ABL Healthcare Member News & Industry Trendletter * November 5, 2020

>>> Muthu Krishnan is Co-Founder, President and CEO of Kencor Health, Inc., which is transforming patient care by enabling healthcare professionals to digitally engage with their patients outside of their traditional care setting using a SaaS-based chronic care management platform. Kencor Health has created an AI-assisted care platform that reduces the costs and complexities of providing effective care to patients by delivering automated and personalized care at scale, thereby reducing hospital readmissions and unnecessary ED visits. Kencor’s SAMiConnect integrates with the latest AI technology to keep patients engaged in their treatment plan, while keeping the healthcare-provider team connected to how the patient is doing. SAMi gathers, interprets, and reports critical patient data collected from all connected devices, and then processes and presents the data in a simple dashboard so that the care team can take action. Muthu co-founded Kencor Health in 2016, was named President in 2018, and CEO in late 2019. His career background includes being an Advisor and Senior SME for Healthcare & Life Sciences for The Advanced Technology Group, an investment holding firm where he advised on healthcare projects. He was also SVP/Consultant, Strategic Initiatives/ Business Development/ Operations at HD Medical, Inc.; Senior Program Manager at Providence Health & Services, Northwest Region; held executive roles at TeleVital, Inc.; President and CEO of masIT; Senior Healthcare Consultant to Kaiser Permanente; and Senior Program Manager/ Acting CIO at InSound Medical. Muthu’s leadership skills were developed at Kaiser Permanente, where for over seven years he managed multiple complex projects ($2.5+ billion) for a healthcare IT matrix organization while building cross-functional teams and deep client relationships. Muthu has joined the ABL-Health SV Round Table.

    These upcoming ABL Round Tables will be held via ZOOM to ensure Social Distancing for our Members. See your Round Table invitation for participation instructions, and the ABL.org Members Only website for all the Healthcare Round Table invitation specifics. (If you haven’t already received an invitation to a ZOOM Table you would like to attend, please email mimi@abl.org for details.)

  • 11/04 - ABL-Health OC Zoom Table: Lessons from Your Long and Winding Road (featuring Bob Funari, Chair, Patient Care America)
  • 11/10 - ABL-Health SV Zoom Table: Keys to Pricing Healthcare Services & Products (featuring Marcia Augsburger, Partner, King & Spalding)
  • 11/12 - ABL-Health SF & OAK Zoom Table: Medi-Cal: Then & Now (featuring Greg Buchert, MD, former CEO or CMO of 5 Medi-Cal Health Plans)
  • 11/20 - ABL-Health LA Zoom Table: Meet Angle Health: The Health Plan Startup for Startups (featuring Ty Wang, CEO, and Andy Leeka, President/COO, Angle Health)
  • 12/02 - ABL-Health Joint OC & LA Zoom Table: Using Co-branding to Leverage Your Brand (featuring Chris De Rosa, President, National Accounts, Cigna)
  • 12/09 - ABL "23rd Innovations in Healthcare - COVID Edition": Featuring 5 “Innovator in Healthcare” Awardees (ABL Members who created & marketed innovative services and products during the depths of COVID)
  • Explore Membership in ABL's Executive Round Tables >>>
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America's Greatest Civics Lesson

                     Blog by Mimi Grant

For weeks we’ve all seen the signs, stickers, and landing pages telling us to “VOTE!” Well, it looks like America got the message - as of Wednesday night, while vote counting continued in many states, NBC News had already projected that “at least 159.8 million Americans voted in the 2020 presidential election.” The significance: it set a record for the highest number of ballots cast in a presidential election and the highest voter turnout rate among eligible citizens since 1900. With around 239.2 million Americans eligible to vote in 2020, according to the U.S. Elections Project, if 158.8 million ballots were cast, that would equate to about a 66.8% voter turnout among eligible citizens. Again, the highest number in 120 years.

In terms of how Americans voted: it’s estimated that 100 million of us voted early; the balance turned out to vote. In fact compared to the 2016 election, in 2020, in Texas, for example, 108% of those who voted in 2016 enthusiastically cast their ballots this year.

