Census: Insured Population Holds Steady, with a Slight Shift from Private to Public Coverage

Despite a pandemic-fueled recession, the number of uninsured Americans has increased only slightly since 2018, according to Census Bureau health insurance data released Tuesday. Twenty-eight million people, or 8.6% of Americans, were uninsured for all of 2020. In 2019, 8% of people were uninsured during the full year; in 2018, it was 8.5%.Still, the annual report shows a shift in where Americans get their insurance coverage. Private insurance coverage decreased by 0.8 percentage points from 2018. Public coverage rose by 0.4 percentage points from 2018. That shift was likely driven partly by older Americans becoming eligible for Medicare, at age 65, and showed a 0.5 percentage point increase from 2018 to 2020.

House Democrats Seek to Add Dental Benefits to Medicare by 2028 as Part of $3.5T Package

House Democrats want to add dental benefits to traditional Medicare in seven years as well as coverage for major treatments and preventive services. The House Ways and Means Committee released the language for the additional benefits Tuesday, which will be part of a $3.5 trillion infrastructure package being considered this fall in Congress. The panel is holding a markup of the legislation on Thursday. The legislation aims to add dental, vision and hearing benefits to traditional Medicare. The legislative text released Tuesday is the first look at how Democrats would implement the benefits.

ASCs + CMS: The Good, the Bad and the Ugly

ASCs are known as the high quality, low cost setting for surgical care, and CMS has taken notice. The agency, along with commercial payers, have made some moves to direct more surgeries to ASCs, but have also developed new policies making it more difficult to perform certain procedures there. At the Becker’s Orthopedic, Spine + ASC Virtual Event Aug. 12, a panel discussed the payer landscape and what to expect in the future.

Medicare Trustees Project Hospital Fund to Run Out in 2026, Same Deadline as Year Before

Medicare’s insurance trust fund that pays hospitals is expected to run out of money in 2026, the same projection as last year, according to a new report from Medicare’s board of trustees. The report, released Tuesday, found Medicare spent $925.8 billion in 2020 and served 62.6 million people. It found that the COVID-19 pandemic had a major impact on the short-term financing for the program, but the financial status overall of the fund hasn’t significantly changed.

Medicare ACOs Saved $4.1B in 2020

The Medicare Shared Savings Program collectively saved Medicare $4.1 billion last year and $1.9 billion after accounting for shared savings payments. It is the highest annual savings to date for the accountable care organization model that served 10.6 million seniors in 2020. The accountable care organizations had an average quality score of 97.8% and 60 earned a score of 100%. The results are an improvement over the $2.6 billion and $1.2 billion in gross and net savings in 2019.

CMS Lays Out the Future of Value-Based Care

The Biden administration’s vision for the future of value-based care rests on curbing the number of CMS payment experiments and a greater focus on health equity. CMS hopes to remake the U.S. healthcare system over the next decade by prioritizing coordinated, team-based care, measuring outcomes that matter to patients, and holding providers more accountable, top officials wrote in a Health Affairs blog on Thursday. The agency thinks simplifying its approach by cutting back the number of models would make participation easier for providers.

Dying MA Customers Are Switching to Traditional Medicare

Medicare Advantage beneficiaries can’t access the care they need as they get sicker, a new report from federal watchdogs suggests. People enrolled in Medicare Advantage plans are switching to Medicare fee-for-service at an alarming rate during their last year of life, according to a Government Accountability Office (GAO) report published Wednesday. Medicare Advantage customers in their last year of life were more than twice as likely to drop their policies and enroll in Medicare fee-for-service than other Medicare Advantage enrollees.

CMS Announces Medicare Pay Hikes for Providers

The latest Medicare payment rules for inpatient rehabilitation, inpatient psychiatric, hospices and skilled nursing facilities are out, and there’s good news for those healthcare providers. Under a final rule CMS published Thursday, inpatient rehab facilities will get a 1.9% pay bump in 2022, raising their reimbursements by $130 million. Inpatient psychiatric facilities will get a 2% hike, an increase of $80 million. Hospices also will get paid 2% more, which amounts to an additional $480 million. Skilled nursing facilities will get a rate increase just over 1%, or $410 million.

Medicare and Dental Coverage: A Closer Look

This KFF brief provides new data on the share of Medicare beneficiaries with dental coverage, the share with a dental visit in the past 12 months, and out-of-pocket spending on dental care. It also takes a closer look at the scope of dental benefits offered to Medicare Advantage enrollees in individual plans in 2021. KFF focuses on Medicare Advantage plans because they have become the leading source of dental coverage among Medicare beneficiaries.

Physician Practice Acquisition Strategy: CMS Stark Advisory Opinion Offers Additional Flexibility

CMS recently issued a Stark Advisory Opinion, which may offer additional flexibility for physician practices in growth mode. CMS-AO-2021-01 concerns a group practice’s proposal to furnish designated health services (“DHS”) through two wholly owned subsidiary entities that do not, themselves, qualify as group practices. CMS concluded the proposed structure did not preclude the group practice from qualifying as a “single legal entity” as required by the Stark group practice definition. This structure offers certain benefits for private equity and other groups looking to quickly expand and acquire other practices, as well as other strategic opportunities.