Policy Updates

Alternative Payment Model Spending Grows

In 2016, 29 percent of all health care payments were made through alternative payment models, continuing the movement toward paying for value rather than for volume. That 29 percent in 2016 was up from 23 percent in 2015. APMs include shared savings and shared risk programs, bundled payments, and population-based payments. Fee-for-service and other “legacy” payments accounted for 43 percent of health care payments in 2016 and pay for performance or care coordination fees accounted for another 28 percent of payments. These numbers come from a report from the Health Care Payment Learning and Action Network. Learn more about the [...]

iqtsupport2017-11-03T06:00:35-04:00November 3, 2017|Uncategorized|

CMS Announces Drive to Reduce Paperwork

The Centers for Medicare & Medicaid Services is launching a new “Meaningful Measures” initiative that will seek to reduce the regulatory burden on health care providers. According to a CMS news release, Meaningful Measures …will involve only assessing those core issues that are most vital to providing high-quality care and improving patient outcomes. The agency aims to focus on outcome-based measures going forward, as opposed to trying to micromanage processes.. In a speech at the Health Care Payment Learning and Action Network, CMS administrator Seema Verma explained that this project will include moving the Center for Medicare and Medicaid Innovation [...]

iqtsupport2017-11-02T06:00:16-04:00November 2, 2017|Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services|

CMS Nursing Home Program Cuts Hospital Admissions

An experimental Medicare program has helped nursing homes reduce the frequency with which their residents are admitted to hospitals. The Centers for Medicare & Medicaid Services’ Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents has reduced avoidable hospitalizations among nursing facility residents 17 percent in the program’s three years. 143 nursing homes in seven states participated in the program, which employed third-party vendors, known as enhanced care and coordination providers, to provide education to nursing facility staff. Hospitals, too, can benefit from the program because it may help reduce avoidable hospital readmissions for which they are penalized financially by [...]

iqtsupport2017-11-01T06:00:28-04:00November 1, 2017|Centers for Medicare & Medicaid Services, Medicare post-acute care|

New Rules Facilitate Integration of Physical, Behavioral Care

New federal regulations are facilitating better integration of physical and behavioral health services for the Medicaid population. Two developments, in particular, are advancing this integration: the 2016 Medicare managed care rule and a 2016 rule implementing the Mental Health Parity and Addiction Equity Act of 2008. Together, these rules encourage providers to perform comprehensive assessments of their patients, increase flexibility for providers in how they use Medicaid payments, and pave the way for improvements in the use of information technology that foster better integration of physical and behavioral medical care. A new issue brief from the Commonwealth Fund presents in [...]

iqtsupport2017-10-31T06:00:27-04:00October 31, 2017|Medicaid managed care, Medicaid regulations|

AMA: Health Insurance Concentration in Urban Areas Threatens Competition

Too much market share by insurers in urban areas can inhibit competition, and according to the American Medical Association, there is too little competition among insurers in too many urban markets today. According to a new AMA study, 69 percent of 389 metropolitan statistical area-level markets are “highly concentrated” in 89 percent of MSAs, at least one insurer issues at least 30 percent of commercial health insurance policies in 43 percent of urban MSAs, a single insurer owns at least 50 percent of the market In a statement accompanying release of the report, an AMA spokesperson explained that After years [...]

iqtsupport2017-10-30T06:00:28-04:00October 30, 2017|Uncategorized|

Survey Says: More Than One in Four Underinsured

28 percent of insured adults under the age of 64 were uninsured in 2016, according to a Commonwealth Fund survey. The survey also found that: More than half of the uninsured are insured through their employer. Nearly one in four insured through their employer are underinsured. More than one in four Medicaid recipients were underinsured. Half of the underinsured report problems paying their medical bills. Individuals with higher deductibles are more likely to report problems paying their medical bills. More than 45 percent of the underinsured report skipping care they need because of cost. Low-income people and those with chronic [...]

iqtsupport2017-10-27T10:56:29-04:00October 27, 2017|Uncategorized|

Despite Uncertainty, States Plan to Raise Medicaid Rates

Even though events in Washington leave the future of Medicaid unclear, 44 states still intend to raise at least some of their Medicaid rates in 2018. Inpatient payments to hospitals are not among the major targets of the planned rate increases: only 17 states plan to increase Medicaid inpatients payments while the others plan to keep those rates as they are or even reduce them. Learn more about trends in Medicaid enrollment, spending, and rates in the Kaiser Family Foundation’s annual survey of state Medicaid programs, the results of which can be found here.

iqtsupport2017-10-26T06:00:12-04:00October 26, 2017|Medicaid|

PA Governor Vetoes Medicaid Work Requirement

Pennsylvania Governor Tom Wolf has vetoed a bill that included a requirement that certain Medicaid recipients either work or search for work. Learn more about the governor’s veto, and his reason for doing so, in this Associated Press news report.

iqtsupport2017-10-24T06:00:15-04:00October 24, 2017|Pennsylvania Medicaid|

Braving the Unknown, States Increase Medicaid Benefits

Despite the prospect of Congress and the administration enacting major reductions of federal Medicaid spending as part of repealing and replacing the Affordable Care Act, more than half the states expanded their Medicaid programs in 2017 and many plan to do so in 2018 as well. In all, 26 states expanded or enhanced Medicaid benefits this year while 17 plan to do so next year. Most of the changes involve enhancing mental health and substance abuse treatment services. Learn more about expanded Medicaid benefits in the face of anticipated reductions in Medicaid spending in this Healthcare Finance News report.

iqtsupport2017-10-23T06:00:49-04:00October 23, 2017|Medicaid|

Helping With Homelessness Reduces ER Costs

Hospitals are finding that helping homeless, frequent emergency room visitors find housing can reduce their unreimbursed ER costs. Throughout the country, hospitals are investing money – in some cases, millions of dollars – in housing programs for the homeless. What they are finding when they do so is that the stability of reliable housing – coupled with supportive social services – appears to be reducing the frequency with which such individuals appear in their ERs. Examples of such programs can be found in Sacramento, Orlando, Portland, New York City, Los Angeles, and elsewhere. Learn more about what hospitals are doing, [...]

iqtsupport2017-10-20T06:00:26-04:00October 20, 2017|Uncategorized|