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Thursday, Jun 22, 2017
  • Contact Information
  • We are located in the BioTech One building of the VA Bio•Technology Research Park.

    SMA Informatics
    800 E. Leigh Street
    Suite 206-14 Building One
    Richmond, VA 23219

    Phone: (804) 344-8111
    FAX: (804) 344-8113

Last Modified: May 10, 2016
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News Item - 06/15/2017
3 Million Children Would Lose Coverage Under House Health Bill
The American Health Care Act (AHCA) would cause 23 million people of all ages and income levels to lose health insurance by 2026.

About 3 million children would lose coverage under this House-passed bill, increasing the uninsured rate for children by about 50 percent.

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News Item - 05/01/2017
Comprehensive Government Funding Bill Released
The House Appropriations Committee today released the fiscal year 2017 Omnibus Appropriations bill, the legislation that will provide discretionary funding for the federal government for the current fiscal year.

The bill includes full Appropriations legislation and funding for the remaining 11 annual Appropriations bills through the end of the fiscal year, September 30, 2017. This level meets the base discretionary spending caps provided by the Bipartisan Budget Act of 2015, and provides additional funding for national defense, border security, and other emergency needs.

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News Item - 04/28/2017
Health Care In America: An Employment Bonanza And A Runaway-Cost Crisis
In many ways, the health care industry has been a great friend to the U.S. economy. Its plentiful jobs helped lift the country out of the Great Recession and, partly due to the Affordable Care Act, it now employs 1 in 9 Americans - up from 1 in 12 in 2000.

As President Donald Trump seeks to fulfill his campaign pledge to create millions more jobs, the industry would seem a promising place to turn. But the business mogul also campaigned to repeal Obamacare and lower health care costs - a potentially serious job killer. It’s a dilemma: One promise could run headlong into the other.

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Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.
News Item - 04/16/2017
Public Use File
The Centers for Medicare & Medicaid Services (CMS) has developed a public use file that enables researchers and policymakers to evaluate geographic variation in the utilization and quality of health care services for the Medicare fee-for-service population.  The Geographic Variation Public Use File includes demographic, spending, utilization, and quality indicators at the state level (including the District of Columbia, Puerto Rico, and the Virgin Islands), hospital referral region (HRR) level, and county level.

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News Item - 04/08/2017
Drug Spend Trends Under The Medical Benefit
As prescription drug spend continues to be top of mind for healthcare purchasers, this week was timely for Magellan Rx Management to release its 92-page seventh annual Medical Pharmacy Trend Report, which this year highlighted "the member and payer impact of high-cost specialty drugs billed on the medical benefit..."

Drug Spend Trends Under The Medical Benefit

As prescription drug spend continues to be top of mind for healthcare purchasers, this week was timely for Magellan Rx Management to release its 92-page seventh annual Medical Pharmacy Trend Report, which this year highlighted "the member and payer impact of high-cost specialty drugs billed on the medical benefit,"

Magellan Rx Management Medical Pharmacy Trend Report

Tidbits from the report examining Rx costs and utilization covered under plan medical benefits, and rendered through medical pharmacies (home infusion/specialty pharmacy; hospital outpatient pharmacy or physician office) included:
  • Commercial pmpm Rx costs were $23.68 and Medicare Advantage Rx costs were $46.01
  • 4% of Commercial members and 12% of Medicare Advantage members had a medical pharmacy claim
  • Commercial Rx spend increased by 12 % each year from 2011-2015,
  • Medicare Advantage Rx spend increased 5 % in total over the same five-year period.
  • Oncology and supportive care agents represent nearly 50% of commercial Rx spend
  • Oncology and supportive care agents represent nearly 60% of Medicare Advantage Rx spend
  • The 10 most expensive commercial drugs averaged $421,220 annually per patient
  • Commercial utilization for these 10 most expensive drugs was two per 100,000 members
  • The 10 costliest Medicare drugs averaged $268,780 annually per patient
  • Medicare utilization for these 10 costliest drugs was eight per 100,000 members
  • For the top 25 drugs, the avg. annual cost per patient was $24,751 for Commercial and $11,063 for MA
  • Consumer out of pocket costs averaged  3% for Commercial and 5% for Medicare Advantage

Magellan's recommended strategies for addressing these trends include: (1) Clinically and operationally managing drugs billed with unclassified Healthcare Common Procedure Coding System codes; (2) Improving claims system capabilities to capture and report National Drug Codes; (3) Employing provider network strategies for commercial members to remove disparities in cost by outpatient site of service; (4) Implementing benefit design strategies, and (5) Bringing transparency of medical benefit drug costs and therapeutic options to members.

