Medicaid is Toughest Insurer for Providers

Medicaid is the hardest insurer for providers when it comes to billing.

Or so reports a new study published in the journal Health Affairs.

According to this analysis, Medicaid claims take longer to file, are more likely to be rejected, more likely to be challenged, and take longer to be paid than Medicare and private insurance claims.  While the biggest problem is Medicaid fee-for-service claims, even Medicaid managed care claims pose more problems than Medicare and private insurance claims.

Learn more about the challenges providers face when working with Medicaid in the Health Affairs report “The Complexity Of Billing And Paying For Physician Care” or see this Healthcare Dive summary of the study.…

Eat! You’ll Feel Better

And maybe need to spend less on health care.

That is the lesson learned from a program in Massachusetts that provided home delivery of food to dually eligible Medicare/Medicaid recipients who were struggling with their meals.

In a limited experiment, selected individuals received home delivery of food:  some received general meal deliveries while others received food tailored to their individual medical conditions.  The purpose:  address a major social determinant of health in this difficult-to-serve population.

The result, according to a report published in the journal Health Affairs, was that

Participants in the medically tailored meal program also had fewer inpatient admissions and lower medical spending. Participation in the nontailored food program was not associated with fewer inpatient admissions but was associated with lower medical spending. These findings suggest the potential for meal delivery programs to reduce the use of costly health care and decrease spending for vulnerable patients.

Learn more about the program and its results in the Health Affairs article “Meal Delivery Programs Reduce the Use of Costly Health Care in Dually Eligible Medicare and Medicaid Beneficiaries,” which can be found here.…

Tackling Social Determinants of Health

The growing awareness of the impact of social determinants of health comes at a time when health care providers are assuming unprecedented degrees of risk for the health of their patients, leaving many providers wondering how best to invest resources that will meet both their own needs as well as the needs of their high-cost, high-need patients.

A new document from the Commonwealth Fund, “Investing in social services as a core strategy for healthcare organizations:  Developing the business case,” seeks to serve as a manual for providers seeking to move into this relatively new territory.

The report takes providers through key steps in the process, including establishing a common definition of social service investment; identifying common barriers to social service investments; and building the business case for such investments.  It also addresses six aspects of building that business case:

  • identifying potential social investment options
  • defining success
  • measuring costs
  • determining an investment model
  • developing a return on investment approach
  • sensitivity analysis and investment launch

Finally, it identifies the major social determinants of health providers might seek to address:

  • economic stability
  • neighborhood and physical environment
  • education
  • food
  • community and social context

For a closer look at the considerations that go into the …

Senate Committee Looks at 340B Program

The Senate Health, Education, Labor, and Pensions Committee (HELP) held a hearing last week on the 340B prescription drug discount program.

The hearing was prompted by complaints from pharmaceutical companies about the discounts they are required to provide to eligible providers and by concern that hospitals are insufficiently accountable for how they use the savings they derive from those discounts to serve their low-income patients.  In addition, the Centers for Medicare & Medicaid Services recently reduced its Medicare payments to participating hospitals.

During the hearing, Senate Republicans expressed support for the program but spoke of the need for greater transparency in the use of the savings the 340B program generates for hospitals and a clearer sense of how those savings benefit low-income payments.  Committee Democrats expressed similar concern but with less urgency.

Hospital industry representatives expressed concern that any new requirements could weaken the program and rejected the idea that savings are misused.  Committee members pushed back against these contentions.

The Senate HELP Committee intends to hold additional hearings about the 340B program.

Learn more about the 340B hearing and the concerns that led to in this Healthcare Dive article.

 …

MedPAC Issues 2018 Report to Congress

The Medicare Payment Advisory Commission has issued its 2018 report and recommendations to Congress.

The report includes MedPAC’s recommendations for next year’s Medicare fee-for-service payments; a review of the Medicare Advantage and Medicare Part D programs, with recommendations; and a report telehealth required by the 21st Century Cures Act.

For Medicare fee-for-service rates, MedPAC proposes:

  • the inpatient and outpatient rate increases, physician and other health professional rate increases, and outpatient dialysis increase included under current law
  • no increase for ambulatory surgical centers, long-term-care hospitals, and hospice providers
  • no rate increase for skilled nursing facilities
  • a five percent reduction of payments for home health providers and the introduction of a two-year rebasing of home health rates beginning in 2020
  • a five percent reduction of inpatient rehabilitation facility payments

In addition, MedPAC recommends that Medicare base future payments to post-acute providers on a blend of “each sector’s setting-specific relative weights and the unified post-acute care prospective payments system’s relative weights.”

MedPAC also recommends that Medicare abandon its merit-based incentive payment system (MIPS) in favor of an alternative approach for achieving “the shared goal of high-quality clinician care for beneficiaries in traditional Medicare.”

MedPAC is a non-partisan legislative branch agency that advises …