Unquestionably this has been a controversial election/reelection cycle in the making for years. But one thing is clear, more youngsters and seniors have been brought to the rallies - or enabled to vote than in prior years. For example, a Christian Science Monitor article entitled, "In 2020, parents weigh how to talk politics", pointed out how “activist children” were vocally participating in marches against gun control, climate change, and “closing the camps.” And, even before taking to the streets to march, youngsters like six year-old Olivia Cooper became an engrossed listener (and face billboard) for candidate Joe Biden, when he spoke in Carroll, Iowa last December.

On the other end of the age spectrum, ABL Member Debbie Toth and her Choice in Aging team, worked with the Contra Costa County Supervisors and Contra Costa County Elections to ensure that adults living in congregate facilities (like SNFs) throughout the County would be enabled to vote, by setting up mobile voting units across the county to ensure elders had their right to vote met.

With lawsuits already filed demanding recounts in Wisconsin, Pennsylvania, Michigan, Nevada, and Georgia, and protesters gathering in Detroit, Chicago, Portland, Seattle, Phoenix, and New York, this election appears to be far from “over.” But the civics lessons learned (and even the math lessons on how to count to 270) hopefully will strengthen our collective appreciation of the Constitution, and our hard-earned right to vote.


Anthem Blue Cross Opens Neighborhood Stores in L.A. & Debuts New Health Plan in San Francisco

Anthem Blue Cross recently opened two Anthem Neighborhood Stores in Los Angeles-area Koreatown and Alhambra for virtual and by-appointment, in-person services, as well as expanded its Anthem Assist program, which consists of associates who can help consumers in English, Spanish, Chinese, Korean, or Vietnamese. Also, Anthem has introduced Blue Connection, a new health plan option designed to meet the needs of San Francisco Bay Area businesses and their employees. An Exclusive Provider Organization, Blue Connection includes direct access to 3,500+ high-quality doctors and healthcare professionals, including 2,500+ behavioral health providers. For employers, Blue Connection offers up to 25 percent savings compared to Anthem’s standard PPO. (David Pryor, MD, LA)

Axene on: Blues Plans’ Antitrust Suit & Cost of Employer-Sponsored Health Insurance

In Competition Between “Blues” Health Plans and a Recent Antitrust Settlement, Axene Health Partners discusses how the recently proposed settlement of an antitrust suit against BCBSA will affect the Blues plans going forward. And, in Cost Disparities in Employer-Sponsored Health Insurance, Axene notes that rising premiums hinder employers’ ability to pay higher salaries and reduce employees’ take-home pay, and suggests some solutions. (John Price, SF)

Biospectal’s Smartphone Software Achieves Blood Pressure Cuff Accuracy: Study Published in Scientific Reports in Nature

Scientific Reports in Nature has published the breakthrough results of Biospectal’s in-depth research conducted at the University of Lausanne, Switzerland’s CHUV hospital. Focusing on optical blood pressure sensing using only the fingertip on a smartphone camera, the study demonstrated that Biospectal’s OptiBP software has achieved equivalency with traditional blood pressure cuff performance and the ISO 81060-2 standard, representing a revolution in how we measure and manage high blood pressure. Biospectal’s OptiBP smartphone app and connected data platform enable clinical grade blood pressure management at the point of patient without any bulky extra device. (Eliott Jones, SV)

Choice in Aging Helps Bring Mobile Voting to Elders & Hosts Video Series on Caregiving

On election day, Choice in Aging (CiA) spearheaded the successful effort to set up mobile voting units across Contra Costa County to ensure elders living in congregate facilities had their right to vote met. [See Mimi's blog above for more info.] Meanwhile, throughout October, CiA hosted a video series of “Dishing with Debbie” on the topic of Caregiving. Episodes are available on-demand: PART 1: Dishing with Congressman Mark DeSaulnier on His Experience as a Caregiver. PART 2: Navigating the Caregiving Experience with Lorna Van Ackeren of Hillendale Home Care. PART 3: The Caregiving Workforce & Its Impact on the Healthcare System with Donna Benton, Ph.D., of USC. PART 4: Caregiving Pre-Pandemic Vs. Now & Resources Available with Jo McCord of Family Caregiver Alliance. (Debbie Toth, OAK)

