HHS: ACA Exchange, Medicaid Expansion Coverage Reaches Record 31M

A record 31 million people have gotten coverage through the Affordable Care Act thanks to growth in Medicaid expansion and the insurance marketplaces, a new report finds. The data shows that 11.3 million people have enrolled in ACA marketplace plans as of February 2021. Another 14.8 million adults have coverage through the law’s Medicaid expansion as of December 2020.

Senate Confirms Chiquita Brooks-Lasure as Head of CMS

The Senate has confirmed health policy veteran Chiquita Brooks-LaSure as the Biden administration’s head of CMS, following a drawn-out approval process. As CMS administrator, Brooks-LaSure will have extensive oversight over the massive Medicare and Medicaid insurance programs and the exchanges set up by the Affordable Care Act. Industry groups including the Federation of American Hospitals and the Surgical Care Coalition cheered her confirmation, saying Brooks-LaSure’s policy know-how and experience managing insurance programs should help increase equitable access to affordable care in the U.S.

Biden Admin to End Next Gen ACO Model after This Year

The Biden administration has decided to not extend the Next Generation accountable care organization model, which is expected to end at the end of 2021. The decision announced late Friday ends a program that called for ACOs to take on more financial risk than the Medicare Shared Savings Program. The model was originally expected to end at the start of 2021 but was extended by the Trump administration due to the pandemic.

Medicare and Telehealth: Coverage and Use during the COVID-19 Pandemic and Options for the Future

In light of the rapid, but time-limited, expansion of telehealth coverage under traditional Medicare, this KFF brief provides an overview of the changes made during the COVID-19 pandemic to Medicare’s coverage of telehealth. It also presents new analysis of Medicare beneficiaries’ utilization of telehealth between the summer and fall of 2020, and discusses issues and questions related to extending telehealth coverage under traditional Medicare beyond the public health emergency.

CMS: Mental Health Services Decline by Double-Digits for Medicaid, CHIP Beneficiaries Last Year

Mental health services used by children and adults declined by double-digits from March through October 2020 compared to the same periods in 2019, new data show. The Centers for Medicare & Medicaid Services (CMS) released the findings Friday and emphasized that the decline could impact long-term health outcomes. The data looked at use of mental health services on Medicaid and the Children’s Health Insurance Program (CHIP).

CMS 2021 Final Rule: What Practices Can Do

At MGMA’s Medical Practice Excellence Pathways Conference, Justin Chamblee, CPA and senior vice president of Coker Group, gave a presentation overviewing CMS’s 2021 Final Rule changes and exploring the impact these changes will have on wRVUs and physician compensation.Net increases in RVUs means that Medicare payments for E/M visits will increase in 2021, then fall in 2022 compared to 2021 levels, Chamblee said in his presentation. Furthermore, due to budget neutrality requirements, payments for other services will be reduced and, as a result, some specialties will experience reimbursement increases while others experience decreases.

Medicaid Enrollment Increased by 5M during Pandemic—but Not for Reasons You May Think

Medicaid enrollment swelled by approximately 5 million from March through September 2020, but the boost may not just be due to job losses stemming from the pandemic, a new study found. The study, released Wednesday, found enrollment increases were roughly the same between Medicaid expansion and non-expansion states. The study also explored the impact of simplification steps for people to sign up for Medicaid. The study found that from January 2019 to September 2020 Medicaid enrollment increased from 48.2 million to 51.8 million in Medicaid expansion states and 17.2 million to 18.8 million in non-expansion states.

Biden Plan Omits Major Health Care Measures Pushed by Democrats

President Biden’s American Families Plan unveiled Wednesday leaves out two major health priorities pushed by congressional Democrats: reducing the cost of prescription drugs and lowering the eligibility age for Medicare. The major legislative package, which Biden will discuss in an address to Congress on Wednesday night, includes measures in areas like child care and paid leave, but largely steers clear of health care.