Incident-To Audit Alert
nnRecently the Office of Inspector General’s (OIG) website has posted cases of recent penalties that practices and providers have been charged due to incorrect billing of Incident-To. Are you at risk? The numbers are stomach turning and something that every practice should be aware of. We aren’t just talking about the huge hit in penalties, which are in the hundreds of thousands of dollars, but factor in the 15% hit you will take to your reimbursement for claims. With numbers like that it could mean a small practice having to close it’s doors.nnIncorrect submission of these claims is not something any practice aims to do. However, not submitting these claims is leaving money on the table. Read below for the enforcement actions as stipulated by the OIG and contact us today for more information.nnEnforcement ActionsnnCriminal and Civil EnforcementnThese cases often result from OIG’s work as part of its Most Wanted Health Care Fugitives initiative, the Medicare Fraud Strike Force, and other similar efforts. Since this work culminates in legal action by the U.S. Department of Justice (DOJ), links are provided to relevant news releases issued by DOJ or one of their 93 U.S. Attorneys.nState Enforcement ActionsnMedicaid Fraud Control Units (MFCU) investigate and prosecute Medicaid fraud as well as patient abuse and neglect in health care facilities. Currently, MFCUs operate in 49 States and in the District of Columbia. OIG certifies, and annually recertifies, each MFCU. OIG also collects information about MFCU operations and assesses whether they comply with statutes, regulations, and OIG policy.nCivil Monetary Penalties and Affirmative ExclusionsnThe Office of Inspector General (OIG) has the authority to seek civil monetary penalties (CMPs), assessments, and exclusion against an individual or entity based on a wide variety of prohibited conduct.nCorporate Integrity Agreement EnforcementnThe OIG has, as a contractual remedy, the right to impose stipulated penalties for non-compliance with the requirements of a Corporate Integrity Agreement (CIA). A material breach of the terms of the CIA also may result in the provider’s exclusion from participation in the Federal health care programs.nnClick here for more information on the E&M document changes.
Welter Healthcare Partners acknowledges the contributions of physicians to the overall health and well being of our communities. We would like to wish all physicians and specialists a very Happy Doctor’s Day, 2019. nnWe value your service and dedication.nn
You’ve just been assigned a major project. Naturally your mind is racing with a million different thoughts on where to start and what you’ll need to get the job done on time. As a result, you start creating a to-do-list that is massively bulky.nnThe problem with these out-of-control to-do-lists is that they’re overwhelming and prevent you from being productive. That’s because you’re multitasking and directing your energy to unimportant tasks and activities.nnInstead, keep your to-to-lists lean and mean by only focusing on your 3 to 5 most urgent, important, and challenging tasks for the day, aka your Most Important Task (MIT). Focus on one task at a time before moving on to less critical tasks. When you do, you’ll feel more productive and less anxious.nnLou Babauta of ZenHabits suggests that at least one of your MITs should be related to your goals and you should work on them in the AM Whether if it’s at home or in the office, tackle your MIT first thing in morning.nnAccording to Lou, “If you put them off to later, you will get busy and run out of time to do them. Get them out of the way, and the rest of the day is gravy!”nn2. Measure your results, not your time.nWhen it comes to productivity we often focus on how long something takes to complete; as opposed to what we actually accomplished in a day. For example, you just spent four hours writing a 1,000-word blog post. You may be be a bit bummed since that took a nice chunk out of your day.nnBut, what if you focused on the smaller parts of the blog post? For example, you broke into five 200-word sections, formatted it properly, added headings, ran a spellcheck and added images. Suddenly you realize you actually completed a lot in that timeframe.nnIn fact, research from the Behance team found “that placing importance on hours and physical presence over action and results leads to a culture of inefficiency (and anxiety).”nn”The pressure of being required to sit at your desk until a certain time creates a factory-like culture that ignores a few basic laws of idea generation and human nature: (1) When the brain is tired, it doesn’t work well, (2) Idea generation happens on its own terms, (3) When you feel forced to execute beyond your capacity, you begin to hate what you are doing.”nnOne way to assist you with measuring results instead of time is by generating done lists. This is simply an ongoing log of everything you completed in a day. By keeping this list you’ll feel more motivated and focused since you can actually see what you accomplished.nnAdditionally, according to Buffer co-founder Leo Widrich, done lists allow “you to review your day, gives you a chance to celebrate your accomplishments, and helps you plan more effectively.”nn3. Have an attitude adjustment.n
