Archive for July, 2014


GAO Questions State Medicaid Financing

States are now financing more than a quarter of their share of Medicaid expenditures with money from sources other than state general funds, according to a new study by the Government Accountability Office (GAO).

According to the GAO, 26 percent of state share of Medicaid funding comes from taxes on health care providers, transfers from local governments and local government providers, and other sources.  Such funding, the GAO noted, shifts additional Medicaid costs to the federal government.

Exacerbating this problem, the GAO reports, is that the Centers for Medicare & Medicaid Services (CMS), which oversees Medicaid, does not assure that it receives complete and accurate data on funding sources from the states, leaving CMS without a complete understanding of how states are financing their Medicaid expenditures.  In the report, the GAO recommends a stronger CMS effort to gather such data – a recommendation that CMS did not accept.

Learn more about the GAO study “States Increased Reliance on Funds From Health Care Providers and Local Governments Warrants Improved CMS Data Collection” by finding the complete report and a summary here, on the GAO web site.…

IOM Releases Graduate Medical Education Report

‘’…there is an unquestionable imperative to assess and optimize the effectiveness of the public’s investment in GME (graduate medical education).”

So says the Institute of Medicine (IOM) in its new report Graduate Medical Education That Meets the Nation’s Health Needs.

The IOM also calls for “significant changes to GME financing and governance to address current deficiencies and better shape the physician workforce for the future.”

The report notes that government today, mostly through Medicare, plays the primary role in financing graduate medical education.  It observes that while there is a common perception that the nation faces a shortage of physicians, simply increasing the number of residency slots that Medicare supports – a limit set in 1997 – without addressing geographic and specialty distribution issues will not solve the problem.

In the report, the IOM proposes six goals for improving GME financing.

  1. Encourage production of a physician workforce better prepared to work in, help lead, and continually improve an evolving health care delivery system that can provide better individual care, better population health, and lower cost.
  2. Encourage innovation in the structures, locations, and designs of GME programs to better achieve Goal 1.
  3. Provide transparency and accountability of GME programs, with

Group to Assess Impact of Socioeconomic Factors on Care

The National Quality Forum (NQF) will perform a “robust trial” to assess the role and impact of sociodemographic factors on health care outcomes.

In a news release, the NQF announced that

Sociodemographic factors can be socioeconomic, e.g., income, education, and occupation, and demographic, e.g., race, ethnicity, and primary language. Growing evidence shows that sociodemographic factors may influence patient outcomes, which has implications for comparative performance measurement used in pay-for-performance programs.

Among the socioeconomic and sociodemographic factors the NQF will consider are income, education, and occupation, and demographic considerations such as race, ethnicity, and primary language.

With the Affordable Care Act requiring Medicare to adjust payments based on outcomes such as hospital readmissions, value-based purchasing requirements, hospital-acquired conditions, and more, reviews of the preliminary results of such programs have led some to question whether hospitals that serve especially large numbers of low-income patients may be especially and unfairly harmed by such programs.

Learn more about the NQF plan for a new study from this news release and find a link to further information about the planned study as well.…

GAO Compares Medicaid, Private Insurance Rates

The U.S. Government Accountability Office (GAO) has completed a new study that compares how physicians are paid by Medicaid (both fee-for-service (FFS) and managed care plans) and private insurers.

Looking at payments for 26 different physician evaluation and management (E&M), the agency also compared payments both before and after passage of the temporary increases mandated by the Health Care and Education Reconciliation Act of 2010 (HCERA).

Among the GAO’s findings:

Among the three types of E/M services analyzed (office visits, hospital care, and emergency care), Medicaid payments generally were lower than private insurance for all three types, but the magnitude of the difference was often largest for emergency care and smallest for office visits.


Within the Medicaid program, managed care payments for E/M services were generally equal to or higher than FFS prior to the HCERA-mandated increases. Specifically, in the 20 states where GAO compared managed care payments to FFS, managed care payments were 0 to 12 percent higher than FFS in 15 states. Managed care payments for emergency care and hospital care were approximately equal to FFS payments in most states, while office visits showed more variation.

The new study is titled Comparisons of Selected Services under Fee-for-Service,

CMS Seeks to Jump-Start Medicaid Innovation

A new federal program seeks to encourage states to work faster to find ways to improve care and improve the health of their Medicaid patients and to reduce health care costs through payment and service delivery reforms.

The Center for Medicare & Medicaid Services’ (CMS) new Medicaid Innovation Accelerator Program is a collaboration between the Center for Medicaid and CHIP Services, the Center for Medicare and Medicaid Innovation, the Medicare-Medicaid Coordination Office, and other federal agencies and centers.  According to a CMS fact sheet, the program

…aims to jumpstart innovation in key areas while supporting states in their efforts to improve health, improve health care, and lower costs. In consultation with states and stakeholders, the IAP will develop strategically targeted functions aimed at advancing delivery system and associated payment reforms, aligned with transformation efforts underway in Medicare and the commercial market.

The program will develop resources to support innovation through four key functions:  identifying and advancing new models of care delivery and payment; data analytics; improving quality measurement; and state-to-state learning, rapid-cycle improvement, and federal evaluation.

Learn more about the launch of the Medicaid Innovation Accelerator Program from this CMS fact sheet and go here for a more detailed description …