Healthcare Connect Advisors’ Post

As the December 20 government funding deadline approaches, Congress is deep into discussions over a comprehensive year-end health care package. These negotiations carry significant implications for healthcare access, provider support, and public health preparedness across the nation. The current proposal includes: • 𝗧𝗲𝗹𝗲𝗵𝗲𝗮𝗹𝘁𝗵 𝗮𝗻𝗱 𝗖𝗮𝗿𝗲 𝗜𝗻𝗻𝗼𝘃𝗮𝘁𝗶𝗼𝗻𝘀: 𝗔 𝘁𝗵𝗿𝗲𝗲-𝘆𝗲𝗮𝗿 𝗲𝘅𝘁𝗲𝗻𝘀𝗶𝗼𝗻 𝗼𝗳 𝗠𝗲𝗱𝗶𝗰𝗮𝗿𝗲’𝘀 𝘁𝗲𝗹𝗲𝗵𝗲𝗮𝗹𝘁𝗵 and hospital-at-home programs, providing continuity for millions of patients relying on virtual and at-home care. • 𝗣𝗿𝗼𝘃𝗶𝗱𝗲𝗿 𝗦𝘂𝗽𝗽𝗼𝗿𝘁: 𝗔 𝘁𝗲𝗺𝗽𝗼𝗿𝗮𝗿𝘆 𝟮.𝟱% 𝗽𝗵𝘆𝘀𝗶𝗰𝗶𝗮𝗻 𝗽𝗮𝘆𝗺𝗲𝗻𝘁 𝗶𝗻𝗰𝗿𝗲𝗮𝘀𝗲 under Medicare and flat funding for Federally Qualified Health Centers, offering short-term financial stability amid broader reimbursement challenges. • 𝗣𝘂𝗯𝗹𝗶𝗰 𝗛𝗲𝗮𝗹𝘁𝗵 𝗥𝗲𝗮𝗱𝗶𝗻𝗲𝘀𝘀: 𝗥𝗲𝗮𝘂𝘁𝗵𝗼𝗿𝗶𝘇𝗮𝘁𝗶𝗼𝗻 𝗼𝗳 𝘁𝗵𝗲 𝗣𝗮𝗻𝗱𝗲𝗺𝗶𝗰 and All-Hazards Preparedness Act and the SUPPORT Act to address ongoing public health crises. To fund these initiatives, proposed offsets include repealing the Biden administration’s nursing home staffing rule—a contentious measure unlikely to gain bipartisan support—and adjustments to pharmacy benefit manager transparency rules. While key elements such as telehealth expansion have bipartisan backing, other provisions face sharp divides. These discussions will determine not only immediate policy outcomes but also the trajectory of healthcare access and equity in the coming years. What aspects of these negotiations do you believe are most vital for patients and providers? What can you do? Take action by writing your legislators! Click here for templates https://lnkd.in/eh5s-dyC #HealthCarePolicy #EquityInCare #Medicare #Advocacy 

To maximize payment for CCM services in Rural Health Clinics (RHCs), focus on a few key strategies. First, ensure accurate documentation of patient eligibility and care plans to meet Medicare requirements. Next, streamline care coordination with a well-structured team to improve efficiency and patient outcomes. Utilize electronic health records (EHRs) to track and report time spent on CCM services, ensuring proper billing. Additionally, invest in staff training to stay current with Medicare guidelines and reimbursement policies. Lastly, continuously monitor performance metrics to identify areas for improvement and maximize revenue potential. https://lnkd.in/dsKwvrz6 https://lnkd.in/dxDKPbVs https://lnkd.in/dAHBa_Ue #CCMServices #RuralHealth #HealthcareOptimization #ChronicCareManagement #RHCs #MedicareCompliance #HealthReimbursement #PatientCare #CareCoordination #HealthcareBilling #HealthTech #ElectronicHealthRecords #MedicalDocumentation #RevenueMaximization #PatientOutcomes #HealthcareStrategies #RuralClinics #CCMRevenue #MedicareGuidelines #HealthcareInnovation #MedicalBilling #HealthcareEfficiency #ChronicDiseaseManagement #HealthcareTraining #StaffDevelopment #ReimbursementStrategies #ClinicSuccess #HealthCareTeams #MaximizeReimbursement #CareManagement #RuralHealthcare