The team over at Mind Tools state that we’re more effective at work when we have a “positive attitude.”nn”People with a good attitude take the initiative whenever they can. They willingly help a colleague in need, they pick up the slack when someone is off sick, and they make sure that their work is done to the highest standards.”nnAnd, you’ll never hear them say that their work is “Good enough.” That’s because they go above and beyond.nnFurthermore, a good attitude at work will help you set standards for your work, ensure that you’re taking responsibility for yourself, and make decisions easier since they’re based on your intuition. “This admirable trait is hard to find in many organizations. But demonstrating ethical decision-making and integrity could open many doors for you in the future.”nn4. Communicate, communicate, communicate.nRegardless if you’re freelancer, entrepreneur, or employee, there will be times when you will have to work with others. As such, you should strengthen your communication and collaboration skills. When you do, you’ll eliminate unnecessary rework and wasted time from straightening out any misunderstandings and miscommunications.nnYou can start by enhancing your active listening skills and staying on one topic when communicating. For example, when composing an email, keep it short and to point. Don’t throw too much information in the message since it will only confuse the recipient.nn5. Create and stick to a routine.n”We are creatures of habit, and so are our brains. When we establish routines, we can carry out tasks faster since we don’t have to ‘think’ about the task – or prepare for it – as much, and can work on autopilot,” says Hallie Crawford, a certified career coach, speaker, and author.nn6. Automate more tasks.n
Want to the secret of getting more done? Reduce the amount of decisions you have to make throughout the day. That’s why Mark Zuckerberg wore that same outfit for years. Most days he still does. It prevented fatigue. I will say though, I tried this and it was hard on my relationship with my wife. Make sure you find your balance.nn”The counterintuitive secret to getting things done is to make them more automatic, so they require less energy,” wrote Tony Schwartz, president and CEO of The Energy Project, in the Harvard Business Review.nn”It turns out we each have one reservoir of will and discipline, and it gets progressively depleted by any act of conscious self-regulation. In other words, if you spend energy trying to resist a fragrant chocolate chip cookie, you’ll have less energy left over to solve a difficult problem. Will and discipline decline inexorably as the day wears on.”nnIn other words, build routines and habits so that you’re not deciding. You’re just doing. Hence why Zuck wore the same clothes everyday. By eliminating those silly or frivolous, he could focus all of his energy on more important work decisions.nn7. Stop multitasking.nWe all believe that we’re multitaskers. In fact, humans just aren’t capable of doing multiple things at once.nn”People can’t multitask very well, and when people say they can, they’re deluding themselves,” said neuroscientist Earl Miller. “The brain is very good at deluding itself.”nnInstead, we’re simply shifting our attention from one task to another very quickly.nn”Switching from task to task, you think you’re actually paying attention to everything around you at the same time. But you’re actually not,” Miller said.nn”You’re not paying attention to one or two things simultaneously, but switching between them very rapidly.”nnIn fact, researchers have found that they can actually see the brain struggling when multitasking.nnSo the next time you have the urge to multitask, stop. Take a breather and then go back to focus on the one thing that needs to get done right now. Once that’s done, then you can move on to something else.nn8. Take advantage of your procrastination.nThis may sound counterproductive. But, there’s actually a method to the madness here.nnAccording to Parkinson’s Law, which was named after after historian Cyril Northcote Parkinson, “If you wait until the last minute, it only takes a minute to do.”nnThink about it. You’ve had a deadline at work looming over your head for a month, but you just cranked it during the final week.nnThis doesn’t give you permission to wait until the 11th hour. It does, according to Thai Nguyen of the TheUtopianLife.com, provide “great leverage for efficiency: imposing shorter deadlines for a task, or scheduling an earlier meeting.”nn9. Relieve stress.n
Since stress can cause physical, emotional, and behavioral problems – which can impact your health, energy, well-being, and mental alertness – it’s no surprise that stress hinders your work performance.nnThe good news is that you may be able to relieve that workplace stress.nnAccording to the American Psychological Association, “the most effective stress-relief strategies are exercising or playing sports, praying or attending a religious service, reading, listening to music, spending time with friends or family, getting a massage, going outside for a walk, meditating or doing yoga, and spending time with a creative hobby.”nnThe least effective strategies, however “are gambling, shopping, smoking, drinking, eating, playing video games, surfing the Internet, and watching TV or movies for more than two hours.”nnAnother effective stress management technique is to increase your control of a situation in advance. You can start by planning tomorrow the night before and sticking to your routine. This way you know what to expect in the morning.nn10. Do more of the work you enjoy.nNot everyone is privileged enough to do what you love for a living. Even if you are chasing your dreams and following your passions, there will still be tasks you’re not fond of doing. In either case, focus more on the work that you actually enjoy doing.nnFor example, if you’re a chef, then you obviously have a love for cooking. Instead of spending your days doing administrative tasks, outsource or delegate those tasks so that you can spend more time in the kitchen or at the market finding fresh ingredients.nnWhen you do, you’ll feel more fulfilled, inspired, challenged, and productive.nnOriginal 
