2017 December

Medicare Penalizes Hospitals for Avoidable Injuries, Illnesses

Medicare is reducing payments to 751 hospitals because of the high rate at which their patients have suffered avoidable injuries and illnesses while in the hospital. The penalties come under Medicare’s Hospital-Acquired Condition Reduction Program, which was established by the Affordable Care Act. Among the penalized hospitals, more than half were penalized last year as well 115 are academic medical centers – about one-third of all such facilities more than one-third of all safety-net hospitals were penalized Learn more about the program, the penalties, and why the penalties were assessed in this Kaiser Health News report.

iqtsupport2017-12-26T06:00:25-05:00December 26, 2017|Affordable Care Act, Medicaid regulations|

Medicaid Directors Meet

The National Association of Medicaid Directors held its fall conference recently outside Washington, D.C. This is an important event at which policy-makers and policy experts meet to discuss Medicaid programs, trends, challenges, and opportunities. Many of the materials used during that conference are now publicly available, including video clips from speeches by CMS Administrator Seema Verma and others and presentations on a number of subjects, including: delivering care across rural and frontier America Medicaid’s role in supporting community engagement and economic mobility busting the silos of physical and behavioral health care alternative payment models and addressing the social determinants of [...]

iqtsupport2017-12-21T06:00:09-05:00December 21, 2017|Medicaid|

MACPAC Meets

The non-partisan legislative branch agency that advises Congress, the administration, and the states on Medicaid and CHIP-related issues met recently in Washington, D.C. The following is the Medicaid and CHIP Payment and Access Commission’s own summary of its meeting. The December 2017 meeting of the Medicaid and CHIP Payment and Access Commission began with a brief update on the State Children’s Health Insurance Program (CHIP). Although federal funding for the CHIP expired at the end of September, legislation to renew funding was still pending in Congress. The Commission then heard from a panel discussing state tools to manage drug utilization [...]

iqtsupport2017-12-20T06:00:38-05:00December 20, 2017|Medicaid|

Reduced Hospitalizations and Improved Care for High-Risk Patients Not Driving ACO Savings

Medicare savings reported in the early years of the Medicare Shared Savings Program are not coming from reduced hospitalizations of high-risk Medicare patients or even through better coordination of care for those patients. Instead, Medicare accountable care organization savings are coming mostly from better and more coordinated care for low-risks Medicare ACO participants. These surprising findings are reported in the article “Medicare ACO Program Savings Not Tied To Preventable Hospitalizations Or Concentrated Among High-Risk Patients,” which can be found in the December 2017 edition of the journal Health Affairs. Find a link to that article here.

iqtsupport2017-12-19T06:00:35-05:00December 19, 2017|Accountable Care Organization, ACO, Medicare, Medicare regulations|

Medicaid Discovery: More Services Can Reduce Costs

States that invest additional money addressing the social service needs of their highest-cost Medicaid patients are finding that the savings they gain from doing so exceed the cost of providing the social services. Often, by as much as two dollars of savings for every one dollar spent. With relatively small numbers of Medicaid patients consuming a significant portion of state Medicaid resources, providing additional social service assistance to such individuals can both improve their health and save money for the states according to a new report from the National Governors Association. Most of these patients suffer from multiple medical problems, [...]

iqtsupport2017-12-18T06:00:07-05:00December 18, 2017|Medicaid|

Examining How Medicare Addresses Primary Care

As the country continues to struggle with a reported shortage of primary care physicians, Medicare, the country’s leading consumer of primary care services, continues to experiment with how best to pay for primary care and address the disparities in compensation between primary care doctors and specialists that has led to this shortage. In general, Medicare takes two approaches: introduce new billing codes that create incentives for primary care physicians to engage in – and get paid for – practices Medicare seeks or establish demonstration programs that facilitate the introduction of incentives for engaging in promising approaches to primary care delivery. [...]

iqtsupport2017-12-15T06:00:05-05:00December 15, 2017|Medicare|

House to Set Sights on Medicare, Medicaid Cuts in 2018

The House of Representatives will pursue entitlement spending cuts next year, House Speaker Paul Ryan recently explained on a radio program. That means Medicare, Medicaid, and possibly even Social Security. Ryan said that We're going to have to get back next year at entitlement reform, which is how you tackle the debt and the deficit... Frankly, it's the health care entitlements that are the big drivers of our debt, so we spend more time on the health care entitlements — because that's really where the problem lies, fiscally speaking. Learn more about Ryan’s remarks, the administration’s priorities, and what other members of Congress are saying [...]

iqtsupport2017-12-14T06:00:11-05:00December 14, 2017|Medicaid, Medicare, Medicare cuts|

MedPAC Meets

The Medicare Payment Advisory Commission met in Washington, D.C. last week. Among the issues on the agenda of the independent agency that advises Congress on Medicare payment issues were: payment adequacy for physicians and other health professional services An alternative to the merit-based incentive payment system (MIPS) payment adequacy for hospital inpatient and outpatient services payment adequacy for ambulatory surgical center services payment adequacy and improving the equity of payments for skilled nursing facility services payment adequacy for inpatient rehabilitation services payment adequacy for long-term-care hospital services payment adequacy for home health services payment adequacy for outpatient dialysis services payment [...]

iqtsupport2017-12-13T06:00:25-05:00December 13, 2017|hospitals, Medicare, MedPAC|

Hospitals, Trade Groups Differ on Supervision Requirements

According to provider representatives and trade groups, the requirement that physicians supervise the administration of outpatient therapeutic services to Medicare patients in critical access and small rural hospitals is onerous and could limit patient access to such services. The people who run those hospitals don’t agree. That is the conclusion reached by the Medicare Payment Advisory Commission, which looked into the matter after Congress overturned a Centers for Medicare & Medicaid Services supervision requirement in the 21st Century Cures Act because, as MedPAC observed, CAH and rural hospital representatives…expressed concerns that, because they have difficulty recruiting physicians to practice in [...]

iqtsupport2017-12-12T06:00:08-05:00December 12, 2017|Medicare, Medicare regulations|

ED Myths Exposed

The uninsured do not use emergency rooms more than the insured. And the expansion of health insurance coverage increases rather than decreases ER use. So concludes the new Health Affairs study “The Uninsured Do Not Use the Emergency Department More – They Use Other Care Less.” Find the study here.

iqtsupport2017-12-11T06:00:12-05:00December 11, 2017|hospitals|