ABL Healthcare Member News & Industry Trendletter * December 7, 2021
    We planned that our January sessions would be In-Person Healthcare Round Tables with Hybrid/Zoom options (vs 100% Zoom Tables). However, given the Omicron variant's uncertainty, we'll be announcing the Meeting Locations, Discussion Topics and Speakers, within the next week - When, ideally, we have a better sense of Omicron's impact. In the meantime, please HOLD THESE DATES...

  • 1/05 - Orange County
  • 1/11 - Silicon Valley
  • 1/12 - San Francisco
  • 1/20 - Oakland
  • 1/21 - Los Angeles

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Presentations NOW Available to View On-Demand from ABL's 24th Innovations in Healthcare - Southern California Edition

On December 1, three "Innovators in Healthcare" presenters stimulated ABL-Southern California Members to rethink how to care for the fragile elderly in their last years of life; how to track an entire population's health and SDOH status; and how to enable the obese to curb their appetites naturally. Presenters - Kim Phan, CEO of CareConnectMD, Harry Soza, CEO of CAREMINDr, and Dalton Combs, PhD, CEO of Temper - have graciously allowed ABL Members to view each of their slide presentations on ABL's Members Only site: go to abl.org, click on "Members Only" on the top far right, and then on "Presentations" in the red bar on the top left. (While you're there, scroll down the postings of the other nine "special event" presentations that have been posted there so far this year.)

Alegre Home Care Describes Therapeutic Communication Techniques

In Are You Using Therapeutic Communication Techniques?, Alegre Home Care explains that therapeutic communication emphasizes compassion and empathy. Unlike a social relationship which centers on a give-and-receive dynamic, a therapeutic relationship is client-centered and the well-being of the person receiving care is always the priority. Alegre goes on to describe specific techniques. (Charles Symes, OAK)

Alvaka Networks Explains Why Firewall Patching is Critical for Your Business

In Why Firewall Patching (Updating Firmware) is Critical for Your Business, Alvaka Networks declares that maintaining up-to-date firewall patching is critical, as the firewall is the first and last border separating your private local network from the rest of the world. People across the globe are scanning the internet's IP addresses 24/7, trying to identify what IPs belong to which companies, and what security measures they have in place. These same individuals look to identify which firewall models companies have and search for ways to gain access past them. (Oli Thordarson, OC)

Anthem Blue Cross and Motivo are Expanding Access to Counseling Services in California

Anthem Blue Cross of California has selected Motivo to receive a grant to help communities throughout California increase access to mental health and substance use disorder counseling services. Motivo has developed an online platform that can connect pre-licensed mental health therapists with clinical supervisors through online videoconferencing. This approach can expedite the path toward licensure and increase access to critically needed care, so Anthem has stepped-up to fund the launch of this technology across the state. (David Pryor, MD, LA)

Bayer Invests €100 million in Sustainable Health Products

Bayer announced that it will invest 100 million Euros (~$112,855,000 U.S.) to further enable sustainable innovation, production, and consumption of its Consumer Health products, which include global brands such as Aspirin, Bepanthen, Claritin and Elevit. Bayer has a three-pronged science-based action plan in line with the company's science based-targets to be climate neutral by 2030 and net zero by 2050: Prioritize Sustainable Brands, Products and Packaging; Urge Collective Action; and Turbocharge Commitment to Net Zero. (Rama Penta, SV)

Biospectal Wins "Next Big Things in Tech" Award from Fast Company

Fast Company has named Biospectal a winner in their 2021 Next Big Things in Tech Awards, for measuring blood pressure through smartphones. Biospectal's OptiBP app can record a user's blood pressure through a fingertip in just 20 seconds. The WHO is currently validating the technology in a large-scale global study. (Eliott Jones, SV)