With nearly a 10% expected growth rate throughout the medical coding market, there will be a high demand for medical coders within the industry. Coding related jobs are expanding among the business side of healthcare. Are you prepared?nnContact Welter Healthcare Partners today to learn more about our 
Just another piece in the telehealth puzzle, Remote Patient Monitoring, or RPM, is adding to the patient/provider relationship. New CPT codes 99453, 99454, and 99457 allow for reimbursement of services providers can utilize to manage and coordinate care at home. Best yet, code 99457 can be reported by clinical staff such as RN’s and medical assistants.nn99453: Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.nn99454: Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.nn99457: Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.
The Trump administration says offering health insurance across state lines will enhance competition and lower premiums, but states may raise objections if their regulatory authority is challenged.nnKey Takeawaysn
Trump’s 2017 executive order also directs the Secretary of Labor “to consider expanding access to Association Health Plans, which could potentially allow American employers to form groups across State lines.” That would allow health insurance providers to bypass state coverage requirements.nnHealth insurance oversight is left largely to the purview of states, which has created a regulatory patchwork that varies widely from state to state.nnState and federal lawmakers, mostly Republican, have for the past decade pushed to sell health insurance across state lines, but the issue has proved to be nettlesome. The National Association of State Legislatures reports that at least 23 state legislatures have considered the idea over the past 10 years.nnThe National Association of Insurance Commissioners hasn’t taken a firm stand on the idea, because it represents independent state insurance commissioners, many of whom may have varying levels of support for the idea.nnIn 
HISTORY OF PRESENT ILLNESS: A 36-year-old female who underwent a revision microdiskectomy for disk reherniation at which point there was an incidental durotomy. The patient developed evidence of CSF leakage including positional headaches. She was treated with 2 blood patches and the patient seemed to improve. Subsequently, she developed a collection under her skin. This was tapped, demonstrating clear fluid consistent with CSF. Given this and the failure of blood patch for treatment of CSF leak, the patient was brought to the OR for direct repair of the CSF leak. The patient understood the risks of surgery including bleeding, infection, continued CSF leak, need for future operation, and agreed to undergo the operation.nnPROCEDURE IN DETAIL: The patient was brought to the OR, placed under general endotracheal anesthesia. She was flipped into the prone position on a Jackson table, prepped and draped in the usual fashion. The previous small incision on the left side of the back over the lumbar spine was opened with a 10 blade until clear fluid was reached. The fluid was drained, and there was a large cavity consistent with a pseudomeningocele left. The tubular retractor system was then placed down over the previous laminotomy at the site of probable CSF leak. The microscope was brought in. The durotomy and leaking CSF was easily identified, and scar tissue was carefully separated from the dura. Further laminotomy was also performed to provide room for suturing the leak. Once this was complete, a 5-0 Prolene suture was used to suture the dura back together. Valsalva after the initial closure demonstrated l area of leakage. A fat graft was then obtained from the patient’s subcutaneous fat layers, and this was sewn into the leakage area. Subsequent Valsalva maneuver did not demonstrate any leakage of CSF. Given this, it was felt that the repair was adequate to stop the CSF leak. A piece of DuraGen was then placed over the exposed dura, and DuraSeal was placed over the DuraGen. Steroids were also placed over the dura. Prior to placement of the DuraGen, the wound was thoroughly irrigated, and hemostasis was achieved with bipolar cautery and Gelfoam powder. Next, the tubular retractor system was removed. The pseudomeningocele tissue was cut away from the normal tissue using monopolar cautery and removed from the patient. Hemostasis was then achieved with bipolar cautery. Attention was then turned to closure. A watertight closure was performed in the fascial layer using 0 Vicryl sutures. Next attempts were made to close down any potential space between the fascia and fat layer using 0 Vicryl sutures. The fat layer was also reapproximated with 0 Vicryl sutures. Finally, the deep dermal layer was closed with 0 Vicryl sutures and the skin was closed with a running subcuticular Monocryl. Dermabond was placed over the wound. The patient was then flipped into the supine position, extubated, and transferred to the PACU.
