Wakely Wire

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Whitepapers, briefs, press releases and more

ACO REACH PY2025 Financial Updates – Could this be the final straw for ACOs?

The long-awaited methodology changes for Performance Year (PY) 2025 ACO REACH benchmarking were finally released in late July. While the more detailed methodology papers have yet to be released as of the time of writing this paper, the quick reference guide on the key changes was released on Friday, July 26th. The methodology changes, while ... Read more

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Week in Washington 08/01/24

Medicare News ACA/Commercial News Medicaid News

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Newsworthy Findings

Fiscal Year 2025 Skilled Nursing Facility Prospective Payment System Final Rule

On July 31, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a final rule updating Medicare payment policies and rates for skilled nursing facilities under the Skilled Nursing Facility Prospective Payment System (SNF PPS) for fiscal year (FY) 2025

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Editor's Note
CMS is updating SNF payment policies, which would result in a net increase of 4.2%, or approximately $1.4 billion, in Medicare Part A payments to SNFs in FY 2025. The 4.2% increase is calculated based on the SNF market basket percentage increase of 3.0%, plus a 1.7 percentage point forecast error adjustment, less a 0.5 percentage point productivity adjustment.

CMS announces new 'premium stabilization' program

The Centers for Medicare & Medicaid Services (CMS) is creating a voluntary demonstration program to support changes to Medicare Part D under the Inflation Reduction Act (IRA).

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Editor's Note
The IRA is designed to limit yearly premium increases from contract year 2024 to 2029. Because Part D and prescription drug plans can result in plan price variation for beneficiaries, CMS is creating the Part D Premium Stabilization Demonstration to “improve premium stability for participating stand-alone prescription drug plans,” according to a news release.

Nearly half of beneficiaries don't know the difference between Medicare and MA: survey

Nearly half of seniors surveyed are confused about the difference between Medicare and Medicare Advantage, highlighting a need for improved health literacy and the potential for technology and AI to aid in understanding healthcare options.

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Editor's Note
Enhancing digital health literacy and incorporating AI tools could reduce confusion, improve beneficiary satisfaction, and potentially lower administrative costs by streamlining information access and decision-making processes.

ACA exchange enrollees could see steep premium increases if enhanced subsidies expire: KFF

The Kaiser Family Foundation (KFF) reports that if the enhanced subsidies for Affordable Care Act plans expire, ACA exchange enrollees could face substantial premium increases, potentially doubling or more in 12 states.

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Editor's Note
The expiration of these subsidies could lead to significant premium adjustments, necessitating early and accurate pricing strategies to mitigate potential financial impacts and maintain enrollee coverage levels.

Average Cost of Healthcare Data Breach Nearly $10M in 2024: Report

Though expenses declined since last year, healthcare is still the costliest industry for responding to and recovering from data breaches — a rank the sector has held since 2011.

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Editor's Note
The average cost for a data breach across industries is half that of the healthcare industry, at just under $5 million in the 2024 report.

Bonus Article

Just for Fun

Math Riddle:

I add six to eleven and get five. Why is this correct?

Prior Week

Prior Week:
Q: Why was the triangle the MVP of the basketball team?
A: It always made three-pointers

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