Covered California Announces Record-Low Rate Changes for 2021

Covered California for Small Business unveiled the health plan choices and rates for small-business employers and their employees for the upcoming 2021 plan year. The statewide weighted average rate change will be 1.5% - the lowest annual increase in the program’s seven-year history, and significantly lower than national projected increases for larger employers. Also, CoveredCA’s annual open-enrollment period officially began November 1, with premiums remaining relatively unchanged for many as the Exchange announced a record-low rate change of 0.5%. Further, some consumers will have more competition in their markets as two carriers announced expanded coverage in Imperial, Inyo, Kern, Mono, Orange, and San Mateo counties. (Kathy Keeshen, JD, SF)

Elemeno Health CEO Declared “Entrepreneur of the Month”

The Angels + Entrepreneurs Network named Arup Roy-Burman, MD, CEO of Elemeno Health, as its October Entrepreneur of the Month, noting his background as the former Medical Director of the Pediatric ICU at UCSF, where he designed the Elemeno prototype. Elemeno’s team-based platform is a virtual coach, delivering custom bite-sized training and communications to the fingertips of healthcare workers - driving practice and consistency at the front lines, reducing costs, increasing safety, and improving outcomes. (Arup Roy-Burman, MD, OAK)

Elevate Addiction Services’ Dan Manson Spotlighted on Podcast

A recent episode of Elevate Addiction Servicespodcast series interviews its President and Chairman Dan Manson, who is “on a mission to approach addiction more holistically, but also from a scientifically evidence-based approach” - healing the whole person not merely their symptoms. (Dan Manson, SV)

HumanGood Communities Earn “Best Nursing Home” Rating by US News & World Report

HumanGood announced that 15 of its life plan communities have earned the 2020-21 Best Nursing Home rating by U.S. News and World Report, which evaluated 15,000+ nursing homes. The ratings are based on analysis of publicly available data, including information that is not factored into CMS star ratings. Unlike the star ratings, the U.S. News ratings recognize that patients undergoing relatively short-term rehabilitation have very different needs from those who require longer-term care. (Tara McGuinness, OAK)

Inglewood Imaging Center Completes MRI Department Upgrade - Outstanding in SoCal

Inglewood Imaging Center has completed its MRI department upgrade following a successful $1.7 million capital funding, becoming one of the first sites globally to install this new wide-bore high-channel MRI system, which is 17% more spacious, +/- 50% faster, up to 75% quieter than previous, and customizable with music, lighting, and air flow to help create a more comfortable patient exam experience unparalleled in Southern California. In addition, IIC added features to help improve referring physician practices - for example, in orthopedics, there is a new software feature called MARS (metal artifact reduction software), which was added to help solve metal artifacts for orthopedists with metal implant issues. IIC also bought software for nephrologists (non-contrast “contrast” MRA’s), urologists (multiparametric prostate), neurologists (advanced diffusion, SWI), internists (small parts software), and more. (Brad Schmidt, LA)

Irvine Health Foundation Sells IrisOC Tech Platform to Aging Well Solutions

Aging Well Solutions has acquired Iris Digital Communities from Irvine Health Foundation, and will establish a presence in Orange County, branded as IrisOC. The technology platform is an outgrowth of IHF’s work in supporting innovations and collaborative initiatives that improve the well-being and lives of older adults and veterans in OC. IHF President Ed Kacic said, “We aim to work with others in order to help Orange County residents optimize their health status, and using various forms of technology is an effective approach to reaching target populations. Building and deploying the Iris platform for OC was a core part of our strategy. The technology enables older adults, their caregivers and the organizations that serve them to engage with and manage Social Determinants of Health at the local level. We are pleased that Aging Well Solutions has acquired the IDC platform and technology.” (Ed Kacic, OC)