Health Centers:  Revenue, Grant Funding, and Methods for Meeting Certain Access-To-Care Requirements  GAO-24-106815, March 7 Highlights What GAO Found In 2022, nearly 1,400 health centers provided primary and preventive health services to more than 30 million people, regardless of their ability to pay. Health centers' total revenue rose from about $28.7 billion in 2018 to $42.9 billion in 2022—an increase of more than $14 billion. The largest single source of revenue was Medicaid, accounting for over one-third of total revenue each year. The second largest revenue source each year was grants, including those provided by the Health Resources and Services Administration (HRSA). Health Center Revenue Sources and Amounts, 2018 and 2022 About GAO, often called the "congressional watchdog,” is an independent, non-partisan agency that works for Congress. GAO examines how taxpayer dollars are spent and provides Congress and federal agencies with objective, non-partisan, fact-based information to help the government save money and work more efficiently. https://lnkd.in/eSFMp3th #USA #Health

Some rural hospitals, like critical access hospitals, receive special Medicare reimbursement to sustain services for their community. The cost of care has dramatically risen since limits were placed on the CAH program in 2006, which is why @ahahospitals encourages Congress to reopen the necessary provider status to continue support for rural health. https://buff.ly/3Z1ZNQC

Demands on the NHS are too high with almost 8 million people on a waiting list for NHS treatment and 1 in 3 struggling to see their family GPs, which is why employees are increasingly turning to private healthcare. But access isn’t always easy with high and hidden costs, and lots of choices in the private sector. That’s why Health Plans like ours are critical to enabling employees to easily access trusted healthcare professionals when they need to. Find out more about the Health Plan Evolution: https://lnkd.in/e4q6mfyk

We love this "silly rules" campaign, check it out. If you asked your team what could be scrapped to provide better care it would begin a beautiful conversation and create an opportunity to shake out all those things that no longer serve your staff and the people you support (patients/clients/customers). Are you brave enough to try it? You could simply do it in your team meeting. Please share with us a "silly rule" that was identified as an obstacle in your business. #ihi #sillrules #reduceyour policiesandprocedures #makesuretheyserveyou

In rural areas, every second counts. With #SimulationTraining, we're equipping healthcare providers with the hands-on experience they need to make those seconds count. #RuralHealth #EmergencyCare 🚨

ConcertoCare’s value-based, in-home care model is transforming support for Medicare and Duals members while delivering health plan cost savings. For payers, an investment in ConcertoCare's program pays dividends through reduction of unnecessary ED visits and admissions, prevention of readmissions, and reductions in the need for costlier institutional care. It's a win-win for health plans, their members, and the health system at large.

Advancing health equity is a critical element of health care quality that directly ties to improved patient experiences and outcomes. Efforts to promote health equity reflect a moral imperative and can reduce health care costs through effective care management, which in turn helps decrease avoidable hospitalizations, emergency department visits, and low or no-value care. Health care payers play a vital role in this effort by designing and implementing value-based care models and payment arrangements that enhance high-quality, coordinated patient care.

Since the end of the public health emergency (PHE), healthcare providers have experienced a significant increase in both the quantity and aggressiveness of billing/coding audits simply because the payers must make up for the time during the PHE that audits were suspended. Extrapolation has resulted in a massive increase in overpayment demands with almost no increase in effort. What we are witnessing is a virtual feeding frenzy, and healthcare providers are the prey. During this presentation, Mary Malone and others will provide comprehensive guidance on understanding the process, challenges and strategies involved in successfully defending all types of payer audits.