Policy Updates

MACPAC Looks at Medicaid Substance Abuse Treatment

The treatment of substance abuse problems with medication within the Medicaid population is the subject of a new report by the Medicaid and CHIP Payment and Access Commission. As required by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, which was enacted last year, MACPAC has prepared a report on how selected states administer and regulate the use of medications used to treat opioid and alcohol use disorders. Among its findings: The frequency with which providers are prescribing medication to treat opioid and alcohol use disorders has exploded in recent years. States are [...]

iqtsupport2019-11-05T06:00:24-05:00November 5, 2019|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission|

Safety-Net Hospitals Gird for Loss of Medicaid DSH Money

Safety-net hospitals and others will lose a significant portion of their Medicaid disproportionate share (Medicaid DSH) payments on November 22 unless Congress delays implementation of the cut in those payments that was mandated by the Affordable Care Act. And hospitals that receive these payments are now preparing for the worst. The Medicaid DSH cut was included in the 2010 health care reform law in anticipation of a great reduction in the number of uninsured people leaving hospitals providing much less uncompensated care and therefore not in need of as much DSH money. The law’s reach has not proven to be [...]

iqtsupport2019-11-04T06:00:14-05:00November 4, 2019|Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments|

High-Deductible Plans Losing Luster Amid Low Unemployment

The competition for employees is leading more businesses to offer more generous health insurance plans in addition to high-deductible plans. As health insurance premiums rose in recent years, more and more companies were offering their employees more high-deductible insurance options to help keep down the cost of premiums. Now, however, with some workers clamoring for more conventional plans and businesses finding themselves in competition for workers at a time of low unemployment, more businesses are offering those conventional plans to their workers. 2020, in fact, will mark the third consecutive year during which the percentage of companies offering only high-deductible [...]

iqtsupport2019-11-01T06:00:26-04:00November 1, 2019|Uncategorized|

Azar: More Value-Based Care Coming

Medicare may add more value-based care initiatives and alternative payment models to those it already operates, Health and Human Services Secretary Alex Azar suggested at a recent event in Washington, D.C. During his remarks, Azar spoke about population health benefits, global budgeting for Medicare patients, more primary care programs, and new models that address kidney care and opioid use and hinted at future efforts that address social determinants of health. Learn more about Azar’s remarks about Medicare value-based purchasing and alternative payment models and other current federal health policy matters in the Healthcare Dive article “HHS chief keeps focus on [...]

iqtsupport2019-10-31T13:00:29-04:00October 31, 2019|Alternative payment models, Centers for Medicare & Medicaid Services, Medicare, Medicare reimbursement policy|

Verma Hints at More Medicaid Changes, Deregulation

Stay tuned for more Medicaid changes, Centers for Medicare & Medicaid Services administrator Seema Verma told a Las Vegas health care gathering last week. CMS, she told her audience, will …soon outline new opportunities for states to flip the Medicaid paradigm and free themselves from federal micromanagement. While Verma offered few details, one idea clearly emerged: there will be more deregulation. She insisted, for example, that Medicaid work requirements are not dead. While such requirements have run into trouble in the courts in recent months, she explained that CMS is developing new implementation guidelines to address some of the challenges [...]

iqtsupport2019-10-31T06:00:04-04:00October 31, 2019|Centers for Medicare & Medicaid Services, Medicaid, Medicaid regulations|

More Hospitals Gain Than Lose in FY 2020 Value-Based Purchasing Program

Medicare’s value-based purchasing program will reward more hospitals than it will penalize in FY 2020 through its value-based purchasing program. The program, in which 2700 hospitals are scored in four domains – clinical outcomes, safety, person and community engagement, and efficiency and cost reduction – will distribute $1.9 billion in bonus payments to 1500 hospitals. Bonus payment average 0.6 percent, with a high of 2.93 percent. Penalties average -0.39 percent, with a high of -1.72 percent. Overall, rural hospitals performed better in the safety, person and community engagement, and efficiency and cost reduction categories and had a higher average score [...]

iqtsupport2019-10-30T15:15:04-04:00October 30, 2019|hospitals, Medicare, Medicare reimbursement policy|

Tools for Controlling Cost Growth Limited

Employers and insurers sometimes have limited means of reducing growth in health care costs, a new study has found. While hospitals can take incremental steps to manage rising costs, those efforts will be outstripped in geographic markets that have undergone a great deal of consolidation, according to a new analysis from the Georgetown University Health Policy Institute. In areas of such consolidation, the study found, insurers can be reluctant to negotiate hard with hospitals and health systems or to threaten to exclude those providers from their networks and businesses, rather than backing insurers or pressuring providers, are more likely to [...]

iqtsupport2019-10-30T06:00:25-04:00October 30, 2019|hospitals|

Hospitals Advocate Losing Chargemaster

Hospitals would no longer need to post their chargemaster prices under a new approach to Medicare payments being advocated by a new hospital lobbying group. The small group, calling itself the Chargemaster Alternatives for Medicare Payment Alliance, wants Medicare to eliminate payment formulas based on chargemaster prices and base them instead on actual costs. Acting in response to a new proposal that hospitals be required to post their chargemaster prices, the group argues that chargemaster prices are irrelevant for all but a few consumers. Learn more about the group, its members, and its argument for ending use of chargemaster prices [...]

iqtsupport2019-10-28T06:00:54-04:00October 28, 2019|Medicare, Medicare reimbursement policy|

It’s Hospitals’ Turn to Sue Opioid Makers

Hospitals are now joining cities and states in suing opioid makers for the financial damages their products have caused. In Arizona, Florida, Kentucky, Mississippi, Tennessee, Texas, and West Virginia, hundreds of hospitals are now suing opioid makers in state courts to seek compensation for the unreimbursed costs they incurred caring for uninsured patients who came to them suffering from overdoses and addiction. For the most part, the most prominent hospitals and health systems in these states have not joined the suits. According to court documents, the suing hospitals estimate that it cost them an average of $107,000 to treat complicated [...]

iqtsupport2019-10-26T06:00:04-04:00October 26, 2019|hospitals|

Use of APMs, Value-Based Payments Continues to Increase

Payments based on alternative payment models and value-based measures continue to play a larger role in health care reimbursement. Almost 36 percent of health care payments involved APMs in 2018. In addition, fee for service accounted for 39 percent of payments. While these figures represent both represent increases over 2017, the rate at which they are growing has slowed. With APMs, one of the challenges is that providers have yet to come to terms with downside risk, which is required under some models. Medicare Advantage plans are especially advanced in adopting new approaches, with 53.6 percent of their payments tied [...]

iqtsupport2019-10-25T06:00:47-04:00October 25, 2019|Alternative payment models|