Kaiser Permanente Creates COVID-19 Social Health Playbook - A Free Resource

Kaiser Permanente has created guidance that can be widely adopted across the healthcare industry - the KP COVID-19 Social Health Playbook - which provides clinical care teams with guidance and tools for screening COVID-19 patients for social needs, connecting them to help, and following up to ensure their needs are met, and to prevent further transmission of the virus. It is publicly available as a free resource for care providers across the industry. Meanwhile, according to the CMS’ 2021 Star Ratings, KP Medicare health plans in California, Colorado, Georgia, Hawaii, the Mid-Atlantic states, and the Northwest received 5 out of 5 stars, CMS’ highest Medicare star rating. This is the 10th consecutive year all KP Medicare health plans have been rated 4.5 stars or higher. (Marcos Vasconcelos, OAK)

Kencor Health Launches Ecosystem Integration and Professional Services for Hospitals, Clinics & Med Facilities

Kencor Health recently debuted Ecosystem Integration and Professional Services to provide implementation, professional services, support, and advisory services, to hospitals, clinics, and medical facilities, for system optimization and improved operational performance. The integration and services are focused on complete implementation of EHR/EMR, as well as Kencor’s current modular offerings in its Health Ecosystem: Remote Patient Monitoring, Telehealth, and Virtual Clinical Trials (T3). Meanwhile, Kencor CEO Muthu Krishnan recently served as a panelist at the 2nd Annual Patient Experience and Engagement Summit, on the topic of “Craft the New Normal: What Will Never be the Same Again in the Healthcare Experience?” (Muthu Krishnan, SV)

King & Spalding Declared a Leading Litigation Firm; Marcia Augsburger a “Litigation Star”

King & Spalding has again earned top practice and lawyer rankings in Benchmark Litigation’s guides to the top litigation firms in the U.S. and Europe. In its national-level rankings in the Benchmark Litigation United States 2021 guide, K&S ranks in Tier 1 for General Commercial Litigation, International Arbitration, Product Liability and Recall, and White-Collar Crime. Partner Marcia Augsburger is named a “Litigation Star California 2021.”

Meanwhile, on November 10, K&S will hold a webinar - Challenging Payers’ New Specialty Pharmacy Policies That Reduce Payment to Hospitals. And, on Nov. 10-11, it will present the virtual 13th Annual King & Spalding Medical Device Summit. Plus, on Nov. 18, K&S will hold a webinar - COVID-19's Impact on the Senior Care Industry: A Discussion on Crisis Management in the Face of Litigation and Enforcement Activity. (Marcia Augsburger, JD, SF & Travis Jackson, JD)

KMD Architects Make Progress on Tacoma ED Expansion & Use Virtual Reality to Monitor Projects

KMD Architects announced that phase 2 expansions and renovations to the MultiCare Allenmore Emergency Department have been completed and will improve access to care for the Tacoma, WA community. Some services will be shared between the ED and the new crisis stabilization unit recently built as part of the new adjacent 120-bed behavioral health hospital, also designed by KMD. Meanwhile, to assist with COVID-19 measures and work-from-home schedules, KMD has instituted virtual site tours, implemented by Skanska: through VR and 3D cameras mounted on hard hats as construction staff walk through KMD’s CHA Hollywood Presbyterian Medical Center project, architects can keep a careful eye on all components of its construction from their home offices. (Rob Matthew, SF)

LigoLab’s Platform Supports Pooled Testing & TestDirectly Eliminates Paper Requisitions

In LigoLab’s LIS & RCM Operating Platform Supports Pooled Testing, LigoLab reports that there are clear advantages for labs that have a laboratory information system (LIS) that can support a COVID-19 PCR pooled testing strategy for the screening of asymptomatic individuals. Pooled testing, which involves the mixing of multiple specimens together into a batch sample, enables labs to boost testing capacity, improve turnaround times, conserve testing kits and other supplies, and reduce the cost per test. The LigoLab Platform has pooled testing technology built into its clinical module, and supports the tracking of multiple specimens in one well and the retesting of a pooled sample if it comes back positive for the coronavirus. And, in TestDirectly Eliminates the Paper Requisitions That Cause Accessioning Headaches, LigoLab explains that its TestDirectly Direct-to-Consumer Portal is the latest addition to its fully integrated LigoLab LIS & RCM Operating Platform. (Suren Avunjian, LA)

