Archive for October, 2012


Programs for Dual Eligibles May Produce Only Modest Savings

The federal government’s planned demonstration projects seeking to find better, more economical ways to serve the dual eligible (Medicare and Medicaid) population may not be as productive as enthusiasts for such programs hope.

This is the conclusion reached in the new study “Best Bets for Reducing Medicare Costs for Dual Eligible Beneficiaries:  Assessing the Evidence,” just published by the Kaiser Family Foundation.

The study examines past efforts to provide better coordination of care for the dual eligible population, and while it found examples of programs that reduced hospitalizations, the overall cost savings to Medicare generally were modest.  While not evaluating current and planned Medicare demonstration programs, the study’s authors suggest that significant savings from new approaches funded under the Affordable Care Act may be difficult to achieve.

Learn more about this new study and download a copy here on the web site of the Kaiser Family Foundation.…

Implementation of Reform Act’s Medicaid Doc Pay Raise Uncertain

With the Affordable Care Act-mandated increase in Medicaid payments to primary care physicians now just a little more than two months away from taking effect, much remains unknown about how the increase will be implemented.

Under the 2010 reform law, payments to Medicaid primary care physicians will be increased to the same level as comparable Medicare payments, with the federal government picking up the entire $11 billion tab.

At this point, however, there are no regulations delineating how the increase will be achieved, leaving unanswered a number of questions, including what the new rates will be; how and when they will be paid; which physicians will receive them; and how physicians caring for Medicaid patients through managed care plans will receive their enhanced payments.

The purpose of the temporary, two-year increase is to attract more physicians to the care of Medicaid patients in time for the increased Medicaid eligibility that begins under the reform law in 2014.

Learn more about the challenges of implementing this primary care physician Medicaid pay raise in this Kaiser Health News article.…

Dual Demos Rolling Out Slower Than Expected

A new federal program that will enable states to shift as many as two million low-income, chronically ill, dually eligible (Medicare and Medicaid) seniors into managed care plans is taking longer to launch than federal officials anticipated.

Twenty-five states have applied to participate in the program, and while 14 requested permission to launch their demonstrations in 2013, only one state – Massachusetts – has received federal approval for its plans so far.  The other 11 states anticipate launching their programs in 2014.

While the program has many supporters in the health care community, it also has its share of critics.  The Medicare patients who would participate in the program are among the most challenging and costly for providers to serve.

Learn more about this new program for dual eligibles, its potential, and its possible shortcomings in this CQ HealthBeat article presented by the Commonwealth Fund.…

High ER Use May Not Mean Abuse

Some frequent visitors to hospital emergency rooms are not necessarily abusing access to emergency care.

Instead, they often are people with emotional problems and chronic medical conditions who lack access to alternative sources of care.  They often live near the hospital, and while they are low-income individuals, they frequently are not uninsured.

This information comes from a new study abstracted in the October issue of the Annals and Emergency Medicine and reported on the web site of American Medical News.

According to the study, the emergencies such patients bring to hospital ERs are in fact often legitimate emergencies and not trivial problems, as commonly thought.

Read more about people who make frequent visits to hospital ERs and why they do so in this American Medical News report.…

Feds Seek to Spark State-Level Innovation

The federal Center for Medicare and Medicaid Innovation (CMMI) is seeking to use a $275 million competitive grant program to inspire health system delivery innovation and reform at the state level.

Under the program, states may receive grants to plan collaboration between health care purchasers.  The five best proposals will share $225 million in federal grant money.

The program’s objective is to foster improvements in the delivery of care – improvements like better preventive care, a more team-based approach to care delivery, new means of gaining access to health services, and more.

Read more about CMMI and examples of the approaches it is cultivating in this CQ report presented by the Commonwealth Fund.…