Archive for July, 2013


Tackling Medicaid “Super-Users”

Most hospitals have them:  a relatively small number of Medicaid patients who are constantly in need of care.

Five percent of all Medicaid beneficiaries account for more than half of all Medicaid expenditures.  The challenges such patients pose are legitimate:  many have multiple chronic conditions.

How best to serve these patients?  The Center for Medicaid and CHIP Services has been looking into this problem and the Center for Medicare and Medicaid Innovation and the Robert Wood Johnson Foundation have been underwriting demonstration programs designed to find better ways to care for these patients.

Read more about the problem and these models, and find a direct link to a Center for Medicaid and CHIP Services advisory bulletin on the subject, here on the Fierce Healthcare web site.…

IOM Rejects Basing Medicare Payments on Geography

Differences in Medicare spending in different parts of the country are mostly the result of differences in the use of post-acute care services and not mere geography, the Institute of Medicine has concluded.

The findings refute the assertion by members of Congress representing rural states that the hospitals they represent are underpaid by Medicare, and the IOM study was undertaken at Congress’s direction for that reason.

In the new report Variation in Health Care Spending:  Target Decision Making, Not Geography, the IOM wrote that

the majority of health care decisions are made at the provider or health care organization level, not by geographic units.  Adjusting payments geographically based on any aggregate or composite measure of spending or quality would unfairly reward low-value providers in high-volume regions and punish high-value providers in low-value reasons.

The IOM findings contradict previous assertions that geographic is the primary factor in Medicare spending – assertions advanced over the years primarily by the Dartmouth Institute for Health Policy.

Read more about the IOM’s findings in this New York Times article or find the study itself, along with summaries, briefing slides, data sets, and other materials, on the Institute of Medicine’s web site.…

PA Lawmakers Mull Tax Exemption Issues

The Pennsylvania General Assembly is considering a constitutional amendment that would enable the state legislature, not the courts, to decide whether non-profit organizations deserve exemption from selected state taxes.

Officials also are considering whether all non-profits should be evaluated based on the same standards.  Some officials argue that large hospitals should be viewed separately from small community organizations and that large health systems might even be evaluated according to different criteria than smaller community hospitals and rural critical access hospitals.

Currently, organizations are judged according to a 1997 state charities law, but a recent court decision in a Pike County case has raised questions about that law’s validity.

In recent years a number of jurisdictions throughout the state have considered or pursued challenges to the non-profit status of large institutions in the hope of generating additional tax revenue.

The proposed amendment, which calls for the legislature to decide on tax-exempt status, has been passed by both chambers of the state legislature but must be approved by consecutive sessions of the legislature before it can be placed on an election ballot.  The next legislative session does not begin until 2015.

Read more about the non-profit controversy in Pennsylvania in this Scranton

Medicare Tackles Doc Pay

Medicare plans to introduce new standards that will reward and penalize physicians for the quality of the care they provide.

In accordance with the Affordable Care Act, this program will start in FY 2015.  At first, only physician groups with more than 100 caregivers will participate, and based on selected patient outcomes, providers could receive penalties or bonuses of up to one percent of their Medicare payments in FY 2015, with the stakes to double the following year.

The bonuses and penalties are formally known as “physician value-based modifiers.”

Under a recent Medicare proposal, physician groups with 10 to 99 caregivers will begin a similar program in FY 2016, a year earlier than original plans, with even smaller groups to begin in FY 2017.

The purpose of the program is to encourage physicians to focus more on the quality of care they provide than on the quantity of services they deliver.

Read more about Medicare’s latest attempt to raise the quality of care and reduce health care costs in this Kaiser Health News article.…

The Implications of Rejecting Medicaid Expansion

Twenty-one states have decided not to expand their Medicaid programs under the Affordable Care Act and another six states remain undecided.

How will these decisions affect these states and their residents?  How many people who might have become eligible for Medicaid will remain uninsured?  How much federal Medicaid revenue will these states forgo?  How will these decisions affect hospitals’ uncompensated care costs?  How might payments to hospitals be affected?

A new study from the Urban Institute attempts to quantify the answers to these and other questions.  Find “The Cost of Not Expanding Medicaid” here, on the web site of the Kaiser Commission on Medicaid and the Uninsured.…