Archive for June, 2013


Senate Committee Gets Earful About RAC Audits

Medicare RAC audits cost hospitals a great deal of money and often are unfair, hospital executives told the Senate Finance Committee at a recent committee hearing.

Among other problems caused by audits performed under Medicare’s RAC (Recovery Audit Contractors) program, according to hospital officials, they too often deny payments for inpatient services; they leave hospitals feeling forced to hold for observation status patients they believe should be admitted as inpatients; and they cost hospitals significant amounts of staff time and money to prepare for, defend, and appeal decisions with which they disagree.

RAC audits also often leave Medicare patients with a far larger hospital bill than they expected.

Read more about RAC audits and testimony given before the Senate Finance Committee in this Kaiser Health News report.…

Meet Pennsylvania’s New Welfare Secretary

The Central Penn Business Journal has published an interview with new Department of Public Welfare Secretary Beverly Mackereth.

In this capacity, Mackereth oversees the state’s Medicaid program.

Among other issues, Secretary Mackereth addresses Pennsylvania’s high Medicaid costs, Medicaid expansion in the state, and her department’s preparations for implementation of various facets of the Affordable Care Act.

Read the complete interview here.…

Is Hospital Ownership of Physician Practices Driving Up Costs?

Hospital acquisition of physician practices may be driving up health care costs.

So warns the Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare payment issues.

Among the causes:  hospitals charge more for certain types of work performed in practices they own and also have more bargaining power when they negotiate fees with private insurers.

Learn more about this issue, and how it is playing out in one market, in this Tampa Bay Times article.…

PA Senate to Move on Medicaid Expansion

Pennsylvania state Senate leaders plan to bring a vote to expand the state’s Medicaid program to the Senate floor this week.

The bill, according to Senate leaders, will include conditions that will make it more palatable to more conservative Republicans and the governor.  Democrats are already thought to support Medicaid expansion.

While the bill is considered likely to enjoy solid support in the Senate, it is not clear whether the state House is as interested in Medicaid expansion as envisioned under the federal Affordable Care Act.

Read more about the Senate bill, who is behind it, and what the bill says in this Centre Daily Times article.…

MedPAC: Readmissions Penalties Unfairly Target Safety-Net Hospitals

Medicare penalties for hospital readmissions are inappropriately hurting hospitals that serve especially large numbers of low-income patients.

That was the message MedPAC conveyed to Congress last week.

The agency, which advises Congress on Medicare reimbursement matters, expressed concern earlier this year about the effect of Medicare’s hospital readmissions reduction program on safety-net hospitals, and it articulated that concern more formally in its June report to Congress.

As reported by Kaiser Health News,

MedPAC found that hospitals where fewer than 3 percent of Medicare patients were low income received an average penalty of 0.21 percent. Hospitals where more than 18 percent of Medicare patients were low income had an average penalty more than twice that, 0.45 percent.

As an alternative to the current approach, MedPAC has proposed setting readmission rate targets for hospitals and then exempting from penalties hospitals that meet their targets.

Read more about MedPAC’s report to Congress in this Kaiser Health News article or read the entire MedPAC report, Report to the Congress:  Medicare and the Health Care Delivery System, which can be found here, on MedPAC’s web site.…