Choice in Aging's Affordable Housing Campus Gets $6 Million Grant

Choice in Aging (CiA)'s partner for its Aging in Place Campus - Satellite Affordable Housing - has been awarded a $6 million grant to provide 21 of these housing units to veterans - bestowed by California's Veterans Housing and Homelessness Prevention Program. And, CiA has been honored as a 2021 Top-Rated Nonprofit by GreatNonprofits.
Meanwhile, on January 29 CiA will hold its 47th Annual Crab Feed on January 29. And, watch recent episodes of CiA's "Dishing with Debbie" video series, where CEO Debbie Toth speaks with special guests on relevant topics. (Debbie Toth, OAK)

Covered California Announces Compensation Boost to Insurance Agents

Covered California announced that three of the biggest health insurance carriers that it contracts with - Anthem Blue Cross, Blue Shield of California, and Kaiser Permanente - will be increasing the amount they pay insurance agents who provide independent assistance to consumers signing up for coverage in the individual market. The increased compensation will come at no additional cost to consumers, as Covered California's Licensed Insurance Agents are paid through the monthly premiums that the carriers receive. The move comes after Covered California studied agent-commission trends and found that while people were continuing to rely on an experienced person to help them understand and choose their coverage options, agent compensation had steadily declined since 2014. (Kathy Keeshen, JD, SF)

Covisus Gets Series A Funding; ChromoLogic Study Featured in Industry Journal

Covisus, a pioneer in covert, intrinsic, tag-less item-level supply chain protection solutions secured Series A funding with Hale Capital Partners. The funding comes on the back of Covisus' unprecedented growth in its solution development, since its parent company Chromologic LLC launched Covisus in 2015.
Meanwhile, ChromoLogic's article summarizing the outcome of its NHP whole thorax irradiation study of miRNA biomarkers for late radiation injury was accepted for publication in the Radiation Research Society journal. (Naresh Menon, Ph.D., LA)

El Camino Health Achieves 'A' Grades from Leapfrog & Wins Press Ganey Award

El Camino Health's Mountain View and Los Gatos campuses both earned an 'A' in the fall 2021 Leapfrog Hospital Safety Grade program, making it one of the only health systems in the South Bay to have two hospitals that received the top grade. Leapfrog measures publicly available safety data to grade 2,600+ U.S. acute-care hospitals twice per year with A, B, C, D or F ratings based on their performance to prevent errors, injuries, accidents, and infections.
Also, the Los Gatos hospital has won a 2021 Press Ganey Guardian of Excellence Award for Patient Experience in Outpatient Oncology, having reached the 95th percentile for patient experience metrics each reporting period in the award year. (Cecile Currier, SV)

Elemeno & LCMC Partner to Support Frontline Staff in Louisiana

Elemeno Health and LCMC Health, one of the fastest-growing health systems in Louisiana, have announced a partnership to support neonatal ICU staff with just-in-time best practices, extending care standards from Children's Hospital New Orleans, and across the health system's birthing centers at East Jefferson General Hospital, Touro, and West Jefferson Medical Center. (Arup Roy-Burman, MD, OAK)

HumanGood Life Plan Communities Among US News & World Report's "Best"

Eleven HumanGood communities have been named as "Best Nursing Homes of 2021-2022" by U.S. News & World Report, which evaluated 15,000+ nursing homes and rated them in a variety of quality measures, including staffing, medical outcomes, resident complaints, and processes of care. (Tara McGuinness, OAK)

Irvine Health Foundation Announces Upcoming Major Grant Awards

The Irvine Health Foundation (IHF) has made an announcement regarding upcoming major grant awards, proactively developed by IHF in partnership with the recipients, and designed to improve the health of Orange County residents for many decades to come. Because the above-mentioned final grants will utilize the remainder of IHF's endowment funds, December 31, 2021, will mark the beginning of a prudent process to finalize the work of the Foundation. The specific details of these grant awards will be announced later. (Ed Kacic, OC)