Mazzetti & Arup Team to Push MEP Boundaries for New Hospital

University of California, San Francisco has selected healthcare specialists Mazzetti and global consulting and engineering firm Arup as the lead MEP engineers of record for its new hospital - UCSF Helen Diller Medical Center at Parnassus Heights. Collaborating with architect partners HDR and Herzog & de Meuron to design the “hospital for the future,” Mazzetti and Arup will integrate forward-looking, innovative design, supporting UCSF’s commitment to world-renowned clinical research and training. (Walt Vernon, JD, SF)

Nelson Hardiman Delves Into Purdue Pharma Settlement, COVID, Opioid Crisis & Reimbursement

Nelson Hardiman Managing Partner Harry Nelson recently appeared on KTLA5 to discuss the National Prescription Drug Take-Back Day and the impact of COVID-19 on addiction and rehabilitation facilities that have had to shut down due to the pandemic. They also discuss the Department of Justice’s $8-billion Purdue Pharma settlement and all the work that is now needed to get people the help they need. In particular, Harry touches on steps the state of California has been taking. Also, Harry presented a webinar with Florida AG Ashley Moody: "Confronting the Overdose Crisis"; watch a replay here. And, Harry takes part in the podcast, Legal Talk Network: The President, COVID 19, and Impact on the American Public. Meanwhile, watch a replay of Nelson Hardiman’s recent webinar: The Collections Continuum - Reimbursement Guide from Treatment to Payment. (Harry Nelson, JD, LA)

On Lok Lifeways Rebranded as On Lok PACE; New Website Unveiled

On Lok, which has been serving seniors for almost 50 years, has unveiled a new brand identity, which includes a redesigned logo, website, and renaming of its innovative PACE offering from On Lok Lifeways to On Lok PACE. With the new brand identity, On Lok will continue to bridge the spectrum between frail seniors served through On Lok PACE to more active seniors through programs such as those offered by On Lok 30th Street Senior Center. On Lok founded PACE and has remained committed to its innovation, spurring its expansion to 31 states. Expanding initiatives include a pilot with California Pacific Medical Center ACE (Acute Care for the Elderly) Unit at Mission Bernal Campus; a partnership with Openhouse to expand services for LGBTQ seniors; and an evolution from in-person care to virtual care in all aspects of senior care and wellness. (Grace Li, SF)

PreludeDx Identifies Breast Cancer Patients Who May Be Undertreated with Surgery Alone

Prelude Corporation (PreludeDx) recently presented pivotal data at the American Society of Radiation Oncology (ASTRO) 2020 National Meeting, regarding its commercially available test, DCISionRT, and its new genomic signature presently in development for women with invasive breast cancer (IBC). ASTRO Poster #2034 included nearly 1,800 women diagnosed with ductal carcinoma in situ (DCIS) and classified as clinicopathologically low-risk by Radiation Therapy Oncology Group-like criteria for recurrence of DCIS or progression to IBC. PreludeDx’s DCISionRT assay reclassified almost half of these patients to elevated risk, suggesting a group of patients who would be under-treated with surgery alone. More information. (Dan Forche, OC)

Savi Group Reports on How to Optimize Your Denial Management Process

In How to Optimize Your Denial Management Process, Savi Group examine ways you can help streamline the claims submission process to reduce denials and make denial management in healthcare more efficient. Click here to read other recent blog posts from Savi, including: “Essential Steps in EHR Implementation;” “Your Ultimate Guide to Claims & Payment Processing;” and “Hard vs Soft Denial in Medical Billing: What’s the Difference?” (Sumit Mahendru, OC)

Wipfli's Healthcare Webinars to Address Cyber Risk & Attributes to Help Healthcare Leaders Succeed

On November 17, Wipfli will present a webinar - Managing cyber risk: Protecting yourself beyond HIPAA, which will discuss leading practices for what you can do to protect yourself and your healthcare organization. And, on December 15, Wipfli will present a Wipfli Healthcare Connections webinar, that will include Q&A - Leading during challenging times - Attributes to help healthcare leaders succeed. (Jeff Johnson, OAK, & Steve Rousso)

