Archive for February, 2015


Insurance Expansion Won’t Hurt Access to Primary Care, Study Finds

Fears that significant increases in the numbers of Americans with health insurance as a result of Affordable Care Act policies would overwhelm the health care system and lead to access to care problems are unfounded, according to a new Commonwealth Fund report.

According to the new report “How Will the Affordable Care Act Affect the Use of Health Care Services?”, the country’s current supply of primary care providers is more than adequate to meet any demand for primary care services. The study found that

… primary care providers will see, on average, 1.34 additional office visits per week, accounting for a 3.8 percent increase in visits nationally. Hospital outpatient departments will see, on average, 1.2 to 11.0 additional visits per week, or an average increase of about 2.6 percent nationally.

The study concludes that

It is critical that the expansion of health insurance coverage leads to improved access to care for those who were previously uninsured and does not limit access for those who already have coverage. Our results suggest that the current supply of primary care physicians and physicians in most specialties is sufficient to ensure this result will hold.

For a closer look at the study’s methodology and …

States Seek to Reduce ER Use Among Medicaid Patients

Even though the rate at which non-Medicaid recipients inappropriately use hospital emergency rooms exceeds the rate of inappropriate use among Medicaid patients, a number of states are launching efforts to reduce ER overuse among their Medicaid recipients.

Medicaid patients currently use – as distinguished from inappropriately use – hospital ERs at twice the rate of privately insured patients, typically for a number of reasons: they are less healthy than insured patients; they have a more difficult time finding primary care physicians who will treat them; and they have jobs that prevent them from going to doctors during ordinary office hours.

To address overuse, states are trying a number of approaches. Nearly half of the states are imposing or increasing Medicaid co-pays for ER visits. Some are identifying Medicaid patients among their frequent ER users and making primary care appointments for them before they leave the ER. Some Medicaid managed care plans are doing the same, analyzing ER data among their users and making an extra effort to connect them to primary care physicians.

Some of these approaches are showing promise. When Washington state ER personnel started setting up appointments with primary care patients for Medicaid-insured ER visits, ER use among …

Administration Blocks No-Hospitals Insurance Plans

Health insurance plans that do not include hospital benefits fail to meet employers’ obligations under the Affordable Care Act and will leave companies that provide such insurance vulnerable to fines of $3000 a year for every worker covered by such a plan, the Centers for Medicare & Medicaid Services (CMS) announced last week.

But in recognition that some employers had arranged such coverage well in advance, the federal government is permitting companies that committed to such plans by November 4 to use them for the next year, after which they must be replaced. In addition, employees who seek to compensate for that shortcoming in their coverage by purchasing supplemental insurance will be eligible for tax credits based on their income.

Such plans have been favored by many companies that employ large numbers of low-wage workers.

In a regulation issued last week, CMS wrote about health insurance without hospital benefits that

A plan that excludes substantial coverage for inpatient hospital and physician services is not a health plan in any meaningful sense and is contrary to the purpose of the MV [minimum value] requirement to ensure that an employer-sponsored plan, while not required to cover all EHB [essential health benefits], nonetheless

“Super-Utilizers” Costing Health Care System, Report Shows

“Super-utilizers” – people who visit hospital emergency rooms often and are admitted to hospital beds with unusual frequency – are costing the health care system enormous amounts of money.

According to a new report from the Pennsylvania Health Care Cost Containment Council (PHC4), super-utilizers – people admitted to Pennsylvania acute-care hospitals at least five times in a year – while just three percent of hospital patients in FY 2014, accounted for 17 percent of the state’s Medicaid expenditures for inpatient care ($216 million) and 14 percent of federal Medicare inpatient spending ($545 million). In all, 18 percent of Medicaid hospital admissions in Pennsylvania in FY 2014 and 10 percent of Medicare admissions were for super-utilizers.

PHC4 identified the three leading reasons for these admissions as heart failure, septicemia, and mental health disorders.

Learn more about super-utilizers and their impact on hospital admissions and health care spending in the PHC4 report, which can be found here.…

Feds Toughen Nursing Home Rating System

Nursing homes will have a harder time getting top ratings from the federal government under a toughened scoring system.

The rating system for Nursing Home Compare, which classifies nursing homes from one to four stars based largely on self-reported data, has been revised by the federal Centers for Medicare & Medicaid Services (CMS) to reflect the addition of a new factor in the rating formula:  the frequency of nursing homes’ use of anti-psychotic drugs.

Currently, more than half of all nursing homes are rated four or five stars based on three categories:  government inspections, quality measures, and staffing levels.  Critics have complained about the large numbers of highly rated facilities, including many that have problems, complaints lodged against them, or have been fined for various infractions.

The new rating system takes effect immediately.

To learn more about the new nursing home rating system, why it is being introduced, and how it will differ from its predecessor, see this Kaiser Health News report and a CMS fact sheet on the subject.…