Kaiser Permanente & Unions Reach Tentative Agreement, Avoiding Strike

On November 13, 2021, Kaiser Permanente (KP) and the Alliance of Health Care Unions reached tentative agreement on a 4-year contract, covering nearly 50,000 KP healthcare employees in 22 local unions, and strengthening the Labor Management Partnership. The agreement includes new staffing language to continue to protect employees and patients, annual wage increases, and maintains benefits while providing career development and advancement opportunities for Alliance union-represented employees. The Alliance and KP have agreed to form a national Affordability and Competitiveness Task Force with specific targets to find innovative ways to address issues of affordability while continuing to work together to protect high-quality patient care.
Meanwhile, according to KP research published in JAMA Network Open, patients who made appointments to see their primary care doctors by video or over the phone did not seek substantially more follow-up care overall than those who had traditional in-person visits. (Marcos Vasconcelos, OAK)

King & Spalding Earns Numerous Honors from US News & Best Lawyers + Announces Webinar

U.S. News & World Report and Best Lawyers has ranked multiple King & Spalding practices from across the country in their "Best Law Firms 2022" edition. The firm earned 42 national rankings, including Tier 1 designations in 22 practice areas - including Health Care Law, as well as 128 regional rankings for various practices in Sacramento, San Francisco, San Jose, and Los Angeles, as well as Atlanta, Austin, Charlotte, Chicago, Houston, New York, and Washington, D.C.
Meanwhile, K&S will present a webinar on December 16 - White Bagging 2.0: Strategies Based on How Providers, Plans and Regulators Have Responded.
And, recent K&S Client Alerts include:
>> FDA Makes First Significant Changes to Premarket Medical Device Software Guidance in 16 Years;
>> Biden Administration Unveils New COVID-19 Vaccination and Testing Requirements for Large Businesses and Healthcare Workers. (Marcia Augsburger, JD, SF)

KMD Architects Projects Spotlighted in Recent Articles

A Seattle Times article highlights EvergreenHealth's recently opened ICU, for which KMD Architects led the design team in making major upgrades. An excerpt: "Changes, big and small, have swept through the suburban Kirkland, WA hospital since it became the center of the nation's first major identified COVID outbreak in February 2020. In many ways, the virus has pushed medical technology and patient care forward."
Also, Next Gen Healthcare: Kaiser Permanente Opens its first MOB in Berkeley spotlights the opening of KP's first medical office building in Berkeley, for which KMD led the design and planning of interior tenant improvements. (Rob Matthew, SF)

Life Adjustment Team Explores the Impact of the Pandemic on Mental Health

In The Impact of the Pandemic on Mental Health, Life Adjustment Team (LAT) notes that a pandemic is more than just a medical phenomenon; it disrupts individuals and society at every level and causes anxiety, stress, stigma, and fear, all of which impact a person's mental health and the way they interact with the world. LAT discusses some ways the pandemic may have affected your mental health, including: Anxieties about getting sick; Emotional repercussions of social distancing; Anxiety over finances; Grief caused by loss; and Struggling with returning to normal.
Meanwhile, other recent LAT articles include: How a Daily Routine Can Improve Your Mental Health and Early Signs of Psychosis and Schizophrenia. (Cynthia Sampson, LA)

LigoLab & TestDirectly Featured in Industry Media

In LigoLab's Direct-to-Consumer Portal: An Innovative Solution for an Industry-Wide Problem, LigoLab goes in depth on its TestDirectly Direct-to-Consumer Web Portal, a cloud-based patient engagement tool that replaces paper forms and manual processes with an electronic workflow that entirely supports a case from specimen collection to the delivery of the report, and everything in between.
Also, find out how labs plan to use the TestDirectly Portal to comply with the 21st Century Cures Act in the American Association for Clinical Chemistry's article, The Lab Is Moving From a Black Box to a Smartphone App.
And, LigoLab's revenue cycle management module is featured in the New & Noteworthy section of the latest issue of MedicalLab Management. (Suren Avunjian, LA)