UnitedHealthcare is revising the Consultation Services Policy and will no longer reimburse CPT® codes 99241-99255. This change aligns UnitedHealthcare with the Centers for Medicare and Medicaid Services (CMS). We would like to partner with care providers on older fee schedules (2009 and prior) to move to more current fee schedules.nnUnitedHealthcare will take a phased approach to implement this change as follows:nn1. Effective with dates of service of June 1, 2019, UnitedHealthcare will no longer reimburse CPT codes 99241-99255 when billed by any health care professional or medical practice with a participation agreement that includes contract rates determined on a stated year 2010 or later CMS RVU basis.nn2. Effective with dates of service of October 1, 2019, UnitedHealthcare will no longer reimburse CPT codes 99241-99255 when billed by any health care professional or medical practice.nn3. Health care professionals and medical practices should instead bill consultation services in accordance with current evaluation and management guidelines published by CMS.nn4. With respect to telehealth and telemedicine services, the Telehealth & Telemedicine Policy will continue to apply and HCPC codes G0406 – G0408, G0425 – G0427, G0508 and G0509 will be payable pursuant to that policy, the participation agreement and the member’s benefit plan.nn5. Consultation services may still be reimbursed when billed in accordance with the Preventive Care Services Coverage Determination Guideline for services such as lactation counseling.nn6. At this time, we will not be altering the Global Days Policy to apply a reduction to evaluation and management codes submitted with modifiers 25 or 57 as once announced with this Consultation Services policy change.nnCMS ceased reimbursement of consultation services CPT codes in January 2010 and increased the Relative Value Units (RVUs) for E/M codes at that time to offset this shift in its reimbursement methodology.nnFor this reason, UnitedHealthcare encourages providers who are on an older fee schedule to modernize their fee schedules to bring them into alignment with CMS’s current Relative Value Unit methodology, since the older fee schedule reimbursement does not appropriately align with current RVU structure for E/M services and many other procedure codes.nnUnitedHealthcare appreciates this change may have an impact on participating health care professionals and medical practices. So, if you have concerns or questions, or to update your fee schedule to a more current fee schedule, please reach out to your UnitedHealth Network representative.nClick 
2019 has begun a long process to eliminate redundant paperwork for providers and giving greater importance to patient interaction. One of the first changes to this multi-year program is the elimination of some home visit documentation requirements.nnE/M visits in the patient’s private residences (CPT codes 99341-99350) had, in previous years, to justify the home visit by documenting medical necessity. Effective January 1, 2019 CMS, as part of the “Final Rule”, has finalized the policy change and removed the requirement to the medical record documentation for these visits.
