PBN’s 2018 predictions: Some came true, some did not, some a mixed bag

Why This Topic Matters

The piece helps health care stakeholders see which policy and reimbursement trends were gaining traction in 2018 and which were not, providing context for planning, compliance, and operational strategy.

Article Sections

1. 2018 predictions

   Introduces the retrospective review of the year’s forecasted health care and policy trends.

2. Medicare Advantage participation

   Covers enrollment growth and plan availability trends in Medicare Advantage.

3. CMS authorization for ambulatory surgical centers

   Discusses changes related to surgical procedures and outpatient facility coverage policy.

4. MIPS bonuses and reporting environment

   Reviews the competitive landscape around MIPS performance, reporting, and payment adjustments.

5. Mergers and acquisitions among medical practices

   Summarizes activity in health care transactions and practice consolidation across several sectors.

6. HIPAA enforcement and OCR penalties

   Looks at enforcement activity, case resolution trends, and civil monetary penalties under HIPAA.

7. Overpayments, fraud, and qui tam enforcement

   Examines federal recovery expectations and broader fraud enforcement trends affecting the health care industry.

8. New codes for prolonged preventive care and behavioral health care

   Addresses early adoption of newly introduced services and general reporting barriers.

9. Migration to risk-based models and ACOs

   Covers expansion of accountable care organizations and related value-based payment initiatives.

10. Interoperability and payment program alignment

    Discusses policy efforts to promote interoperability through federal payment programs.

11. ACA individual mandate and marketplace premiums

    Reviews premium and enrollment effects tied to changes in the ACA marketplace environment.