article thumbnail

SCAN Group CEO Sachin Jain: Medicare Could Use a Major Facelift

Hospice News

The mission and function of the Medicare program have evolved over time, and the agency that runs it also may need to adapt to the new ways that health care organizations are doing business, according to SCAN Group CEO Dr. Sachin Jain. billion nonprofit Medicare Advantage (MA) organization that covers more than 270,000 members.

Medicare 233
article thumbnail

MA Beneficiaries More Likely than Fee-for-Service Patients to Enter Hospice from Community Setting

Hospice News

Medicare Advantage (MA) beneficiaries are more likely to enroll in hospice from a community setting than patients in traditional fee-for-service programs. million patients who elected hospice in the last 90 days of life during the years 2011, 2013, 2016 and 2018. .” This is close to half of all Medicare beneficiaries.

2011 246
professionals

Sign Up for our Newsletter

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Trending Sources

article thumbnail

How Four Questions Can Reduce Costs, Boost Hospice Utilization

Hospice News

The Center for Medicare & Medicaid Innovation ran the project between 2011 and 2015 at 32 participating hospitals and health systems. It’s on all our minds, the Medicare Advantage carve-in and how we are going to weather whatever changes come,” Irhig told Hospice News. “If

2011 306
article thumbnail

How Palliative Care Could Help Break the SNF-to-Hospital Cycle

Hospice News

Even more so, specific Medicare and Medicaid policies perpetuate this cycle. After experiencing a functional decline at the hospital, the woman, no longer able to live at home safely, was sent to an SNF for post-acute care, covered by Medicare. Older adults frequently utilize such services, often in skilled nursing facilities (SNF).

article thumbnail

Humana CEO Broussard to Step Down in 2024, Succeeded by Envision Healthcare Exec Jim Rechtin

Hospice News

All told, he has more than 22 years of experience with value-based health care and payment models, including Medicare Advantage, according to a Humana press release. Humana is the second-largest operator of Medicare Advantage plans, representing 18% of that market, according to the Kaiser Family Foundation.

2024 263
article thumbnail

Advance Care Planning Billing Rules Impede Equitable Access

Hospice News

On the patient side, Medicare beneficiaries face out-of-pocket costs when advance care planning is performed in any setting outside of an annual wellness visit. Across 150 different studies, white adults represented nearly two-thirds (65.1%) of roughly 800,000 individuals who had completed advance directives between 2011 and 2016.

article thumbnail

CMS Issues Final Rule for MA Risk Adjustment Audits

Hospice News

Many hospice providers rely on Medicare Advantage (MA) reimbursement to support palliative care, PACE and social determinants programs, among others. Centers for Medicare & Medicaid Services (CMS) laid out its policy for validating MA plans’ risk adjustment data, which the agency uses to calculate capitation rates.

2011 246