nnIn addition, please call your local DEA office and provide them with the details of the call.n
Rural hospitals are suffering and it is scary to those of small communities who rely on them for health care. Studies show that they are closing at a rapid rate because they just don’t have the funds. Read more below on these closings and how people are coming up with solutions for this concerning issue. nnMore than 20% of rural hospitals are at a “high risk of closing” due to wobbly finances, a Navigant analysis of publicly available data shows.nnThe study, released Wednesday, also shows that 64% of these at-risk rural hospitals are considered essential to the health and economic well-being of their communities.nnThe analysis examines the financial viability and community essentiality of more than 2,000 rural hospitals nationwide. It found that 21% of the rural hospitals are at high risk of closing based on their total operating margin, days cash on hand, and debt-to-capitalization ratio. This equates to 430 hospitals across 43 states that employ 150,000 people.nn”Our analysis shines a new light on a rural hospital crisis that must be addressed and could significantly worsen with any downturn in the economy,” study co-author David Mosley, managing director at Navigant, said in a media release.nn”Local, state, and federal politicians, as well as health system administrators, need to act,” he said.nnThe study also reviewed of the “community essentiality” of these cash-strapped rural hospitals, measuring factors such as trauma status, service to vulnerable populations, geographic isolation, and economic impact.nnThey determined that 64% or 277 of these hospitals are considered essential to their community’s health and economic well-being. In 31 states, at least half of these financially distressed rural hospitals are considered essential.nnSouthern and Midwestern states, including Mississippi, Alabama, Kansas, Georgia, and Minnesota, are projected to be impacted the most, the data shows.nnThe study blamed “multiple factors” for the ongoing crisis with rural hospitals, including low rural population growth, payer mix degradation, excess hospital capacity due to declining inpatient care, and an inability for hospitals to leverage technology due to a lack of capital.nnOne possible solution involves collaborations between rural hospitals and academic and regional health systems, that leverages the larger systems’ resources for telehealth, revenue cycle management, human capital, electronic health records, physician training, and clinical optimization.nnThe study also supports supporting legislation that advances telehealth reimbursements, such as the bipartisan Rural Emergency Acute Care Hospital (REACH) Act.nnReintroduced in 2017 by Sens. Chuck Grassley, R-Iowa, Amy Klobuchar, D-Minn., and Cory Gardner, R-Colo., the REACH Act would create a new Medicare classification under which rural hospitals would offer emergency and outpatient services but no longer have inpatient beds.n
Welter Healthcare Partners is excited to present our new Code Spotlight! Each month, Welter Healthcare Partners will spotlight a unique CPT or ICD-10 code to profile and discuss practice applications of the code, as well as pertinent guideline reminders. Today, we focus on two new codes, 99451 & 99452 related to inter-professional Telehealth consultations.nn99451 — Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative timenThe code covers assessment and management services via telephone, Internet, or electronic health record (EHR) and includes a written report to the requesting or referring provider. Report 5 minutes or more of medical consultative time by a consulting physician, typically a specialty physician who receives a written or verbal request from a physician or other qualified healthcare provider to offer an opinion on a case.nn99452 — Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes.nReport 30 minutes of time spent on interprofessional telephone, Internet, or electronic health record (EHR) referral services by a requesting or treating provider, that is, a physician or other qualified healthcare professional who is providing a consulting physician with background information regarding a patient’s condition.nnKeep in mind that in addition to these two new codes that codes 99446-99449 have also been revised. Reporting similar services with a verbal and written report, see 99446, Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified healthcare professional; 5-10 minutes of medical consultative discussion and review and add-on codes +99447, +99448, and +99449 for additional time.nnClick the links below to learn moren