For More Information: Magellan Rx Management Medical Pharmacy Trend Report 2016
News Item - 03/19/2017
The Wrong Way to Lower Health-Insurance Premiums
For proponents of the American Health Care Act, perhaps the most encouraging nugget in the Congressional Budget Office’s otherwise critical analysis is that insurance premiums could fall by 10 percent on average by 2026. Even this prediction is more mirage than reality, however, in part because of an obscure concept known as “actuarial value.”

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News Item - 03/07/2017
The American Health Care Act: the Republicans’ bill to replace Obamacare, explained
House Republicans released their long-awaited replacement plan for the Affordable Care Act on Monday.

The American Health Care Act was developed in conjunction with the White House and Senate Republicans. Two big questions — how many people it will cover and how much it will cost — are still unresolved: It will likely cover fewer people than the Affordable Care Act currently does, but we don’t know how many. And the Congressional Budget Office has not yet scored the legislation, so its price tag is unknown.

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News Item - 02/24/2017
The Department of Health and Humans Services’ Office of the National Coordinator for Health Information Technology (ONC) announced the Phase 2 winners of the Move Health Data Forward Challenge.
Winning submissions will now move on to the challenge’s last phase to develop applications that will allow individuals to share their personal health information safely and securely with their health care providers, family members or other caregivers.

Phase 1 of the Move Health Data Forward Challenge required applicants to submit their plans describing how they would develop solutions to help with the flow of health information. The ten Phase 1 winners were awarded $5,000 each and moved on to Phase 2, which required participants to demonstrate a viable solution to achieve those goals by allowing for the safe and secure exchange of consumer or provider health records.

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News Item - 02/23/2017
New Report Shows that Medicare Advantage Payments Won’t Keep Pace With Costs in 2018
Payment cuts would threaten benefits and savings for more than 18 million seniors

Millions of seniors who depend on Medicare Advantage (MA) plans could see cuts to their coverage and benefits if new payment changes take effect next year. That’s according to a new analysis by Oliver Wyman prepared for America’s Health Insurance Plans (AHIP).

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News Item - 02/17/2017
CMS Issues MOON Implementation Guidance
The Centers for Medicare & Medicaid Services (CMS) has updated its Medicare claims processing manual to include guidance on implementing the Medicare Outpatient Observation Notice (MOON), a standard notice that all hospitals and critical access hospitals must provide effective March 8 to all Medicare beneficiaries who receive outpatient observation services for more than 24 hours. Under the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act of 2015, hospitals must provide oral and written notice to beneficiaries within 36 hours after observation services are initiated, or sooner if the individual is transferred, discharged, or admitted as an inpatient. The notice informs patients they are an outpatient receiving observation services, not an inpatient, and about the associated implications for cost-sharing and eligibility for Medicare coverage of skilled nursing facility services. Among other things, the guidance addresses:

  • The scope of the requirements;
  • How hospitals must deliver the notice and within what timeframe;
  • Steps to take if a beneficiary refuses to sign the MOON, or if the notice must be delivered to a beneficiary’s representative;
  • Ensuring beneficiary comprehension;
  • What may be provided in the “additional information” field of the MOON;
  • Retention requirements for the MOON; and
  • The intersection with state laws on observation notices.

CMS issued the final policies for implementing the NOTICE Act last August with the inpatient prospective payment system final rule, but delayed implementation until 90 days after the updated MOON was posted.

FY2018 Medicare Hospital IPPS
Fiscal Year (FY) 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective Payment System Proposed Rule, and Request for Information CMS-1677-P
On April 14, 2017, the Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that would update 2018 Medicare payment and polices when patients are admitted into hospitals. The proposed rule aims to relieve regulatory burdens for providers; supports the patient-doctor relationship in health care; and promotes transparency, flexibility, and innovation in the delivery of care.

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Understanding MS-DRG Grouping under ICD-10
Understanding MS-DRG Grouping under ICD-10
Now that ICD-10 is in full swing, we are seeing a lot of activity with providers, payers, consultants and regulators who need to understand how Acute Inpatient and Long Term Care Hospital claims "behave" when the claim is coded in ICD-10. This includes both prospective and retrospective review of claims scenarios to understand MS-DRG grouping. This article offers a basic primer on MS-DRG grouping logic, and research techniques for using related MediRegs Coding Suite tools. If you'd like a personalized training on these tools, or a demonstration of them in action to see if they are a good fit for your research scenarios, please let us know!

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SMA White Paper - 08/31/2015
New Health Analytics, a national  healthcare software developer and data analytics firm, is pleased to announce that it has released a special report with an concise  review of the FY 2016 Hospital Inpatient Prospective Payment System (IPPS) Final Rule recently posted by the Centers for Medicare & Medicaid Services.

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