Archive for January, 2013


Medicaid Primary Care Fee Increases: How Much?

The Affordable Care Act requires state Medicaid programs to raise primary care provider fees to Medicare levels in calendar years 2013 and 2014.  The purpose of the rate increase is to improve access to Medicaid services at a time when the program will be adding millions to its rolls across the country.

But how much will those primary care fees actually rise?

According to a survey conducted by the Urban Institute for the Kaiser Commission on Medicaid and the Uninsured, Medicaid primary care fees currently average 66 percent of Medicare fees and currently range from  58 percent of the national Medicaid average in Rhode Island to 242 percent of the national average in Alaska.  The gap between Medicare and Medicaid primary care fees has been growing in recent years, so the two-year policy change will raise the average Medicaid primary care fee 73 percent in 2013.

The Urban Institute survey includes a 50-state survey that also examines current fees for a wide variety of services and shows how they vary from state to state.  Find a report on the survey’s findings here, on the web site of the Kaiser Commission on Medicaid and the Uninsured.…

Many States Still Straddling Affordable Care Act Fence

With implementation of key aspects of the Affordable Care Act months and in some cases just weeks away, some states still have not declared what aspects of the health reform law they will embrace and what parts they will reject.

Some states, for example, have already received federal approval for their own health insurance exchanges; others have delegated responsibility for creating their exchange to the federal government; and some still have not announced their decision, the deadline for which now just two weeks away.

Similarly, some states have already committed to expanding their Medicaid programs while others have rejected that expansion and still others still have not publicly articulated their intentions.

Read an update on the status of states’ decisions, and the factors that go into making those decisions, in this Stateline report.…

Key Reform Panel in Jeopardy?

Members of Congress are targeting the Affordable Care Act-created Independent Payment Advisory Board (IPAB) for elimination before the board even begins its work.

The board, envisioned in the 2010 reform law as a tool for helping to control rising Medicare costs in the absence of administration or congressional action, has been accused of lacking accountability by critics even though the President appoints its members, subject to Senate confirmation, and Congress would have the authority to overturn any of its recommendations.

Now, a bipartisan group of House members, including two sponsors and 83 co-sponsors, has proposed a bill to abolish the IPAB.

Read more about the IPAB, what role it is supposed to play in health care reform, and why some people object to it in this Fierce Healthcare article.…

States Finding it Hard to Say No to Federal Medicaid Money

While many of the nation’s governors have ideological problems with many aspects of the Affordable Care Act, it appears that more of them are preparing to accept one major facet of the bill with which they particularly disagree:  Medicaid expansion.

When the law passed, the mandatory expansion of Medicaid eligibility was one of its most controversial aspects and encountered a great deal of resistance from many governors.  When the Supreme Court ruled last year that the mandate was unconstitutional, many governors indicated that they would decline the now-optional Medicaid expansion.

But as the time for implementing the Medicaid expansion draws closer, more governors are concluding that the lure of millions, and even billions, of “free” federal Medicaid matching dollars is too hard to resist.

In addition, some governors are concerned about appearances if they turn down the federal Medicaid money while a clause in the reform act would enable legal immigrants in their state to receive health insurance premium subsidies while other low-income residents remain ineligible for those subsidies and uninsured.

Read about the challenges governors face in refusing the federal Medicaid money in this RealClearPolitics article and about the immigration twist on the issue in this Washington Post report

Readmissions Unrelated to Original Problem?

A new study has found that most hospital readmissions among Medicare patients are unrelated to the medical problem that necessitated their original admission.

In an article published in the Journal of the American Medical Association, researchers analyzed more than 650,000 readmissions of Medicare fee-for-service patients originally admitted to the hospital for heart failure, acute myocardial infarction, and pneumonia from 2007 to 2009 and found that in the vast majority of cases, the readmissions were necessary for reasons other than the cause of the original admission.

The study controlled for patients’ age, gender, and race and found no meaningful variations based on those factors.

The findings may be important in light of the recent implementation of Medicare’s hospital readmissions reduction program, which imposes financial penalties on hospitals found to have too many Medicare readmissions.

Read the report “Diagnoses and Timing of 30-Day Readmissions After Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia” here, in the Journal of the American Medical Association.…