Archive for December, 2014


Access to Medicaid Services

A commentary in the New England Journal of Medicine by noted Medicaid expert and advocate Sara Rosenbaum examines the issues of access to Medicaid services, the effect of adequate (or inadequate) Medicaid reimbursement on that access, and the role the federal government and public policy can play in enhancing access to care for low-income Medicaid recipients.

Find that commentary here.…

PA Wins Innovation Planning Grant

Pennsylvania is among 21 states that will receive State Innovation Models Initiative Model Design Awards from the federal Center for Medicare and Medicaid Innovation.

The award of $3 million will be used to

…engage a diverse group of stakeholders, including public and commercial payers, providers and consumers, to develop a State Health Care Innovation Plan.

The purpose of the state innovation models program is to support

…states that are prepared for or committed to planning, designing, testing, and supporting evaluation of new payment and service delivery models in the context of larger health system transformation. The Innovation Center is interested in testing innovative payment and service delivery models that have the potential to lower costs for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), while maintaining or improving quality of care for program beneficiaries.

The grant funds were awarded on a competitive basis, with funding decisions based on an initial round of state innovation model planning.  Michael Chirieleison, managing partner of DeBrunner & Associates’ Pennsylvania health care consulting practice, served on the committee that developed the commonwealth’s state innovation model proposal.

Learn more about the federal State Innovation Models Initiative here.…

MedPAC Moves Toward Recommending Site-Neutral Payments for Rehab Services

The independent agency that advises Congress on Medicare payment issues is likely to recommend that Congress require Medicare to implement site-neutral payments for some rehabilitation services.

During last week’s meeting of the Medicare Payment Advisory Commission (MedPAC), members received a briefing from their staff that compared the costs and efficacy of treatment for conditions currently treated at both inpatient rehabilitation hospitals and skilled nursing facilities.  Based on this presentation, MedPAC is leaning toward recommending to Congress that research be undertaken to identify specific medical conditions that can be treated effectively at either type facility and then make Medicare payments for those services site-neutral – that is, the same payment regardless of which facility is providing the care (which generally means the lower, skilled nursing facility rate).

MedPAC members are expected to vote on this recommendation at their January 2015 meeting.

See the presentation on site-neutral payments for selected Medicare rehabilitation services here, on MedPAC’s web site.…

MedPAC Considers FY 2016 Pay Boost for Inpatient, Outpatient Payments

Medicare payments to hospitals for inpatient and outpatient care could rise 3.25 percent in the coming fiscal year.

At least that is what members of the Medicare Payment Advisory Commission (MedPAC) discussed recommending to Congress when they met last week in Washington.

During MedPAC’s two-day public meeting, members discussed recommending to Congress a 3.25 percent increase in Medicare inpatient and outpatient payments in FY 2016.   They will vote on their recommendation at their next meeting.

A presentation to MedPAC members by their staff also offered a number of observations about Medicare services:

  • Demand for hospital services is stable.
  • With hospital occupancy down to 60 percent, it appears hospitals have excess capacity.
  • The quality of care hospitals provide is improving according to several metrics.
  • Hospital cost growth is down.
  • Hospitals’ Medicare margins are steady, although they remain negative, especially for outpatient services, with non-profit hospitals averaging Medicare margins of -6.9 percent and for-profit hospitals averaging Medicare margins of +1.2 percent.
  • MedPAC should consider recommending policies to reduce or eliminate differences between payments to hospitals and doctors’ offices for selected outpatient services.

For a closer look at the Medicare inpatient and outpatient issues MedPAC examined at its December meeting, see the presentation …

700+ Hospital Face Medicare Cut Because of Infections, Injuries

724 hospitals will see their Medicare payments cut this year because too many of their patients suffered infections and injuries under their care.

The cuts, part of Medicare’s hospital-acquired conditions program, are for the current fiscal year and will amount to one percent of Medicare payments or $373 million overall.  One in seven U.S. hospitals will be penalized under the program, including half of all teaching hospitals.

Despite the large number of hospitals penalized, the program appears to be having a positive effect on hospital performance.  For most of the types of problems for which hospitals are penalized – bed sores, blood clots, infections from catheters, and others – the frequency of infections and injuries has declined in recent years.

Learn more about the program and hospital penalties in this Kaiser Health News report and go here for Medicare’s news release on the subject.…