Archive for August, 2011


Proposal Calls for Major Medicaid Overhaul

Adequate funding for Medicaid and hospitals that serve many Medicaid patients could be jeopardized under proposals released by the Republican Governors Public Policy Committee’s Health Care Task Force.

In a 16-page report that calls for the repeal of the Affordable Care Act, the task force presents seven principles and 31 solutions for reforming Medicaid in a manner that give states greater flexibility to decide how to structure and finance their Medicaid programs, whom to serve through those programs, what services to offer, and how to compensate those who care for Medicaid patients.

The report is a precursor to a health care summit to be held by the Republican governors group in October in Washington, D.C.  It includes among its solutions the transformation of Medicaid into a block grant program; the repeal of current “maintenance of effort” requirements; giving states greater freedom to determine eligibility standards; enabling states to reduce benefits and payments; and empowering states to impose greater cost-sharing requirements on recipients.

Read the Republican Governors Policy Committee’s report and recommendations here.…

Possible Medicare, Medicaid Changes Could Hurt Pennsylvania Hospitals

Medicare and Medicaid cuts currently under consideration in Washington, D.C. could hurt Pennsylvania hospitals.

According to an August 28, 2011 article in the Scranton Times-Tribune, Pennsylvania faces a number of challenges on the federal legislative front, including a possible 30 percent cut in Medicare payments to doctors; proposed conversion of Medicaid to a block grant program; and a two percent cut in Medicare payments to hospitals if Congress cannot agree by the end of the year on $1.2 trillion in future federal spending cuts.  Read here about these and other such possibilities and how they might affect Pennsylvania hospitals.…

Growth of Medicaid Managed Care Seems Likely

States are likely to make greater use of managed care in their Medicaid programs as implementation of the Affordable Care Act continues.

Health care reform will add approximately 16 million people to the Medicaid rolls in 2014, and states will be eager to do everything they can to keep their Medicaid costs as low as possible.  One tool they are likely to turn to is managed care, which enables them to pass along some of the financial risk to the private sector.  In the article “Medicaid managed care is a growing but risky business,” the Washington Post describes the expansion of Medicaid managed care in Texas and looks at the prospect for further use of Medicaid managed care in other states both now and in the future.…

Hospitals and Accountable Care Organizations

How hard will it be for hospitals to launch effective accountable care organizations (ACOs)?

ACOs are a major component of health care reform and the Affordable Care Act but represent new territory for hospitals.  Health care reformers envision ACOs as a means of achieving three goals in serving the Medicare population (and eventually, other types of patients as well):  improving the quality of care, improving the health of communities, and reducing health care costs.  Achieving these goals, however, will require an unprecedented level of cooperation and coordination among hospitals, physicians, and other providers.

Some of the obstacles hospitals will face are outlined in a new article in the Journal of the American Medical Association entitled “Implementing Accountable Care Organizations:  Ten Potential Mistakes and How to Learn From Them.”…

Deficit Reduction and Medicaid in Pennsylvania

Will future federal deficit reduction efforts hurt Pennsylvania’s Medicaid program?  State officials are already speculating – and worried, according to a recent report in the Pittsburgh Tribune-Review.…