Quality of Care Standards

News & Analysis as of

Home Health PPS CY 2017 Proposed Rule: Payments Rebased, Quality Measures Updated

Downward adjustments to home health episode payments arising from rebasing of the national payment rates, case mix adjustments, and an increase to the fixed dollar loss ratio for calculating outliers will result in an overall...more

CMS 2016 Nursing Home Action Plan Overview

On May 17, the Centers for Medicare & Medicaid Services (CMS) released its new Action Plan for Further Improvement of Nursing Home Quality (Action Plan). The Action Plan is CMS’ strategic plan for nursing homes that is...more

CMS Proposes Updates to Hospital Conditions of Participation

CMS recently published a proposed rule to update certain of the hospital and critical access hospital (CAH) Medicare and Medicaid conditions of participation (CoPs). With its goals of modernizing hospital and CAH CoPs,...more

Healthcare Systems Offer Shared Medical Visits to Address Physician Shortages and Chronic Illnesses

With the advent of an increasing aging population, physicians and other healthcare providers are seeking alternative approaches in offering patients access to quality health care. Among the innovations in healthcare delivery...more

CMS Update to Medicaid Managed Care Regulations Should Prompt Significant Change

The Centers for Medicare & Medicaid Services (“CMS”) has released the final version of its much anticipated revisions to the regulations governing Medicaid managed care (the “Final Rule”). First proposed in May 2015, the...more

Tennessee Legislature Passes Sweeping Changes to CON Law

On April 20, 2016, the Tennessee House and Senate completed final actions to pass legislation that makes significant modifications to the state’s certificate of need (CON) laws. The legislation, SB1842/HB1730 was sponsored by...more

Talking about The Challenge of Quality in Health Care Policy Development

Last week, I spoke at the National Quality Forum Annual Conference in Washington, D.C. about the role of health care quality in policymaking on the Hill....more

CMS Announces Collaborative Core Quality Measures

CMS, in a collaboration with American’s Health Insurance Plans (AHIP), announced on February 16, 2016, seven sets of “core measures” to align quality measures required for physician reporting. These core measures align the...more

Groundbreaking Multi-Payer Alignment on Core Measures for Quality-Based Payments

For too long, health industry stakeholders have bandied about massive amounts of information that could not be used in a comparative sense. Both public and private payers had their own proprietary reporting metrics,...more

CMS Model Payment & Initiatives - The Growing Target of Quality & Care Improvement in Skilled Nursing Facilities

Like it or not, the Centers for Medicare & Medicaid Services (CMS) is expanding its strong commitment to focus on quality and care improvement as the basis for payment to providers throughout the continuum of care....more

CMS Payment Initiatives Target Quality & Care Improvement - The Short Version

Like it or not, the Centers for Medicare & Medicaid Services (CMS) is expanding its strong commitment to focus on quality and care improvement as the basis for payment throughout the continuum of care. The final rule for the...more

CMS Releases Home Health Compare “Patient Experience of Care” Star Ratings

In yet another move emphasizing the Centers for Medicare & Medicaid Services’ (CMS) focus on quality health care, the agency has released the first patient experience of care star ratings on Home Health Compare. ...more

Health Alert (Australia) - January 18, 2016

In This Issue: - Judgments; Legislation; and Reports. - Excerpt from Judgments: New South Wales 14 January 2016 - Health Care Complaints Commission v Athour [2016] NSWCATOD 5 The New South Wales...more

CMS Initiatives Target Quality & Care Improvement - Corridors January 2016

Like it or not, the Centers for Medicare & Medicaid Services (CMS) is showing a strong commitment to moving forward with its focus on hospitals’ quality and care improvement as the basis for payment. In November, CMS...more

Corridors - January 2016 - News for North Carolina Hospitals

Final Stark Rule Changes Adopt New Exceptions For Hospitals and Significant Clarifications - In the Medicare Fee Schedule Final Rule with Comment Period for calendar year 2016, the Centers for Medicare & Medicaid...more

Also In The News - Health Headlines - December 2015 #2

CMS Releases HAC Data for FY 2016, Showing More Payment Reductions – On December 10, 2015, CMS published quality measure scores related to hospital-acquired conditions (HACs) for hospitals participating in the HAC Reduction...more

CMS Publishes Proposed Rule on Hospital/HHA Discharge Planning Requirements

On November 3, 2015, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule that would modify the discharge planning conditions of participation (COPs) for hospitals, including long-term care hospitals...more

GAO Finds Limited Hospital Impact from Hospital Value-Based Purchasing Program

According to a recent Government Accountability Office (GAO) report, bonuses and penalties triggered by the Medicare Hospital Value-based Purchasing (HVBP) program have had no apparent impact on quality measure performance...more

Also In The News - Health Headlines - October 2015 #3

CMS Announces Part D Enhanced Medication Therapy Management Model Demonstration – On September 28, 2015, CMS announced a Part D Enhanced Medication Therapy Management Model (Enhanced MTM Model) that is designed to assess...more

GAO Releases Report on Initial Results of CMS’s Hospital Value-Based Purchasing Program

The U.S. Government and Accountability Office (GAO) issued an October 2015 report to congressional committees concluding that the initial results of the Hospital Value-Based Purchasing (HVBP) program show “no apparent shift”...more

CMS Issues Proposed Rule Significantly Modifying the Requirements for Long-Term Care Facilities Participating in the Medicare and...

On July 16, 2015, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule comprehensively updating and extensively revising the requirements for participation for long term care (“LTC”) facilities...more

MedPAC Suggests Streamlining CMS’s Proposed Performance-Based Physician Payment System

On September 8, 2015, the Medicare Payment Advisory Commission (MedPAC) released its comments to the proposed rule that will begin implementing the new Merit-Based Incentive Payment System (MIPS) for physician services, in...more

CMS Announces New Value-Based Insurance Design Model for Medicare Advantage

On September 1, 2015, CMS unveiled a new Medicare Advantage Value-Based Insurance Design (MA-VBID) model, which will allow Medicare Advantage plans to offer clinically-nuanced benefit packages aimed at improving quality of...more

2014 Medicare ACO Results Released: CMS Asserts Success but Few ACOs Receive Payments

The Centers for Medicare and Medicaid Services (CMS) released, on August 25, 2015, the quality and financial performance results for Medicare Accountable Care Organizations for 2014. CMS touted that Medicare ACOs continued to...more

CMS Schedules Provider Calls on Medicare Quality Programs

CMS is hosting several calls and webcasts in September and October 2015 on various Medicare quality programs, including the following...more

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