Archive for August, 2012


Hospitals Becoming Insurers

In a growing trend, more and more hospitals are responding to cost pressures from insurers by becoming health insurers themselves.

According to a Washington Post report, 20 percent of all hospital systems now have insurance products and another 20 percent are exploring going into the insurance business.

Under this new model, the hospital/insurer makes or saves money by keeping patients out of their hospital – a drastically different approach from the traditional hospital model.

Read more about hospitals moving into the health insurance business, the obstacles they face, and the implications for patients and the health care system in general in this Washington Post story.…

Can Counties Skirt States’ Rejection of Medicaid Expansion?

While some governors have already indicated that they will take advantage of the recent Supreme Court decision in the Affordable Care Act case to reject the reform law’s call for expanding Medicaid eligibility, several counties in Texas are considering going around their governor’s decision and seeking to expand Medicaid eligibility on their own.

According to the Washington Post, several of Texas’s major urban counties have already been providing care to very low-income residents who do not meet the state’s especially stringent threshold for Medicaid eligibility and believe they should pursue the generous federal matching funds associated with Medicaid expansion to expand eligibility within their borders and capture the federal matching funds for that expansion.

Doing so, they note, would ease some of the financial burden they currently shoulder – Medicaid would essentially assume much of the costs the counties currently bear – while serving more people, expanding benefits, and making care more accessible.

Among the counties considering such an effort are those that encompass Dallas, Fort Worth, Houston, and San Antonio.  Should they move forward, their plan would require the approval of the Texas state legislature and the federal Centers for Medicare & Medicaid Services (CMS).

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“Medicaid Works,” Foundation Declares

Medicaid improves access to care and saves lives and deserves to be expanded in the manner envisioned in the Affordable Care Act, according to a new blog entry on the web site of the health care-focused Commonwealth Fund.

According to the blog commentary, Medicaid “fulfills the two main purposes of health insurance – ensuring access to needed care and providing adequate financial protection from burdensome medical expenses.”  It also cites research that “confirms that expanding Medicaid not only improves access to care and financial protection of vulnerable individuals and families, but actually saves lives.”

In addition, the blog suggests that Medicaid recipients have only slightly greater cost-related access-to-care problems than individuals with private insurance.

The title of this commentary is “Medicaid Works:  Public Program Continues to Provide Access to Care and Financial Protection for Society’s Most Vulnerable,” and it can be found here, on the Commonwealth Fund’s web site.…

Analysts Look at GME

Medicare graduate medical education payments – GME – help pay for the training of future physicians and also underwrite an important source of labor in many hospitals.  They are an important funding source for teaching hospitals.

Between the current interest in reducing federal spending, the perceived need for more physicians to care for people when more Americans are insured as a result of the Affordable Care Act, and the perception that the country’s medical schools may not be producing enough primary care physicians, policy-makers, analysts, and others are taking a hard look at GME – what is, what it is supposed to accomplish, and whether it is achieving its goals.

The publication Health Affairs has published a policy brief that looks at these and other aspects of Medicare GME.  Read that brief here.…

New Medicare Readmissions Policy to Hit Safety-Net Hospitals Hardest

A new Medicare reimbursement policy that will penalize hospitals financially for readmitting patients within 30 days of discharge will have a disproportionate impact on hospitals that care for large numbers of low-income patients.

According to an analysis by Kaiser Health News, hospitals that treat significant numbers of low-income patients – those eligible for Medicare disproportionate share (DSH) payments – are more likely to be penalized by Medicare than other hospitals.  Those that serve the most poor patients are twice as likely to suffer the maximum Medicare penalty as those that care for the fewest low-income patients.

The penalties apply to patients readmitted after suffering pneumonia, heart attacks, and heart failure.

Read more about the new Medicare reimbursement program and the Kaiser analysis in this Kaiser Health News report.…