iqtsupport, Author at DeBrunner & Associates

CMS Shares Evaluation of Medicare-Medicaid Financial Alignment Efforts

In 2011 the Centers for Medicare & Medicaid Services launched a “Medicare-Medicaid Financial Alignment Initiative” that seeks “…to provide Medicare-Medicaid enrollees with a better care experience and to better align the financial incentives of the Medicare and Medicaid programs.” How is that initiative working so far? CMS recently released three reports that evaluate different aspects of the program. Those reports are: “Early Findings on Care Coordination in Capitated Medicare-Medicaid Plans under the Financial Alignment Initiative” “Beneficiary Experience: Early Findings from Focus Groups with Enrollees Participating in the Financial Alignment Initiative” “Issue Brief: Special Populations Enrolled in Demonstrations under the Financial [...]

iqtsupport2017-03-29T06:00:30-04:00March 29, 2017|Centers for Medicare & Medicaid Services, Medicaid, Medicare|

Temporarily Gone But Not Forgotten

While last week’s withdrawal of the American Health Care Act at least temporarily halted talk of immediate repeal and replacement of the Affordable Care Act, at least one aspect of that proposed legislation, often discussed in the past, is sure to arise in the future as well: replacing the current manner in which the federal government matches state Medicaid funding with Medicaid per capita limits or Medicaid block grants. In a new issue brief, the Kaiser Family Foundation examines how a switch to per capita limits or block grants might affect low-income seniors served by both Medicare and Medicaid. Among [...]

iqtsupport2017-03-29T06:00:07-04:00March 29, 2017|Medicaid, Medicare|

Non-Profit Illinois Hospitals Keep Tax Exemption – for Now

Non-profit Illinois hospitals will not have to start paying local property taxes. At least not right away. That decision comes from the Illinois Supreme Court, which did not address the question of whether hospitals merit exemption from the local property taxes that some Illinois communities seek to impose on them. Instead, the Supreme Court concluded that the lower courts that ruled unconstitutional the law giving these hospitals their tax-exempt status lacked the jurisdiction to making such a ruling. So the Illinois Supreme Court sent the case back to a circuit court to be reconsidered. Learn more about the latest in [...]

iqtsupport2017-03-26T06:00:40-04:00March 26, 2017|hospitals|

MACPAC Looks at Medicaid DSH

Hospitals that serve especially large numbers of Medicaid and low-income patients still need Medicaid disproportionate share hospital payments (Medicaid DSH) to avoid red ink despite the expansion of Medicaid and the increase in the number of uninsured people fostered by the Affordable Care Act. So concludes the Medicaid and CHIP Payment and Access Commission (MACPAC) the non-partisan legislative branch agency that advises Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on Medicaid and Children’s Health Insurance Program issues. In its March 2017 report to Congress, MACPAC writes that In both expansion and non-expansion [...]

iqtsupport2017-03-23T06:00:53-04:00March 23, 2017|Affordable Care Act, hospitals, Medicaid|

MedPAC Offers Provider Rate Recommendations for FY 2018

The Medicare Payment Advisory Commission has submitted its annual Medicare payment rate recommendations to Congress. The recommendations, required by law, include: rate increases as required by current law for hospital inpatient payments, hospital outpatient payments, physicians, other health professional services, and outpatient dialysis payments; no updates for ambulatory surgical centers, skilled nursing facilities, long-term-care hospitals, and hospices; and five percent rate reductions for home health agencies and inpatient rehabilitation facilities. MedPAC continued its past practice of recommending reform of the manner in which Medicare pays for post-acute-care services, maintaining that the unified payment system it has proposed would save $30 [...]

iqtsupport2017-03-22T06:00:14-04:00March 22, 2017|Medicare, MedPAC|

The More High-Need Patients, the Better the Care

Physician practices that serve higher proportions of high-need patients have lower health care costs, fewer hospital admissions, and fewer emergency room visits than physician practices that serve lower proportions of high-need patients. This was the conclusion of researchers who analyzed four years of claims data for high-needs patients in Michigan. The study also found some evidence that smaller medical practices are more effective in serving high-need patients than larger practices. The study, “Outcomes For High-Needs Patients: Practices With A Higher Proportion Of These Patients Have An Edge,” was supported by the Commonwealth Fund, and is summarized by the fund here. [...]

iqtsupport2017-03-20T06:00:30-04:00March 20, 2017|Uncategorized|

Telehealth May Not Reduce Health Care Costs

Telehealth may increase rather than decrease health care costs, a new study has found. The study, performed by the Rand Corporation and based on a limited sampling of data from California, found that only 12 percent of telehealth doctor visits replaced office visits while the remaining 88 percent of telehealth encounters constituted new demand. The study focused on virtual visits for respiratory illnesses and found that the telehealth encounters often led to office visits and medical tests that increased annual spending on respiratory illnesses approximately $45 for each user. Learn more about the study, its methodology and findings, and reaction [...]

iqtsupport2017-03-16T06:00:12-04:00March 16, 2017|Uncategorized|

But is the Innovation Working?

Driven by government payers, private payers, and business demands, health care providers are engaging in delivery system innovation to an unprecedented degree. But is that innovation achieving its objectives? How can providers tell? A new post on the Health Affairs Blog offers guidelines for evaluating the effectiveness of delivery system innovation. Among other steps, it proposes identifying the target population the innovation seeks to serve; describing baseline performance; and documenting the components of the innovation. It also suggests how payers can be enlisted to help with this effort. Go here for the article “Strategies For Assessing Delivery System Innovations.”

iqtsupport2017-03-14T06:00:56-04:00March 14, 2017|Uncategorized|

Key Ingredients for Health Care Innovation

What conditions and considerations are needed for innovation in health care? A new article on the Health Affairs Blog asks this very question. To see the answers, go here to see the article “Innovative Environments In Health Care: Where And How New Approaches To Care Are Succeeding.”

iqtsupport2017-03-13T06:00:24-04:00March 13, 2017|Uncategorized|

MACPAC Looks at High-Cost Hepatitis C Drugs

The emergence of exceptionally high-cost drugs that offer unprecedented benefits for Hepatitis C patients has posed a considerable challenge to state Medicaid programs: the drugs offer cures, not treatment, yet their costs are potentially budget-busting. The Medicaid and CHIP Payment and Access Commission commissioned a study to evaluate how these new drugs and their cost have affected state Medicaid programs and the managed care organizations that serve most Medicaid beneficiaries. Among the issues the study considered were: state coverage and prior authorization policies the impact of the new drugs on state Medicaid budgets and Medicaid managed care organizations how these [...]

iqtsupport2017-03-10T06:00:07-05:00March 10, 2017|Medicaid|

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