Bulletin Board
Bulletin Board
Bureaucratic Requirements May Be Driving Medicaid Enrollment Decline
State eligibility redetermination processes may be pushing down Medicaid enrollment nation-wide. Last year, national Medicaid enrollment fell 1.5 million, more than half of them children, and according to a new report from Families USA, much of that decline may be attributable to the challenging eligibility redetermination requirements imposed on Medicaid-eligible individuals by some states. Those requirements include a 98-page packet that Tennessee sends to individuals seeking to retain their Medicaid eligibility; Arkansas’ limit of 10 days to respond to requests for information to redetermine eligibility; and Missouri’s decision to discontinue [...]
Adverse Selection May Explain Rising ACO Costs
Hospital ACO costs are rising because of the sicker patients they attract, a new study suggests. According to researchers at University of Wisconsin Health, patients served by traditional Medicare or by physician-led accountable care organizations often switch to hospital-led Medicare ACOs as they encounter health problems, bringing those hospital-led ACOs sicker patients than those otherwise served by such organizations. As a result, the per patient costs of hospital-led Medicare ACOs often rise more than those of the costs of traditional Medicare and physician-led ACOs. Often, these shifts are encouraged by [...]
Readmissions Program Changes Produce New Outcomes
Many hospitals are faring better under Medicare’s hospital readmissions reduction program since changes in that program were implemented earlier this fiscal year. According to a new study, safety-net, academic, and rural hospitals have enjoyed improved performance under the program since Medicare began organizing hospitals into peer groups based on the proportion of low-income patients they serve rather than simply comparing individual hospital performance to that of all other hospitals. While the current fiscal year is still under way, it appears that safety-net hospitals will enjoy a collective decline of $22 [...]
CMS Posts Proposed FY 2020 Inpatient Regulation
Medicare would change its wage index system, raise inpatient fees, increase funding for Medicare disproportionate share hospital payments (Medicare DSH), enhance payments for new technologies, and make minor modifications in its hospital readmissions reduction, value-based purchasing, and hospital-acquired condition program if a proposed regulation published this week is ultimately adopted. The Centers for Medicare & Medicaid Services has published its proposed FY 2020 Medicare inpatient prospective payment system regulation: its plan for paying acute-care hospitals for Medicare-covered inpatient services in FY 2020. The 1800-page regulation calls for major changes in [...]
Primary Care Accounts for Little Medicare Spending
Spending for primary care services accounts for only about two percent of Medicare fee-for-service spending, a new study has found. Even when the concept of primary care is expanded to include services provided by nurse practitioners, physician assistants, geriatricians, and gynecologists, all of whom bill for primary care services, that figure rises only to 4.88 percent. The proportion of primary care spending falls as Medicare beneficiaries age, a reflection of their greater consumption of specialist, hospital, and surgical care as they get older. Primary care spending was even lower among [...]