Policy Updates

Medicaid Expansion: A Good Financial Decision for States?

Medicaid expansion is a good financial deal for states, according to a new analysis by The Commonwealth Fund. At the heart of this conclusion are three primary considerations: The federal government pays 90 percent of the total cost of Medicaid expansion. States save money by expanding their Medicaid programs – even after paying their 10 percent share, because they shift the cost of care for some of their residents, currently paid entirely by the state, to Medicaid, for which the federal government pays 90 percent of the cost. Any remaining additional state costs represent only a very small portion of [...]

iqtsupport2019-02-20T06:00:57-05:00February 20, 2019|Affordable Care Act, Medicaid|

Protections Overlooked as Medicaid Reforms are Implemented

In its eagerness to help states introduce changes in their Medicaid programs and reduce administrative burdens, the Centers for Medicare & Medicaid Services is ignoring regulatory requirements designed to understand and measure the impact of those changes on beneficiaries. According to an analysis by the Los Angeles Times, many states seeking to implement Medicaid work requirements have not projected how many of their beneficiaries would be affected by those requirements nor have they projected how many beneficiaries who are removed from the Medicaid rolls will gain employment after losing their Medicaid benefits. Both projections are required under Medicaid regulations adopted [...]

iqtsupport2019-02-15T06:00:51-05:00February 15, 2019|Centers for Medicare & Medicaid Services, MACPAC, Medicaid, Medicaid regulations|

Hospital Prices Lead Rise in Health Care Costs, Study Finds

A new study has concluded that rising hospital prices, not increased utilization, is primarily responsible for rising health care costs. Overall, according to a new analysis by the Health Care Cost Institute, health care costs continue to rise despite declining health care utilization. Among the report’s findings: Hospital prices are rising faster than physician prices. ER prices rose more than twice as much as ER utilization in 2017. Increases in spending for psychiatric services outpaced increases in utilization of those services. Inpatient spending rose 10 percent between 2013 and 2017 even though inpatient utilization fell five percent during that period. [...]

iqtsupport2019-02-14T06:00:19-05:00February 14, 2019|hospitals|

Government More Effective Than Private Sector at Controlling Health Care Costs

For the past dozen years, Medicare and Medicaid have done a better job of controlling rising health care costs than private insurers. Since 2016, according to a new report from the Urban Institute, private insurers’ costs per enrolled member have risen an average of 4.4 percent a year. By contrast, Medicare costs have risen an average of 2.4 percent per enrollee and Medicaid costs have risen just 1.6 percent per enrollee. The primary driver of Medicare cost increases has been prescription drug spending. For Medicaid the primary driver has been physician services and administrative costs. For private insurers, the main [...]

iqtsupport2019-02-13T06:00:47-05:00February 13, 2019|Medicaid, Medicare|

New Study Zeroes in on ER Use

A new study has concluded that more than four million emergency room visits a year are for chronic medical problems that, if treated more effectively at the primary care level, could have been avoided. And that those more than four million visits cost $8.3 billion a year. According to a new analysis performed by Premier, Inc., more than 24 million ER visits a year are by patients with six chronic medical conditions: asthma, chronic obstructive pulmonary disease, diabetes, heart failure, hypertension, and behavioral health problems. Thirty percent of those visits, the study concluded, could have been prevented with better care [...]

iqtsupport2019-02-11T06:00:17-05:00February 11, 2019|hospitals|

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C. The following is MACPAC’s own summary of the sessions. Hospital payment was a key focus of MACPAC’s January meeting with the Commission voting on Thursday to approve two sets of recommendations, the first addressing the structure of disproportionate share hospital (DSH) allotment reductions and the second directed to improving compliance with upper payment limit requirements. Both sets of recommendations are slated for inclusion in MACPAC’s March 2019 Report to Congress on Medicaid and CHIP. Later that morning, the Commission discussed a study on [...]

iqtsupport2019-01-31T06:00:32-05:00January 31, 2019|MACPAC, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid regulations|

Hospitals Sue Over Site-Neutral Outpatient Payment Policy

Nearly 40 hospitals have filed a joint lawsuit in opposition to the Centers for Medicare & Medicaid Services’ site-neutral payment policy for Medicare-covered outpatient services. In the suit, the hospitals charge the federal government with overstepping its authority in implementing such a change through regulation in the face of past congressional action to limit the use of site-neutral payments. Under its site-neutral payment policy, Medicare pays the same for some outpatient services regardless of where those services are provided. Under Medicare’s previous policy, Medicare paid more for services provided in hospital-run outpatient facilities. Hospitals argue that their outpatient facilities are [...]

iqtsupport2019-01-30T06:00:38-05:00January 30, 2019|Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare regulations, Medicare reimbursement policy|

Docs Still Less Likely to Treat Medicaid Patients

Medicaid patients continue to be last in line when it comes to finding doctors willing to serve them. At least that’s the conclusion drawn in a new analysis prepared by the Medicaid and CHIP Payment and Access Commission. According to a presentation delivered at a MACPAC meeting last week: Doctors are less likely to accept new Medicaid patients (70.8 percent) than they are patients insured by Medicare (85.3 percent) or private insurers (90 percent), with a much greater differential in acceptance rates among specialists and psychiatrists. Pediatricians, general surgeons, and ob/gyns have a higher acceptance rate of Medicaid patients than [...]

iqtsupport2019-01-29T13:00:57-05:00January 29, 2019|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission|

Hospitals Flee Downside Risk in Medicare Bundled Programs

More than half of the hospitals that voluntary participate in Medicare bundled payment model programs leave those programs when faced with the possibility of financial penalties based on their performance. So concludes a new report by the U.S. Government Accountability Office. Some of these models feature both “upside” and “downside” risk. Upside risk offers financial incentives to participants that keep their costs below targeted amounts; they share those savings with Medicare. Downside risk occurs when hospitals are penalized when their costs exceed agreed-upon targets. Some of the model programs begin with only upside risk and later move into both upside [...]

iqtsupport2019-01-29T06:00:06-05:00January 29, 2019|Alternative payment models, hospitals, Medicare|

No Medicaid Expansion=Greater Peril for Rural Hospitals

Rural hospitals located in states that did not expand their Medicaid programs, as authorized by the Affordable Care Act, are at much greater risk of closing than hospitals in states that did expand their Medicaid programs. According to a Stateline report, most of the 100 rural hospitals that have closed since 2010 and most of the more than 600 rural hospitals that are considered to be in danger of closing now are located in states like Texas, Mississippi, and 12 others that have not expanded their Medicaid programs. Small rural hospitals that have not closed serve large proportions of uninsured [...]

iqtsupport2019-01-28T06:00:27-05:00January 28, 2019|Affordable Care Act, hospitals, Medicaid|