Archive for November, 2013


Moody’s Cites DSH Loss, Other Causes for Dim 2014 Outlook for Non-Profit Hospitals

Non-profit hospitals will struggle in 2014 in the face of shrinking patient volume and slumping revenue growth according to Moody’s, the bond-rating agency.

Moody’s expects non-profit hospital margins to shrink, and one of the causes of that shrinking for some hospitals will be the loss of Medicare disproportionate share hospital payments (Medicare DSH), as mandated by the Affordable Care Act.   The shifting of care from inpatient to outpatient settings also will contribute to shrinking margins for non-profit hospitals.

For more on the projected financial outlook for non-profit hospitals in 2014, see this Moody’s news release.…

A Closer Look at Medicare’s Hospital Readmissions Reduction Program

The Medicare hospital readmissions reduction program is one of the more prominent components of the Affordable Care Act.

Too many Medicare patients require readmission to the hospital too quickly after their discharge, critics maintain, and reducing those admissions would both improve the health of those patients and reduce Medicare’s costs.  Hospitals are employing a number of approaches to reducing Medicare readmissions and early evidence has produced cause for optimism.

In a new health policy brief, the Robert Wood Johnson Foundation and the journal Health Affairs describe the readmissions reduction program, present a number of the strategies hospitals are employing to reduce their Medicare readmissions, and outline some of the challenges the program has encountered during its first two years.  Read that issue brief here.…

Safety-Net Hospitals Bear Brunt of Medicare Penalties

Hospitals that serve the largest proportion of low-income patients are suffering the greatest financial penalties under Medicare’s value-based purchasing program.

Collectively, hospitals that serve the most low-income patients are seeing their Medicare payments reduced 0.09 percent during year two of the Medicare program while hospitals that serve the fewest low-income patients have seen their Medicare payments rise 0.06 percent, according to a new study by a Harvard School of Public Health professor.

Medicare’s value-based purchasing program, mandated by the Affordable Care Act, bases penalties and bonuses on 24 quality measures.

The author of the study suspects that the performance of safety-net hospitals may be suffering from the manner in which their patients are responding to the patient satisfaction survey that is one of the determining factors in evaluating hospital performance.

For a closer look at the study and its findings, see this Kaiser Health News report.…

400,000 Fall Into PA Insurance Gap

400,000 Pennsylvanians currently fall into a gap between eligibility for the state’s Medicaid program and qualifying for health insurance subsidies through the state’s health insurance marketplace.

Under the Affordable Care Act, states were to expand eligibility for their Medicaid programs while the federal government would provide partial subsidies for low-income people who remained ineligible for Medicaid but were unlikely to be able to afford health insurance without such assistance.

But when the Supreme Court made Medicaid expansion optional for states, many people fell into a new insurance gap that was not anticipated when the 2010 reform law was written.  Approximately half of the 50 states have expanded their Medicaid programs as the law expected, but in the half that did not, millions remain in this gap, earning too much money to qualify for Medicaid but not enough to be able to afford health insurance.

Among those millions are 400,000 Pennsylvanians because the commonwealth has not decided to move forward and expand its Medicaid program.  Currently, state officials are exploring such expansion through a new “Healthy Pennsylvania” initiative and are negotiating possible terms for expansion with the federal government.

Learn more about Pennsylvania’s insurance gap, who is in it, why it …

How Does Medicare’s Value-Based Purchasing Program Work?

Every year, Medicare grades hospitals on the “value” of the services they are providing to their elderly patients.  “Winners” receive bonuses, “losers” are penalized.

But how does Medicare grade hospitals?  What factors does it consider and how does it weigh those factors relative to one another?

The Kaiser Family Foundation has published a detailed description of the methodology Medicare employs.  “Methodology:  How Value Based Purchasing Payments Are Calculated” lists the specific factors Medicare evaluates and how it weighs these factors in comparison to surveys it administers that attempt to ascertain patient satisfaction with the care they received.  It then describes how these factors are translated into a score and how that score affects the payments hospitals receive for the Medicare inpatient services they deliver.

Find this description and links to various tables and other resources here, on the Kaiser Health News web site.…