DarioHealth Chosen by HMC HealthWorks & Vitality Group

DarioHealth Corp. and HMC HealthWorks have entered into a sales and distribution partnership in which HMC will incorporate DarioHealth's digital therapeutics solution into its comprehensive care management programs. And, Vitality Group has chosen DarioHealth's solutions for inclusion in its new Gateway Flex offering, which enables employers to personalize the healthcare experience to meet the diverse and changing needs of their employees, and to pay only for solutions in which their employees engage. (Rick Anderson, ABL-Tech WLA)

Eckert & Ziegler to Run Tumor Radiation Business Through TCL

Eckert & Ziegler Strahlen- und Medizintechnik AG plans to run its business with tumor radiation equipment together with TCL Healthcare Equipment (Shanghai) Co., Ltd. The two companies recently signed a binding letter of intent under which Eckert & Ziegler will transfer its division with the so-called afterloaders (HDR brachytherapy) to a separate company in which TCL will acquire 51% of the shares. The transaction is expected to be completed by the end of 2020. (Frank Yeager, ABL-Tech SGV)

Tanner Research CEO to Present Virtual Nutrition Science Workshops

On the evenings of November 18 and December 17, John Tanner, Ph.D., of Tanner Research, will present free Nutrition Science Virtual Workshops, via Zoom, where he will relay to participants the scientific information they need to avoid heart disease and other leading killers with a proper diet. The group will discuss strategies for change and John will field questions. (John Tanner, Ph.D., ABL-Tech SGV)

California Voters Reject New Rules for Dialysis Clinics

California voters have rejected a ballot measure to require a doctor or highly trained nurse at each of California’s 600 dialysis clinics. With 10+ million votes tallied Tuesday, Proposition 23 had just 36% of votes. It is the second measure seeking to regulate dialysis clinics placed on the ballot in recent years by unions that represent health care workers and drew more than $110 million in spending. Opponents, financed by dialysis clinic companies, say that under that mandate, between two and three doctors would be required at every facility because most are open at least 16 hours a day, creating a financial burden that could lead some clinics to close.

Rick Barnett, who runs the largest nonprofit dialysis provider in California, Satellite Healthcare, with 60 clinics, said a kidney specialist oversees the care of every dialysis patient, highly trained nurses and technicians staff the clinics and both federal and state officials conduct scheduled and random inspections. (SFGate.com, 11/3/20)

Artificial Intelligence Technology Detects COVID-19 Through Cough Sounds

Scientists have developed a new artificial intelligence system they say can tell if someone has COVID-19 just by the sound of their cough. Massachusetts Institute of Technology researchers said the algorithm is able to detect the virus because the illness causes muscle impairment that can alter the way people speak or cough even if they are asymptomatic. (New York Post, 11/2/20)

CMS: Medicare & Most Private Health Plans Must Cover COVID-19 Vaccines Without Cost-Sharing Requirements

CMS released an interim final rule with comment period, on October 28, that implements several CARES Act requirements to prepare for the availability of a COVID-19 vaccine. Among other changes, the rule establishes that COVID-19 vaccines that are authorized or approved by the FDA will be covered by Medicare Part B without co-pays or deductible. It also implements CARES Act provisions that require most private health plans to cover a COVID-19 vaccine without cost-sharing requirements. It also establishes that Medicare will provide enhanced payment to hospitals for new products authorized or approved to treat COVID-19 in the inpatient and outpatient settings. (King & Spalding Health Headlines, 11/2/20)

CMS Expands List of Medicare Telehealth Services Payable During COVID

On October 14, CMS added 11 new services to its Medicare telehealth list that are payable during the COVID-19 public health emergency. This latest expansion of telehealth services is the first to use the new, expedited process that CMS established in May 2020. CMS has also announced additional support to state Medicaid agencies to expand access to telehealth. (King & Spalding Health Headlines, 10/19/20)