Mazzetti is #8 in Top 95 Healthcare Sector Engineering Firms

Mazzetti is ranked #8 in the Top 95 Healthcare Sector Engineering and EA Firms in Building Design & Construction Magazine's 2021 Giants 400 Report, a ranking of the largest architecture, engineering, and construction firms in the U.S.
Meanwhile, Mazzetti has published Why Hospitals Should Eliminate Hot Water for Hand Washing, which examines why, over the last several years, experts in infection control have been uprooting old assumptions that hot water is an essential component in hand washing.
And, in this short video, Mazzetti explains Scope 1, 2, & 3 Emissions. (Walt Vernon, JD, SF)

MedWand Wins "Best Overall Telemedicine Platform of the Year" Award

MedWand Solutions won the "Best Overall Telemedicine Platform of the Year" award at the Middle East HealthTech Innovation Summit / HealthTech Innovation Awards, organized by BII World.
Meanwhile, MedWand is participating in the Futures Exhibition at the Smithsonian in the Arts & Industries Building - both sponsoring and participating in special programs throughout, and likely beyond, the duration of the exhibition, currently scheduled to run into summer of 2022. (Bob Rose, OC)

Nelson Hardiman's Harry Nelson Interviewed + Firm Recognized by US News & Best Lawyers

Authority Magazine has published an interview feature, Top Lawyers: Harry Nelson of Nelson Hardiman On The 5 Things You Need To Become A Top Lawyer In Your Specific Field of Law. In addition to the "5 Things," Harry talks about his background, his practice, his motivation, and more.
And, Nelson Hardiman (NH) was awarded a Los Angeles region Tier 1 ranking in Health Care and Administrative/Regulatory Law by U.S. News & World Report and Best Lawyer's "2022 Best Law Firms." The rankings are based on a rigorous evaluation of client and lawyer evaluations peer review and leading attorneys in their field.
Meanwhile, read NH's article, Despite Jury Win, Opioid Attorneys Predict "A Long Way to Go." (Harry Nelson, JD, LA)

PreludeDx Issued CPT PLA Code for Proprietary Test + Demonstrates 40% Change in Radiation Therapy Treatment Recommendation

The American Medical Association has issued Prelude Corporation (PreludeDx) a new, dedicated Current Procedural Terminology Proprietary Laboratory Analyses code for DCISionRT, the only test available to predict personalized recurrence risk and radiation therapy benefit for patients with ductal carcinoma in situ. The new code will become effective January 1, 2022, and is specific to the DCISionRT test.
Meanwhile, PreludeDx will present scientific data demonstrating a significant (40%) change in radiation therapy treatment recommendations when using the DCISionRT test, this week at the 2021 San Antonio Breast Cancer Symposium. (Dan Forche, OC)

PRODEO Co-Authors Article on Brain Health Innovation Market

Mark Heinemeyer, CEO of PRODEO, co-authored a recent paper in the Psychiatric Times, Avoiding a Brain Health Innovation Market Failure: Lessons from the Hype Cycle, which begins: "As brain health investing sees unprecedented growth and activity, how do we ensure a sustainable rate of progress going forward? An editorial in JAMA Psychiatry reported that in 2019 alone, venture capital companies invested a record-breaking $637 million in 60+ different mental health-oriented companies. This has accelerated further in 2020 and 2021. The whole VC field is booming, and beyond just mental health care, investment in the broader field of brain health science and technology is also on the rise." (Mark Heinemeyer, OC)

Satellite Healthcare Develops Program to Safely Transition Patients to Dialysis at Home

Satellite Healthcare recently unveiled a pilot study that enables dialysis patients to safely transition to home-based peritoneal dialysis (PD), and to maintain this therapy through events that would otherwise require them to transition to in-center hemodialysis. The study is the first multi-center implementation of assisted PD in the U.S. and demonstrates how dialysis staff worked with patients and their families to build problem-solving skills and self-confidence, and to arrange a safe home environment to enable patients to successfully dialyze at home without staff assistance. (Jim Glafkides, SV, & Bernadette Vincent, OAK)

