Policy Updates

New Policy Threatens Provider Payments in Missouri

Health care providers that fail to join the provider networks of Missouri Medicaid managed care plans will see their Medicaid payments cut 10 percent by the state under a new state policy. The purpose of the policy, according to the state, is to encourage hospitals and physicians to join the provider networks of three managed care plans that serve more than 700,000 residents of the state. Providers, on the other hand, say this policy will discourage them from serving Medicaid patients at all and will detract from their ability to negotiate reasonable rates with the state’s three Medicaid managed care [...]

iqtsupport2018-07-11T06:00:15-04:00July 11, 2018|Uncategorized|

Medicaid Managed Care Plans Suffer High Physician Turnover

The physician networks developed by Medicaid managed care plans suffer from a degree of turnover that threatens continuity of care for their members. While the number of Medicaid managed care plans using so-called narrow networks of providers declined by more than a third between 2010 and 2015, physician turnover is higher in those narrow network plans: three percentage points higher after one year and 20 percentage points higher after five years than the networks of plans that do not employ narrow networks. Collectively, Medicaid managed care plans experienced physician turnover of 12 percent a year from 2010 to 2015. Learn [...]

iqtsupport2018-07-10T06:00:28-04:00July 10, 2018|Medicaid, Medicaid managed care|

Comprehensive Primary Care Initiative Showing Mixed Results

The federal Comprehensive Primary Care Initiative is achieving some of its objectives but not others, according to a new Health Affairs study. The program, according to the Center for Medicare and Medicaid Innovation, seeks to use five means – risk-stratified care management, improved access to and continuity of care, planned care for chronic conditions and preventive care, patient and caregiver engagement, and coordination of care – to “achieve improved care, better health for populations, and lower costs, and can inform future Medicare and Medicaid policy.” According to the Health Affairs study, the program is achieving some of these objectives. CPC [...]

iqtsupport2018-07-09T06:00:24-04:00July 9, 2018|Center for Medicare and Medicaid Innovation|

Outcomes Strong at Academic Medical Centers

Patients served at academic medical centers have a better chance of surviving the health problems that brought them to those facilities. Or so concludes a new study published in the journal Health Affairs. According to the study, We examined more than 11.8 million hospitalizations in the period 2012–14 for Medicare beneficiaries ages sixty-five and older and found that, after adjustment for patient and hospital characteristics, high-severity patients had 7 percent lower odds, medium-severity patients had 13 percent lower odds, and low-severity patients had 17 percent lower odds of thirty-day mortality when treated at an academic medical center for common medical conditions, compared to similar [...]

iqtsupport2018-07-06T06:00:14-04:00July 6, 2018|hospitals|

GAO Recommends Changes in Oversight of 340B Program

The federal Government Accountability Office is recommending that the Department of Health and Human Services improve its oversight of the 340B prescription drug discount program. That program was created by Congress to help safety-net providers obtain discounts on prescription drugs they dispense to low-income patients on an outpatient basis. Those discounts are provided by pharmaceutical companies and not paid for with taxpayer money. The 340B program has been controversial in recent years, and in response to a request from Congress for the GAO to look into the contract pharmacies that operate the 340B programs for many safety-net providers, the GAO [...]

iqtsupport2018-07-02T06:00:12-04:00July 2, 2018|340b|

With Eye on Value-Based Care, CMS Eyes Stark Law Change

Interested in addressing legal obstacles that prevent providers from participating in innovative payment models, the Centers for Medicare & Medicaid Services has put out a call for stakeholders to address challenges raised by the so-called Stark law that makes it difficult for physicians to participate in such models. In a news release accompanying CMS’s publication of its request for information, the agency notes that Over the past year, CMS has engaged with the provider community in a discussion about regulatory burden issues. This included publishing a Request for Information (RFI) soliciting comments about areas of high regulatory burden. One of [...]

iqtsupport2018-06-28T06:00:30-04:00June 28, 2018|Centers for Medicare & Medicaid Services, Medicare|

Proposed Federal Reorganization Could Affect Health Care

Aspects of a proposed reorganization of the federal government could affect the agencies that administer key health care programs. In its 132-page Delivering Government Solutions in the 21st Century: Reform Plan and Reorganization Recommendations proposal, the White House calls for consolidating many social safety-net programs in a new Department of Health and Public Welfare. This department would retain responsibility for Medicare and Medicaid but also would assume responsibility for some food aid programs, including food stamps (now the Supplemental Food Assistance Program, or SNAP). In addition, the proposal would: consolidate all health research programs in the National Institutes of Health, [...]

iqtsupport2018-06-27T06:00:39-04:00June 27, 2018|Medicaid, Medicare|

CMS Unveils Medicaid “Scorecard”

The Centers for Medicare & Medicaid Services had introduced a new “Medicaid scorecard” that the agency says it hopes will “…increase public transparency about the programs’ administration and outcomes.” The scorecard, now posted on the Medicaid web site, presents information and data from the federal government, and reported voluntarily by the states, in three areas: state health system performance, state administrative accountability, and federal administrative accountability. The scorecard currently offers information on selected health and program indicators. Visitors can see comparative data between states and also extensive information about individual state Medicaid programs, including eligibility criteria, enrollment, quality performance, and [...]

iqtsupport2018-06-26T06:00:20-04:00June 26, 2018|Medicaid|

Hospital Government Payment Losses Could Reach $218 Billion by 2028

A recent study concluded that hospitals can expect to lose about $218 billion in federal Medicare and Medicaid payments between 2010, when the latest round of major cuts began, and 2028. Among those cuts cited in the study, which was commissioned by the American Hospital Association and the Federation of American Hospitals, are: $79 billion for DRG documentation and coding adjustments $73 billion for Medicare sequestration $26 billion for Medicaid disproportionate share payments (Medicaid DSH) $11 billion in cuts associated with the American Taxpayer Relief Act of 2012 Other cuts came, or will be coming, through regulatory changes, the introduction [...]

iqtsupport2018-06-25T06:00:46-04:00June 25, 2018|Affordable Care Act, health care reform, hospitals, Medicaid, Medicare, Medicare cuts|

Uninsured Rise Could Hurt Non-Profit Hospitals

The recent growth in the number of uninsured Americans could be especially harmful to non-profit hospitals and health systems, according to S&P Global Ratings. As reported by Healthcare Dive, S&P believes that because non-profit hospitals serve larger proportions of uninsured patients, they are more vulnerable to increases in the number of uninsured people. Healthcare Dive also notes that In particular, S&P warns of a credit negative for nonprofits as patients who started in a care plan with health insurance seek to continue treatment without it. Many hospitals already are struggling as volumes and reimbursement decline and more care shifts to [...]

iqtsupport2018-06-22T06:00:43-04:00June 22, 2018|hospitals|