nnMedicare accountable care organizations (ACOs) are not happy that they have a little more than a month to decide on whether to take on more risk or leave the program.nnThe CMS on Wednesday gave new ACOs a Feb. 19 deadline to apply to the Pathways to Success program, which forces them to take on more risk than they did in the Medicare Shared Savings Program. But the National Association of ACOs said on Thursday that the deadline is far too short, coming only two months after the CMS published a final rule for Pathways to Success.nn”ACOs barely have time to understand the new rules, and organizing an application is very complicated and for some it is now a high-risk decision,” NAACOS President Clif Gaus said in a statement.nnThe association, which has fervently fought the changes to the risk-sharing program, wants the deadline moved to late March.nnThe CMS published the Pathways to Success rule on Dec. 19. But CMS did not provide the application deadline when it posted the rule.nnThe CMS told Modern Healthcare there will be two application cycles for ACOs in 2019, and this first deadline is for the July 1, 2019 start date. ACOs joining the second round that starts Jan. 1, 2020 will have a summer deadline.nnThe Feb. 19 deadline only applies to new ACOs that want to join the program or ACOs that have an existing agreement that has expired. An ACO that has a three-year agreement that expires in either 2019 or 2020 can finish that contract before moving to the new program.nnPathways to Success represents a radical departure from the prior Shared Services Program.nn
An ACO entering the new five-year program can only be in a one-sided risk track for two to three years depending on how much they earn, with ACOs that generate a low amount of revenue staying in the track longer. After the initial period, they must start to pay the federal government if they don’t save enough money in healthcare costs or meet quality requirements.nnUnder the previous program, an ACO could be in a one-sided risk track for the duration of the five-year contract and not have to pay the federal government anything if they don’t meet quality benchmarks or cost metrics.nnExisting ACOs also will have to participate in programs that require them to take on more risk in subsequent years.nnThe NAACOS said that ACOs won’t be able to make “several critical decisions,” before the Feb. 19 deadline, such as what physicians will participate and signing agreements.nn”Setting an application deadline two months after passing the final rule does not give ACOs that have expiring agreements the necessary time to vet the decision internally,” Jennifer Moore, chief operating officer at MaineHealth ACO in Portland, Maine, said in a statement.nnThe CMS told Modern Healthcare that it is providing ACOs with documents and sample applications.nnOnly a third of ACOs will be subject to the February deadline, according Ashley Ridlon, vice president of health policy for the consulting firm Evolent Health.nnThere are 561 ACOs that are responsible for 10.5 million Medicare patients, according to data from the CMS.nnRidlon conceded that “the timeline is indeed very tight.”nnThe short turnaround means that hospitals and providers are going to not have a lot of time to think through the pros and cons of whether to apply, said David Muhlestein, chief research officer for the firm Leavitt Partners.nn”The timeline is quite short, though doable,” Muhlestein said. “Potential participants will need to prioritize this and get their boards, leadership and physicians aligned in a hurry.”nnOriginal 
32652-RT J94.2, J98.4nnSurgeon: Surgeon(s) and Role:n* XXXXX, XXXXXXX, MD – PrimarynnCase Length: 3 Hr 2 Min 20 SecnnPre-Operative Diagnosis: right retained hemothoraxnnPost-Operative Diagnosis: SamennOperation Performed: Right Video Assisted Thoracic Surgery (VATS) and total lung decorticationnwith removal of large retained old hematomannFindings (Normal + Abnormal): Large amount of old organized thrombus in the right hemithorax with trapped and scarred portions of the lung. Hematoma removed, trapped lung was released. At the end the lung was completely expanding. Good hemostasisnnOperation Description:nThe patient was brought into the operating room and was placed in a supine position. A time out procedure was carried out identifying a correct patient and site. Then general endotracheal anesthesia with a double lumen tube was placed. The patient was placed in a left lateral decubitus position. Then, the first port was placed along the posterior axillary line. A laparoscope was placed the lung was down. Then the second 5 mm port of was placed in a 5th intercostal space in the posterior axillary line. The third incision was placed in the anterior axillary line in the 5th intercostal space. All the ports were placed under a direct visualization. The soft adhesions were carefully released with a blunt laparoscopic grasper. There were soft clots in the apex that were suctioned. There was an area of the lung that was attached to the chest wall which was gently released with blunt dissection. The chest cavity was irrigated with a warm saline. Then we inspected the right chest for bleeding and meticulous hemostasis was obtained. Then a 36French chest tube was placed through the incision on the 7th intercostal space. The chest tube was secured with a #1 silk sutures. The other incisions the muscle was closed with a silk suture. Then the 2-0 Vicryl for a deep dermal tissue and a 4-0 Monocryl for skin was used. Then, glue applied. All the sponge and instrument counts were correct. The patient was extubated and was transferred to the post operative anesthesia care unit.nnRapid Frozen Section Telephone Diagnosis: NonennSpecimens Removed: NonennWound Classifications: Clean Contaminated