SAVI Group Discusses Telemedicine, Healthcare Worker Shortage, and More

In The Continuing Benefits of Telemedicine, SAVI Group concludes that from improving communication to increasing access to valuable care, telemedicine is here to stay as support rises from various parties.
And, in Sustaining Patient Care Quality During a Hiring Shortage, SAVI Group provides suggestions on what healthcare providers can do to ensure patient care doesn't suffer due to a shortage of workers, and how they can make sure current staff members aren't feeling overburdened/burned-out at work.
Other recent articles from SAVI Group include: The Benefits of Utilizing Digital Health Records and How Medical Practices Can Keep Denial Rates Low. (Sumit Mahendru, OC)

Wipfli to Present Healthcare-Related Webinars + Wins MarCom Awards

Upcoming healthcare-related webinars from Wipfli include:
>> HIPAA & cybersecurity due diligence and compliance for healthcare private equity backed providers, on December 14;
>> Wipfli Home Health webinar,, on Dec. 16.
>> Also, read Wipfli's recent article: How the tone from the top impacts your internal audit.
>> Meanwhile, Wipfli was recently awarded five platinum and two gold MarCom Awards for external and internal communication achievements from the Association of Marketing and Communication Professionals. (Jeff Johnson & John Dao, OAK)

AfterNow's AR/VR Presentations Tool is Helping Medical Pros Communicate

AfterNow recently announced that it has added a Dicom add-on to its Prez offering, enabling doctors to import patient 3D data into Prez and launch a meeting with colleagues, students, and/or patients. In This Augmented Reality and Virtual Reality Presentation Tool is Helping Medical Doctors with Professional Development, AfterNow describes this product to make premium AR and VR presentations that drive professional development and collaboration. With a drag and drop, code free interface, users can make their own presentation using custom or ready-made assets or collaborate with AfterNow's team for bespoke projects. (Phillippe Lewicki, ABL-Tech WLA)

Eckert & Ziegler Acquires Property for Radiopharmaceutical Production Site in China

Eckert & Ziegler AG has acquired an approximately 75,400-square-foot property with an expansion option for the building of its Chinese production facility in Jintan (PR China). The location in the Jiangsu province near Shanghai will be used to build production facilities for radiopharmaceuticals and radioisotopes as well as Eckert & Ziegler's administrative headquarters for the Chinese market. ((Frank Yeager, ABL-Tech SGV)

GIDEON Infectious Diseases Database Achieves AA-Level Accessibility Compliance

GIDEON Informatics is now one of the most inclusive scientific technology platforms, as its comprehensive infectious disease and epidemiology network achieved AA-level compliance with WCAG 2.0 global electronic accessibility standards. Web Content Accessibility Guidelines (WCAG) are international standards to make websites and web applications more accessible to individuals with disabilities. GIDEON offers epidemiological and clinical data for 2,000+ pathogens and 360 diseases and is updated daily. Meanwhile, learn about GIDEON in this 2-minute video. (Uri Blackman, ABL-Tech WLA)

Tanner Research CEO to Present Virtual Nutrition Science Workshop

On the evening of December 14 (click here), John Tanner, Ph.D., of Tanner Research, will present his free Nutrition Science Virtual Workshop, 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, plus give a free book to participants. (John Tanner, PhD, ABL-Tech SGV)

U.S. Plans to Fast-Track Revamped Covid-19 Vaccines to Combat Omicron

The Biden administration is preparing to fast-track authorization of revamped Covid-19 vaccines to combat Omicron as a study from South Africa suggests the fast-spreading variant might cause less severe illness than its predecessors. Federal regulators on Sunday said cases have been identified in 16 states and that the FDA is already in conversations about streamlining authorization for revamped vaccines. Agency officials have met with vaccine makers and are working to set guidelines for the type of data that will be needed to swiftly evaluate the safety and efficacy of changes to current vaccines. (https://www.wsj.com/articles/omicron-may-cause-less-severe-covid-19-small-south-african-study-finds-11638714444)

