Bulletin Board
Bulletin Board
OIG: Medicare Advantage Plans May be Denying Access to Save Money
The Office of the Inspector General of the U.S. Department of Health and Human Services is concerned that Medicare Advantage plans may be denying their members access to services to save money and increase profits. According to the OIG, those Medicare Advantage plans overturn 75 percent of their own denials of service upon appeal and independent reviewers are overturning still more denials. In the OIG’s view, this high rate of service denials raises concerns that Medicare Advantage plans, which today serve more than 20 million seniors, are denying their members [...]
New Approach to Readmissions Program to Take Effect October 1
Medicare’s hospital readmissions reduction program will move in a new direction beginning in FY 2019 after Congress directed the Centers of Medicare & Medicaid Services to compare hospitals’ performance on readmissions to similar hospitals instead of to all hospitals. The policy change, driven by a belief that safety-net hospitals were harmed by the program and excessive penalties because their patients are more challenging to serve, results in all hospitals being divided into peer groups based on the proportion of low-income patients they serve. The readmissions performance of hospitals is then [...]
State Court Upholds Non-Profit Hospital Tax Exemption
The Illinois Supreme Court has ruled in favor of non-profit hospitals in response to a challenge to their exemption from local property taxes. Upholding a 2016 lower court ruling, the state Supreme Court affirmed that non-profit hospitals’ charitable expenditures can be used to offset their local property tax liabilities. Learn more about the court’s decision in this article in Crain’s Chicago Business.
Operating Margins Lag for Non-Profit Hospitals
Non-profit hospitals’ operating margins fell from a median of 2.8 percent in 2016 to 1.9 percent in 2017, according to Fitch Ratings. Non-profit hospitals’ profitability also declined. Despite this, Fitch finds that these hospitals have strong balance sheets, with cash on hand and cash-to-debt ratios rising in the past year. It warns, though, that continuing declines in operating margins could eventually threaten those healthy balance sheets. Learn more about Fitch’s analysis in this summary of its ratings report.
Nursing Home Occupancy Declines
Nursing home occupancy fell to 81.7 percent during the second quarter of 2018, according to the National Investment Center for Seniors House & Care. Among the reasons for this decline in the use of skilled nursing facilities are policy changes that seek to shorten length of stay and competition from home health services and assisted living facilities. Occupancy among seniors enrolled in Medicare Advantage plans has been flat, with those living in urban areas more than twice as likely to spend time in skilled nursing facilities than those who reside [...]