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What We’re Reading: Medicaid Recipients Can Sue Nursing Homes; Wildfire Smoke and COVID-19; CMS to Test VBC Model
The Supreme Court protected Medicaid recipients’ right to sue nursing homes; wildfire smoke raises the risk of contracting COVID-19; CMS announced a new value-based primary care model.
Supreme Court Rules in Favor of Medicaid Nursing Home Residents
The Supreme Court on Thursday ruled 7-2 to guard Medicaid nursing home residents' right to sue in federal court when state officials do not reach a certain quality of care, which policy watchers are acknowledging as a civil rights victory, reported Roll Call. A 1987 federal law that determines whether nursing homes receive federal funding includes a provision that forbids nursing homes from using psychotropic drugs for nonmedical reasons. A hospital system accused of doing so sought the Supreme Court to eradicate a Medicaid patient’s ability to bring such lawsuits, and the court denied their request.
Wildfire Smoke Increases COVID-19 Contraction Risk
Health experts caution that wildfire smoke exposure throughout North America increases the risk of contracting COVID-19 and exacerbates the impacts for people who already have or are acutely susceptible to the virus, according to Bloomberg. Small particles in wildfire smoke can be inhaled and stuck in the body, affecting the immune system, and creating a propensity to lung infections, says the CDC. Therefore, millions of people in Canada and the US are presently at a higher risk of catching COVID-19.
CMS Announces New Value-Based Primary Care Model
A new value-based primary care model, the Making Care Primary (MCP) Model, will be tested for 10 years under CMS' Center for Medicare and Medicaid Innovation in 8 states, CMS announced Thursday. The new model is designed to allure providers with little or no experience in value-based care, and participants will receive support from CMS. Its goal is to improve care coordination, arm primary care clinicians with tools to form connections with health care specialists, and leverage community-based resources to address health needs and health-related social needs like housing and nutrition. However, it won’t include providers who are already in accountable care organizations.
Urticaria Diagnosis Challenged by Overlapping Pruritic Skin Conditions
April 23rd 2025Urticaria is complicated to diagnose by its symptomatic overlap with other skin conditions and the frequent misclassification in literature of distinct pathologies like vasculitic urticaria and bullous pemphigus.
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New Research Challenges Assumptions About Hospital-Physician Integration, Medicare Patient Mix
April 22nd 2025On this episode of Managed Care Cast, Brady Post, PhD, lead author of a study published in the April 2025 issue of The American Journal of Managed Care®, challenges the claim that hospital-employed physicians serve a more complex patient mix.
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Personalized Care Key as Tirzepatide Use Expands Rapidly
April 15th 2025Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, Harvard Medical School, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes.
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ACOs’ Focus on Rooting Out Fraud Aligns With CMS Vision Under Oz
April 23rd 2025Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and abuse.
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