The U.S. Government Accountability Office (GAO) is now reviewing audits of states’ Medicaid disproportionate share payments (Medicaid DSH) to hospitals and is raising questions about states’ compliance with federal requirements for those payments.

Based on its analysis of state Medicaid DSH audits, GAO found that states are making Medicaid DSH payments to hospitals that exceed those hospitals’ uncompensated care costs and are inaccurately calculating those hospital uncompensated care costs.  The GAO also found that states are not always targeting their Medicaid DSH payments to the hospitals that provide the most uncompensated care.

States are required to submit audits and data as a condition of receiving Medicaid DSH funds from the federal government.  Currently, the Centers for Medicare & Medicaid Services (CMS) is not acting on the information it receives but will begin doing so after a transition period that ends when 2014 audits are completed.  In anticipation of that time, GAO is reviewing the information CMS receives for state compliance with six federal standards for Medicaid DSH payments.

This data also may eventually be used to help implement the Medicaid DSH payment reduction mandated under the Affordable Care Act.

Learn more about GAO’s examination of Medicaid DSH payments – why …

Hospitals expect to spend less on capital needs in 2013 because of continuing concern over reduced reimbursement, especially from Medicare.

Hospitals have already been targeted for cuts in Medicare bad debt reimbursement and face $155 billion in additional Medicare cuts as well as a two percent reduction in payments if Congress does not address the fiscal cliff and sequestration cuts take effect on January 1.  In addition, hospitals have experienced Medicare coding adjustments and face further cuts as a result of Medicare’s value-based purchasing program.

These and other cuts, a Premier healthcare alliance survey found, will hurt growth in hospital capital spending in 2013.

Read more about the Premier survey and why hospitals are concerned about their government reimbursement in this Healthcare Finance News article.…

Slightly more than half of all U.S. hospitals will receive enhanced payments from Medicare and slightly fewer than half will see their payments reduced slightly as a result of the first reporting period for Medicare’s new value-based purchasing program.

The largest bonus will be awarded to Treasure Valley Hospital, in Utah.  Each of its Medicare payments will rise 0.83 percent.  The largest penalty will be assessed to Auburn Community Hospital, in Syracuse, which will see its Medicare payments reduced 0.9 percent.  Two-thirds of all hospitals will see their payments rise or fall less than 0.25 percent.

Medicare’s value-based purchasing program, created by the Affordable Care Act, seeks to enhance provider accountability for the care they deliver.  Seventy percent of a hospital’s score is based on its performance according to 12 basic standards of care.  The rest of the score is based on the results of patient satisfaction surveys.

The program will be expanded in the coming years to encompass more standards of care.  A companion program, based on Medicare readmissions within 30 days of patient discharge, is already under way and rewarding top performance and penalizing underperforming hospitals.

Read more about the quality program in this Kaiser Health News report…

In a foundation-funded experiment, six hospitals across the country are trying a new way to care for patients who are thought to visit their emergency rooms too often.

With financial support from the Robert Wood Johnson Foundation, the hospitals are employing a patient-centered approach that seeks to identify why certain patients visit their ERs so often and then attempt to address those causes in ways that ultimately will improve such patients’ health while reducing ER costs.

Among the reasons the hospitals have found that certain patients visit their ERs too often are language issues with their doctors; lack of money to fill prescriptions; transportation issues; fear of disappointing their doctors; and more.

MetroHealth of Cleveland has dubbed its program “Red Carpet Care” and is employing advanced practice nurses to coordinate the care of the hospital’s most frequent ER patients.  The program also is experimenting with new approaches to paying for the care of these patients.

Learn more about this new approach to serving frequent ER patients in this article from Becker’s Hospital Review.…

States are still struggling with rising Medicaid costs, and during the current fiscal year, at least ten states are already over budget.

Among the reasons for these overruns are rising enrollment and rising health care costs, according to a new report published by the National Conference of State Legislatures.

The challenges that states are facing with their Medicaid budgets come at a time when many states still have not decided whether to expand their Medicaid programs as provided for in the Affordable Care Act.  A  Supreme Court decision earlier this year left that decision to the states; the law originally mandated the expansion.

Learn more about the states that are having an especially hard time and the challenges all states face moving forward in this Reuters article.  Find a condensed version of the report here, on the web site of the National Conference of State Legislatures.…