Enrollment in medical plans before the start of the new year is something that is on everyone’s mind to ensure continuity of medical care. However, the article below reveals that enrollment in Medicare Advantage is slower than in previous years. nnMedicare Advantage insurers added 1.4 million members to their rosters for 2019 coverage, as they looked to grow membership in a market known for being politically safe and predictably lucrative. But Advantage membership is growing at a slower pace compared with previous years.nnAccording to the latest federal data showing enrollment as of this month, 22.4 million people are enrolled in Medicare Advantage for 2019 coverage—an alternative to the traditional Medicare program in which private insurers contract with the federal government to administer program benefits. That’s an increase of 6.8% since January 2018. Health insurers, however, managed to grow their Advantage membership base by more than 1.5 million in both 2016 and 2017.nnSome industry experts were expecting more. “The formula was there: Health plans were aggressive, they got nice rate increases, the rules around benefit design relaxed a little bit,” explained Jeff Fox, president of Gorman Health Group, which provides technology and other services to Medicare Advantage plans.nnFox expected Advantage enrollment to increase by double-digits over the past year, as health plans invested heavily in marketing and the federal government provided one of the biggest rate increases for the plans in years at 3.4%. The Trump administration also granted Advantage plans the flexibility to provide more supplemental benefits in 2019, such as transportation and in-home care.nnBut Fox said distraction from the craziness of the November midterm elections may have kept some seniors from enrolling during the annual open enrollment that lasted from Oct. 15 to Dec. 7, 2018. While the CMS data captures some of the sign-ups from open enrollment, figures out next month are likely to be higher.nnDespite the slower pace, many Advantage insurers still experienced big enrollment increases as they picked up more market share. About half of all members are covered by just three companies. UnitedHealth held onto the top spot, adding nearly 500,000 Advantage members in the past year for a total 5.7 million. UnitedHealth holds more than a quarter of the total Medicare Advantage market share.nn
nnHumana remained the No. 2 Advantage insurer with 3.9 million members, an increase of 10.4% over January 2018. But thanks to its acquisition of Aetna, CVS Health took the No. 3 spot with 2.2 million Advantage enrollees. Kaiser Foundation Health Plan and Anthem rounded out the top five insurers with the most Advantage members.nnOn a percentage basis, Anthem and Aetna grew membership the fastest. Anthem’s Medicare Advantage membership spiked 53% to 1.1 million members compared with the same time last year. The Indianapolis-based insurer has long focused on serving employers, but recently turned its sights to growing Medicare Advantage rolls through acquisitions and expansions in places where it already operates.nnAnthem bought Florida-based Medicare plans HealthSun in December 2017 and America’s 1st Choice in February 2018, together giving Anthem about 170,000 more Advantage members. Anthem CEO Gail Boudreaux told investment analysts in July that the company would focus on selling group Medicare Advantage plans and serving medically complex dual-eligible members in 2019.nnCVS Health, meanwhile, grew its Medicare membership by 26.7% in 2018 to 2.2 million through its acquisition of Aetna. The deal is still technically awaiting a federal judge’s approval. In a research note Monday, Barclays equity analyst Steve Valiquette noted that Aetna’s membership growth was driven by its expansion into about 360 new counties. Valiquette wrote that the growth experienced by some public health insurers during the annual enrollment period for 2019 coverage was driven more by market share gains than by industry growth.nnMedicare Advantage enrollment is climbing as the baby boomer generation ages rapidly into Medicare. Those seniors are used to employer-sponsored managed-care plans and are choosing Advantage over traditional Medicare more often than previous generations did. Seniors also often get more benefits, including dental care, eyeglasses and gym memberships, with an Advantage plan.nnMedicare Advantage also enjoys support from both political parties and is able to weather swings from one federal administration to the next, whereas insurers that sell plans in the individual market, for example, may have to deal with more volatility.nnMoreover, Medicare Advantage margins tend to hover between 4% to 5%, whereas Medicaid margins come in at 2% to 3% and the individual market historically has had even lower margins, S&P analyst Deep Banerjee told Modern Healthcare in August. The group employer business has higher margins, but that market isn’t growing like Medicare Advantage is.nnOriginal 
