Archive for November, 2014


MedPAC Meets, Addresses Hospital Issues

The independent federal agency that advises Congress on Medicare payment issues met last week in Washington and addressed a number of issues of importance to hospitals.

Among the issues discussed by the Medicare Payment Advisory Commission (MedPAC) were:

  • beneficiary access to hospital care and how service volume affects hospital costs
  • hospital short stay policy issues
  • per beneficiary payment for primary care
  • the 340B drug pricing program
  • site-neutral payments for selected conditions treated in inpatient rehabilitation facilities and skilled nursing homes
  • payment policies to promote the use of services based on clinical evidence

Find links to the presentations offered by MedPAC staff on these issues here, on MedPAC’s web site.…

Medicaid Expansion in PA: What Happens Now?

Pennsylvania Governor Tom Corbett’s “Healthy Pennsylvania” health care reform program calls for his state to expand its Medicaid program on January 1 through a private insurance market option in which people choose private insurance plans through which to receive the Medicaid benefits for which they are newly eligible.

But Pennsylvania Governor-elect Tom Wolf wants to expand the state’s traditional Medicaid program and not employ the private insurance market coverage.

Governor Corbett will still be in office when his program is set to take effect on January 1, 2015.  Mr. Wolf will not take the oath of office until January 20.

The Philadelphia Inquirer takes a look at how Pennsylvania’s private insurance market option came about and what may happen next.  See its story here.…

Does ACA Get Credit for Decline of Premature Birth Rates?

Some advocates believe the Affordable Care Act is responsible for the premature birth rate falling in 2013 to its lowest level in 17 years.

According to the March of Dimes, the premature birth rate fell to 11.4 percent last year, and some people in the field believe the expansion of Medicaid eligibility in many states, which enabled people with incomes of up to 138 percent of the federal poverty level to obtain health insurance and better access to care, most likely played a major role in this positive development.

The key, advocates believe, is that access to care results in women being in better health before they become pregnant and then receiving prenatal care early in their pregnancies.

For more information about the decline in the premature birth rate and other health care reform provisions that may contribute to further decline in the coming years, see this Kaiser Health News report.  Find the March of Dimes annual report on premature births here.…

Study Suggests Key to Avoiding Medicare Readmissions

Researchers from the Columbia Business School believe they have identified the key to reducing Medicare readmissions.

Keep patients in the hospital for one more day.

The Columbia study “Should Hospitals Keep Their Patients Longer?  The Role of Inpatient and Outpatient Care in Reducing Readmissions” was based on an analysis of hospital records for 6.6 million patients between 2008 and 2011.

The study compared the value of one additional day of hospitalization to that of better post-discharge management of patient care.  It found virtually no difference between the two types of additional interventions for heart failure patients but a significant difference when it came to pneumonia and heart attack patients, suggesting that the extra day in the hospital reduced readmissions within 30 days and saved the lives five to six times as many heart attack and pneumonia patients.

The findings could be useful for hospitals attempting to avoid penalties assessed by the federal government under Medicare’s hospital readmissions reduction program, which was mandated by the Affordable Care Act.

Find a summary of the study in this Fierce Healthcare report and see the study itself here.…

No-Hospitalization Group Plans To Be Banned

Companies will no longer be able to provide their employees with group health insurance plans that do not cover inpatient hospitalization.

This news came in a recent notice published by the Internal Revenue Service.

Recently, many large employers with lower-wage workers were purchasing low-cost health insurance that does not cover hospitalization.  The IRS, however, has ruled that such plans do not meet the Affordable Care Act’s minimum value threshold.  Companies were only able to purchase such plans because they are not required meet the reform law’s essential health benefits package requirement, which applies only to plans offered to individuals on health insurance exchanges.

The no-hospitalization policies were likely to leave many lower-income workers without the coverage they needed – and with large medical bills.  They also were likely to leave hospitals with unexpected uncompensated care.

The administration is permitting employers that committed to such plans by November 4 to use them for one year and is offering affected workers access to premium subsidies that some of those workers did not otherwise have if they choose to purchase insurance on an exchange instead.

The IRS will issue regulations formalizing this policy next year.

To learn more about this issue and its …