hospitals

What is a Hospital?

The Centers for Medicare & Medicaid Services has taken a step toward answering that question in a new, 12-page guidance document that seeks to define whether a facility qualifies as a hospital under section 1861(e) of the Social Security Act. At the heart of the question is that law’s definition of a hospital, which includes that it is “primarily engaged” in caring for inpatients. CMS’s guidance outlines parameters for determining whether a hospital meets this standard. Find that CMS document here.

iqtsupport2017-09-19T06:00:12-04:00September 19, 2017|hospitals|

MedPAC Comments on Proposed Medicare Outpatient Payment Rule

The Medicare Payment Advisory Commission has weighed in with the Centers for Medicare & Medicaid Services on its proposed regulation governing the 2018 hospital outpatient prospective payment system and ambulatory surgical center payment systems and quality reporting programs. Among the issues MedPAC addresses in its comment letter to CMS are the proposal to reduce Medicare reimbursement for 340B-covered prescription drugs; how to reinvest the savings such a payment cut would produce; the ability of hospitals to expand the services they offer at hospital-based outpatient departments; proposed changes in the Medicare hospital outpatient quality reporting program and ambulatory surgery center quality [...]

iqtsupport2017-09-11T09:59:57-04:00September 11, 2017|Centers for Medicare & Medicaid Services, hospitals, Medicare regulations, MedPAC|

Overutilization of ERs May Not be as Great as Perceived

Far fewer hospital emergency room visits are for medical problems better addressed in other settings, according to a new study. In a review of six years worth of data encompassing 424 million ER visits, researchers found that only 3.3 percent of those visits were truly “avoidable,” with the avoidable visits mostly involving problems ERs are not equipped to address, such as dental and mental health issues. This finding flies in the face of the conventional wisdom that people turn too quickly to hospital ERs for routine medical problems or use ERs because they lack access to more appropriate care. Learn [...]

iqtsupport2017-09-08T06:00:25-04:00September 8, 2017|hospitals|

CMS Takes First Steps Toward Medicaid DSH Cuts

Federal funds allocated to states to make Medicaid disproportionate share hospital payments (Medicaid DSH) payments would be reduced beginning in FY 2018 under a new rule proposed by the Centers for Medicare & Medicaid Services. The Medicaid DSH cuts, mandated by the Affordable Care Act but delayed several times at the behest of Congress, would come in the form of reduced Medicaid DSH allocations to individual states, with the size of those allocation cuts based on the nature of individual states’ Medicaid programs and changes in the number of uninsured patients in individual states. The cuts were established in the [...]

iqtsupport2017-07-31T06:00:34-04:00July 31, 2017|Centers for Medicare & Medicaid Services, hospitals, Medicaid|

Denied Hospital Claims Exceed A Quarter of a Trillion Dollars a Year

Insurers deny about $262 billion in hospital inpatient and outpatient claims a year, according to a new study. That amounts to about nine percent of approximately $3 trillion in claims hospitals file with insurers a year. Of that rejected $262 billion, roughly 63 percent is recoverable but that costs hospitals $118 per claim, or nearly $9 billion a year in costs associated with that recovery. Learn more about this analysis produced by Change Healthcare in this Healthcare Finance News article.

iqtsupport2017-06-29T06:00:16-04:00June 29, 2017|hospitals|

MedPAC Testifies Before Congress

Last week Mark Miller, executive director of the Medicare Payment Advisory Commission, testified before the House Ways and Means Committee’s Health Subcommittee. In his testimony, Miller summarized and explained some of the key points MedPAC made in its March report to Congress, including: why MedPAC believes most post-acute-care payments are too high; why Medicare needs to reduce the incentives for hospitals and doctors to deliver more services; why it recommended no FY 2018 payment increases for long-term acute-care hospitals, ambulatory surgical centers, and skilled nursing facilities and reductions of payments for home health care providers and inpatient rehabilitation facilities; why [...]

iqtsupport2017-05-22T06:00:12-04:00May 22, 2017|hospitals, Medicare, Medicare post-acute care, Medicare regulations, MedPAC|

Hospital Uncompensated Care Down

As was surely expected, reforms introduced through implementation of the Affordable Care Act have driven down uncompensated care costs for many hospitals. How much? A new study published by the Commonwealth Fund offers the following findings: uncompensated care declines in expansion states are substantial relative to profit margins; for every dollar of uncompensated care costs hospitals in expansion states had in 2013, the Affordable Care Act erased 41 cents by 2015; and Medicaid expansion reduced uncompensated care burdens for safety-net hospitals that are not made whole by Medicaid disproportionate share payments (Medicaid DSH). Learn more, including how the decline in [...]

iqtsupport2017-05-15T06:00:48-04:00May 15, 2017|Affordable Care Act, hospitals|

Health Reform Helps Hospitals in Medicaid Expansion States

The Affordable Care Act’s enhancement of access to health insurance, whether through Medicaid expansion or the subsidization of insurance premiums for working-class and some middle-class Americans, has improved the financial health of hospitals. Especially hospitals in Medicaid expansion states. According to a new report from the Urban Institute, Using data through fiscal year 2015, this new analysis finds that the Medicaid expansion under the ACA increased Medicaid revenue by $5.0 million per hospital, reduced costs of uncompensated care by $3.2 million per hospital, and improved average operating margins by 2.5 percentage points. This study also finds that the financial benefits [...]

iqtsupport2017-04-24T06:00:07-04:00April 24, 2017|Affordable Care Act, hospitals, Medicaid|

Programs, Not Penalties, Drive Readmission Reductions

Participating in federal value-based payment programs does more to reduce hospital readmissions than penalties levied on hospitals with too many readmissions. Or so reports a new study published by JAMA Internal Medicine. According to the study, hospitals that participated in one or more of three Medicare value-based payment programs – its meaningful use of electronic health records program, the bundled payment for care initiative, or an accountable care organization (ACO) program – enjoyed bigger decreases in their avoidable Medicare readmissions than hospitals that participated in no such programs but were only subject to financial penalties levied under the Medicare hospital [...]

iqtsupport2017-04-18T06:00:36-04:00April 18, 2017|Accountable Care Organization, health care reform, hospitals|

ACA Improved Hospital Financial Performance

Hospitals in states that expanded their Medicaid programs under the Affordable Care Act enjoyed improved financial performance, a new analysis has found. According to the report from the Urban Institute and the Robert Wood Johnson Foundation and based on FY 2015 data, In states that expanded Medicaid through the ACA, hospitals had $5.0 million in increased Medicaid revenue and $3.2 million decreased uncompensated care costs, on average per hospital. Hospitals in states that expanded Medicaid through the ACA improved average operating margins by 2.5 percentage points. Small hospitals, for-profit and non-federal government-operated hospitals, and those in non-metropolitan areas saw the [...]

iqtsupport2017-04-06T06:00:32-04:00April 6, 2017|Affordable Care Act, hospitals|