District Court Grants Preliminary Injunction Blocking Biden Administration's Vaccine Mandate for Healthcare Workers Nationwide

On November 30, the U.S. District Court for the Western District of Louisiana halted the Biden administration's vaccine mandate for healthcare workers at certified Medicare and Medicaid providers and suppliers. The decision applies not just to the 14 states that were parties to the lawsuit but to all healthcare workers nationwide. The court reasoned that unvaccinated healthcare workers in states other than those party to the suit also needed protection. Following the decision, CMS issued a memorandum on December 2, 2021 announcing that it would suspend enforcement of the vaccine mandate while the injunction is in effect. More information: King & Spalding Health Headlines, Dec. 6, 2021.

Over Half of Young Adults Are Obese or Overweight, Study Says

56% of Americans ages 18 to 25 are overweight or obese, according to Johns Hopkins research, published in JAMA. Using data from a nationally representative sample of 8,015 people in that age bracket, the researchers compared average weights over the past four decades. In that time, that population's average body mass index, a measure of body fat based on a person's height and weight, had increased by 4.6 points - from 23.1 (considered normal weight) to 27.7 (considered overweight). That shifted the number of overweight young adults from about 18% percent in the late 1970s to nearly 24% percent by 2018. The biggest spike in weight measurements, however, was in the prevalence of obesity, which increased from about 6% to nearly 33%. (https://www.washingtonpost.com/health/what-percent-young-adults-obese/2021/12/03/b6010f98-5387-11ec-9267-17ae3bde2f26_story.html)

Study: Californians' Health is Struggling Due to Lack of Affordable Housing and Other External Factors

Nearly half of Californians said that affordable housing is not always easily accessible and is one of the top issues negatively impacting their overall health, according to Driving Our Health: A study exploring health perceptions in America, conducted by Anthem, Inc. The study findings also suggest that 45% of Californians are unaware of the concept of social drivers of health - external factors like nutritious food, safe housing, and reliable transportation - that play a key role in determining health outcomes. But the current attention on health provides an opportunity to expand our understanding of whole health, and ultimately improve the health and vitality of people across the nation. (https://www.anthem.com/ca/press/california/new-study-finds-californians-health-is-struggling-due-to-lack-of-affordable-housing-and-other-external-factors/)

Telehealth Rollbacks Leave Patients Stranded, Some Doctors Say

States are curbing access to telehealth services that were expanded during the pandemic, prompting some doctors and businesses to lobby for a permanent expansion of remote care that they say some patients need. Most states over the past two years allowed residents to conduct some medical appointments virtually or by phone, by setting rules that required insurers to pay the same for virtual visits and in-person appointments and by eliminating requirements for in-person check-ins. Insurers also expanded coverage of telehealth appointments during the pandemic. The provisions helped patients avoid exposure to Covid-19 and alleviated some of the pressure on overtaxed healthcare workers. Health insurers began scaling back coverage allowances made during the pandemic in fall 2020, and some state provisions have expired or are set to do so next year. (https://www.wsj.com/articles/telehealth-rollbacks-leave-patients-stranded-some-doctors-say-11637577001?mod=hp_featst_pos4)

CVS & Microsoft Forge Digital Care Partnership

CVS Health and Microsoft established a strategic partnership focused on digital health and personalized care, the two companies have announced. In doing so, CVS is aiming to create more personalized customer experiences through data. CVS plans to provide customized health recommendations, expand its pharmacy capabilities, and scale up retail loyalty and personalization programs that are run on Microsoft's cloud computing service Azure. (https://www.beckershospitalreview.com/disruptors/cvs-microsoft-forge-digital-care-partnership.html)

10 Hospital Execs Define 'Digital Transformation'

"Digital transformation" is a term used often in healthcare, though its meaning differs from organization to organization. In a recent Becker's Health IT article, 10 executives from health systems across the country define what the term means to them. (https://www.beckershospitalreview.com/digital-transformation/10-hospital-execs-define-digital-transformation.html)