Telehealth:n2019 is here and technology is continually getting better. People are able to connect quicker and better than ever, so why not with their physicians?nnTelehealth, unlike telemedicine, incorporates a broader scope of health care services remotely as well as non-clinical services like provider training, administrative meetings and continuing education. Telemedicine is strictly remote clinical services.nnPatients continue to be more involved in their health outcomes by utilizing technology that is already part of their daily lives. With advancements in smartphone apps, activity trackers, automated reminders and blood glucose monitors allowing for better “collect and transmit” health information and monitoring of chronic conditions. There are four methods that make up telehealth, they include live video (synchronous), store and forward (SFT), remote patient monitoring (RPM), and mobile health (mHealth).nnThe American Medical Association, or AMA, has created the STEPS Forward module to help practices integrate this into their care plan. This module contains four steps to adopt telemedicine into your practice:n
With voters clamoring for more affordable healthcare, Colorado’s Democratic Gov. Jared Polis on Wednesday created the Office of Saving People Money on Health Care.nnCiting soaring health insurance premiums in the state’s rural and mountain communities, the newly elected Polis said the office will work with the Democratic-controlled legislature to authorize a reinsurance program and develop lower-cost coverage options. His lieutenant governor, a healthcare expert, will be in charge of the office.nn”We need to take action to really find and act on the root causes of skyrocketing healthcare costs,” he said in announcing the executive order.nnBut Polis may run into healthcare industry resistance with his push to have the office establish programs to reduce prescription drug prices and increase hospital price transparency. He has also said he would consider establishing a public health plan option such as a voluntary Medicaid buy-in program, and allow the importation of cheaper prescription drugs from Canada, two ideas with powerful industry opposition.nnPolis is the latest newly elected Democratic governor to lay out an ambitious agenda to make healthcare more affordable for consumers, reduce costs and expand coverage. With a divided Congress likely to be gridlocked by partisan differences, observers expect most health policy action will take place at the state level for the next two years.nnCalifornia’s Democratic Gov. Gavin Newsom has proposed to extend Affordable Care Act premium subsidies to people with incomes above the law’s current eligibility threshold, and allow state agencies to directly negotiate prices with prescription drug manufacturers.nnMinnesota Gov. Tim Walz wants to allow people to buy into Medicaid. Second-term Washington Gov. Jay Inslee also has proposed a public plan option to reduce premiums.nnPolis was elected in November on a groundswell of voter demand for state action to make healthcare more affordable, said Kyle Legleiter, senior policy director at the Colorado Health Foundation..nn
Last year, his organization conducted a survey with the Kaiser Family Foundation that found nine in 10 Coloradans said lowering healthcare costs was a key issue for the state to work on, with one in four saying it was the top issue.nnMany rural and mountain counties in Colorado have only one insurer in the individual market, and those counties often are served by one hospital and a limited number of physician specialists. So individuals and small businesses in those communities have faced some of the highest premiums in the country.nn”So it’s not surprising to see Gov. Polis address healthcare costs and affordability in the second executive order he has signed,” Legleiter said.nnLt. Gov. Dianne Primavera, a veteran healthcare legislator, patient advocate and breast cancer survivor, will lead the Office of Saving People Money on Healthcare. As part of her role, she’ll also head a permanent interdepartmental healthcare cabinet including all state agencies managing healthcare and behavioral health programs to align their efforts.nnThe Colorado Hospital Association praised Polis’ initiative. “The potential and opportunity for this office’s efforts are significant and could make a great difference for Coloradans,” the association said in a written statement.nnUnder the previous governor, Democrat John Hickenlooper, the Colorado Commission on Affordable Health Care issued a broad range of recommendations in 2017 for improving affordability and access, with a heavy focus on increasing price and quality transparency.nnBut Polis may have more ability to make changes than Hickenlooper did, since the Democrats took full control of the legislature in November.nn”Healthcare costs were top of mind for voters in many states in 2018 and into 2019, and many newly elected leaders, both Democrats and Republicans, heard that loud and clear,” Legleiter said.nn nnOriginal 
Telemedicine refers to remote clinical services that utilize electronic communications and software to facilitate health care without an in-person visit. Telemedicine technology can be used for a number of different services include medication management, management of chronic health conditions, consultations, and follow-up visits. These services are conducted via secure video and audio connections, typically on a mobile device or computer.nnTraditionally used to treat patients in remote places, telehealth is now used in many different healthcare settings, including convenient care facilities. Within healthcare, one of the most hot-button topics is patient expectation. Patients may not be privy to this discussion very often but, it is likely on every doctor’s mind.nnNow that about