Teladoc Finalizes Blockbuster Deal with Livongo in Less than 3 Months

Telehealth giant Teladoc recently completed its $18.5 billion acquisition of Livongo, which provides diabetes monitoring and remote monitoring, in under three months, as the companies likely look to leverage the current financial tailwinds of the telehealth boom and investor interest in digital health spurred by the COVID-19 pandemic. The combined company is expected to reach $1.3 billion in revenue in 2020 and is projecting revenue growth of 30% to 40% over the next two to three years. Jason Gorevic, CEO of Teladoc Health, said: “Together, our team will achieve the full promise of whole-person virtual care, leveraging our combined applied analytics, expert guidance and connected technology to deliver, enable, and empower better health outcomes.” The company expects to directly deliver more than 10 million virtual visits this year and has reported an additional 3 million enabled visits for its health system clients so far in 2020. (Fierce Healthcare, 10/30/20)

New Law Creates 988 Hotline for Mental Health Emergencies

President Trump has signed into law a bipartisan bill to create a three-digit number for mental health emergencies. The FCC had already picked 988 as the number for this hotline and aims to have it up and running by July 2022. The new law paves the way to make that a reality. The existing National Suicide Prevention Lifeline is a 10-digit number: 1-800-273-TALK - and it has seen a rise in call volume in recent years. Still, the number isn't easy to remember or dial in times of crisis. (NPR, 10/19/20)

CMS Finalizes Transformative Medicare Payment Changes to Incentivize Dialysis in the Home

CMS has finalized policies that allow certain new and innovative equipment and supplies used for dialysis treatment of patients with End-Stage Renal Disease in the home to qualify for an additional Medicare payment. The final rule encourages the development of new and innovative home dialysis machines that give Medicare beneficiaries with ESRD more dialysis treatment options in the home that can improve their quality of life. CMS is expanding eligibility for the transitional add-on payment adjustment for new and innovative equipment and supplies that was introduced last year to now cover qualifying new dialysis machines when used in the home. (CMS.gov Press Release, 11/2/20)

CMS Finalizes Home Health Payment Rule for 2021: 4 Takeaways

CMS finalized 2021 payment updates for home health agencies Oct. 29. Here are four takeaways on the changes, which are effective January 1:
1.) CMS will increase payments to home health agencies by about 1.9%, or $390 million, for 2021.
2.) CMS also finalized home infusion therapy rates for 2021. The rates will result in a 0.7% decrease in payments to home infusion therapy suppliers, or $384,800.
3.) The rule finalizes a 5% cap on wage decreases in 2021.
4.) Under the rule, home health agencies can provide telehealth visits to Medicare beneficiaries as long as remote patient monitoring and other telecommunication services are included in the plan of care. Providers will need to document in patients' medical records how telehealth services will help treatment outcomes. (Becker’s Hospital CFO Report, 11/2/20)

CMS Completes Price Transparency Initiative

CMS, along with the Departments of Labor and the Department of the Treasury, recently issued a final rule on price transparency. Starting on January 1, 2023, the rule will require health plans to offer an online shopping tool that will allow consumers to see the negotiated rate between their provider and their plan, as well as a personalized estimate of their out-of-pocket cost for 500 of the most shoppable items and services. Then starting on January 1, 2024, these shopping tools will be required to show the costs for the remaining procedures, drugs, durable medical equipment, and any other item or service they may need. (CMS.gov Press Release, 10/29/20)

New California Law Expands Supplemental Paid Sick Leave Requirements

California Governor Gavin Newsom on Sept. 9, 2020 signed Assembly Bill 1867 into law, expanding California’s supplemental paid sick leave requirements for employers with 500+ employees nationwide and creating two new sections of the California Labor Code. Among its requirements, AB 1867 expands California’s supplemental paid sick leave requirement to all private employers with 500+ employees in the U.S., and public and private employers of healthcare providers or emergency responders who were previously excluded from federal emergency paid sick leave requirements. It also applies to unionized employees. This provision went into effect on September 19, 2020; it is currently set to expire on December 31, 2020, or upon the expiration of the Emergency Paid Sick Leave Act, whichever is later. (National Law Review, 10/12/20)

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