Digital Health Ecosystems: Voices of Key Healthcare Leaders

A recent article analyzes data from an interview series with 22 key international industry experts, as well as with 81 participants in McKinsey's ninth Digital Healthcare Roundtable, to explore the following three themes: why and when healthcare players seek to provide digital healthcare solutions, what kind of digital health ecosystem healthcare players should provide, and how the implementation of a digital health ecosystem should be approached. (https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/digital-health-ecosystems-voices-of-key-healthcare-leaders)

CMS Issues Outpatient Prospective Payment System Final Rule for CY 2022

On November 2, 2021, CMS published the final rule to update the payment policies and rates for services furnished under the Medicare Outpatient Prospective Payment System and the Ambulatory Surgery Center Payment System for calendar year 2022. Highlights include increasing the civil monetary penalties for noncompliance with the price transparency rules, halting the elimination of the inpatient only list, changing the list of covered procedures, and continuing the payment rate of Average Sales Price minus 22.5% for 340B drugs. More information: King & Spalding Health Headlines, Nov. 8, 2021.

CMS Releases Final Rule Regarding Payment Policies under the Physician Fee Schedule & Other Changes to Medicare Part B Payment Policies

CMS issued a final rule addressing several topics, including changes to the physician fee schedule (PFS) and changes to Medicare Part B payment policies. Key changes include a net reduction in the PFS conversion factor of $1.30, changes to policies for split (or shared) evaluation and management (E/M) visits, critical care services, and services furnished by teaching physicians involving residents, and revisions to the Medicare Shared Saving Program among other issues. The regulations go into effect on January 1, 2022. More information: King & Spalding Health Headlines, Nov. 8, 2021.

CMS Issues Final Rule Affecting Home Health, Hospice, Inpatient Rehab & Long-Term Care Facilities for 2022

On November 2, CMS put on display its final rule that, among other things, updates the home health and home infusion therapy services payment rates for calendar year 2022; makes significant changes to the provider and supplier enrollment processes and survey and enforcement requirements of hospice programs; finalizes modifications to the effective date for reporting of measures and certain standardized patient assessment data in the Inpatient Rehabilitation Facility Quality Reporting program; and makes permanent selected regulatory blanket waivers related to home health aide supervision that were issued to Medicare participating home health agencies during the COVID-19 public health emergency. More information: King & Spalding Health Headlines, Nov. 8, 2021.

Medicare FFS Estimated Improper Payments Decline by $20+ Billion Since 2014

CMS announced that its aggressive corrective actions led to an estimated $20.72 billion reduction of Medicare Fee-for-Service improper payments over seven years. The 2021 Medicare FFS estimated improper payment rate (claims processed July 1, 2019 to June 30, 2020) is 6.26% - an historic low. This is the fifth consecutive year the Medicare FFS improper payment rate has been below the 10% threshold for compliance established in the Payment Integrity Information Act of 2019. (https://www.cms.gov/newsroom/press-releases/biden-harris-administration-announces-medicare-fee-service-estimated-improper-payments-decline-over)

152 Members of Congress Submit Letter Urging Revisions to No Surprises Act Independent Dispute Resolution Process

On November 5, 2021, 152 members of the U.S. House of Representatives submitted a letter to the Secretaries of the Departments of Health and Human Services, Labor, and the Treasury urging the Departments to amend the second interim final rule implementing the independent dispute resolution (IDR) process under the No Surprises Act to comply with the letter of the law. The Representatives assert that by establishing the qualifying payment amount (QPA) as the presumptive out-of-network rate, the interim final rule contradicts Congress's bipartisan intent to enact a fair, balanced dispute resolution process to resolve payment disputes between providers and plans. This letter comes on the heels of Texas Medical Association's federal lawsuit challenging the portions of the interim final rule relating to the IDR process. More information: King & Spalding Health Headlines, Nov. 15, 2021.

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