Archive for March, 2015


State Uses Innovation Funding to Improve Care for Urban Poor

New York Medicaid program is taking advantage of federal innovation money to explore new approaches to serving low-income urban Medicaid patients.

With the help of Delivery System Reform Incentive Payments (DSRIP), special Medicaid funding from the federal government, caregivers serving Medicaid patients are organizing into accountable care organizations (ACOs) in New York City.

Under the experiment, doctors and hospitals join together to serve populations of Medicaid patients. While the doctors are currently paid on a fee-for-service basis, the program’s goal is to move them toward outcomes-based reimbursement, with bonuses paid to providers who achieve specific goals for improving the health of their patients.

The state plans to spend $1 billion over the next five years on this aspect of its innovation program.

Learn more about how New York seeks to use DSRIP funding to improve the delivery of care to its Medicaid population in this New York Times report.…

340B Program Faces Challenges, Change

A federal program that helps selected health care providers obtain discounted drugs for low-income patients they are serving on an outpatient basis may soon face major changes.

The 340B prescription drug pricing program, created more than 20 years ago to help serve low-income individuals, has come under fire in recent years in both the House and the Senate over how qualified, participating providers – disproportionate share hospitals, Federally Qualified Health Centers and their look-alikes, children’s hospitals, critical access hospitals, rural referral centers, and others – use the savings they derive from the program. While there is a general expectation that providers will use those savings to provide additional services to low-income patients, they are required neither to do that nor to discloses how they do use their savings.

The House Energy and Commerce Committee held a hearing about the program this week and Congress has asked the Medicare Payment Advisory Commission (MedPAC) to look into the program as well.

In addition, the U.S. Government Accountability Office (GAO) recently published an update on the status of its 2011 recommendations for improving the program, which it found suffered from inadequate oversight by Health Resources and Services Administration (HRSA), lacked adequate criteria for …

Hospital Uncompensated Care Down, Feds Say

Hospital uncompensated care fell $7.4 billion in 2014, according to a new report from the U.S. Department of Health and Human Services (HHS), led by the 28 states that took advantage of the Affordable Care Act to expand their Medicaid programs.

Hospitals in those 28 states saw their uncompensated care costs fall $5 billion, according to the HHS analysis, which was based on hospital financial reporting (Medicare cost reports) and member surveys from state hospital associations.

The analysis also found that if all 50 states had expanded their Medicaid programs, hospital uncompensated care would have declined another $1.4 billion in 2014.

For a closer look at HHS’s findings, go here.…

House May Address Doc Fix Bill This Week

Means-testing for Medicare beneficiaries.

Modest raises for doctors now and the promise of no cuts for a decade.

An extension of the Children’s Health Insurance Program (CHIP) for ten years.

These and other provisions are part of a new bill expected to move to the House this week that would eliminated the use of the Medicare sustainable growth rate formula (SGR) that threatens to cut Medicare payments to doctors 21 percent beginning on April 1.

For years Congress has implemented temporary measures to prevent similar cuts but now, it appears to be serious about addressing the problem permanently by eliminating the SGR formula and introducing in its place a new payment system for doctors that pays them based on the quality rather than the quantity of care they deliver.

What’s in this latest proposal? Kaiser Health News has published an FAQ that describes the issue, the proposed solutions, and the challenges those solutions face in the coming days. See that FAQ here.…

OIG Reiterates Medicare, Medicaid Recommendations

Every year the U.S. Department of Health and Human Services’ Office of the Inspector General (OIG) examines the operations of various department offices, programs, and policies and offers recommendations for changes and improvements. Some of those recommendations are adopted and others are not.

The OIG annually publishes a document reiterating what it believes to be its most important and potentially useful recommendations that were not adopted, and that publication was just released.

Among the Medicare and Medicaid recommendations it has presented again are:

  • Establish accurate and reasonable Medicare payment rates for hospital inpatient services.
  • Establish accurate and reasonable Medicare payment rates for hospital transfers.
  • Reduce hospital outpatient department payment rates for ambulatory surgical center-approved procedures.
  • Prevent inappropriate payments to Medicare home health agencies.
  • Reduce inappropriate payments to skilled nursing facilities.
  • Prevent payments for ineligible Medicare beneficiaries.
  • Reconcile Medicare outlier payments in accordance with federal guidance and regulations.
  • Ensure that states calculate accurate costs for Medicaid services provided by local providers.
  • Ensure the collection of identified Medicare overpayments.
  • Improve oversight of management of Medicaid personal services.
  • Improve the Medicare appeals process at the administrative law judge level.
  • Enhance efforts to identify adverse events to ensure quality of care and safety.
  • Ensure