Archive for June, 2015


MedPAC Sends Annual Report to Congress

As required by law, the independent federal agency that advises Congress on Medicare payment issues has transmitted its annual report to Congress with its observations, analysis, and policy recommendations.

The June 2015 report of the Medicare Payment Advisory Commission (MedPAC) addresses the following subjects:

  • hospital short-stay policy
  • payment policies for Part B drugs
  • value-based incentives for Part B drugs
  • polypharmacy and opiod use
  • risk-sharing in Part D
  • synchronizing policy across Medicare’s various payment models
  • next steps in measuring quality
  • the next generation of Medicare beneficiaries

Find a fact sheet on the MedPAC report here and the complete report itself here.…

Feds Approve Plan for PA to Establish Insurance Exchange

The U.S. Department of Health and Human Services (HHS) has approved a request by Pennsylvania Governor Tom Wolf for permission for his state to develop a state-based marketplace through which to offer health insurance to Pennsylvanians as provided for in the Affordable Care Act.

Currently, Pennsylvanians seeking health insurance use the federal exchange. The constitutionality of the use of that exchange is currently being weighed by the Supreme Court and the Wolf administration’s desire to create a state exchange is widely considered an attempt to avoid a crisis should the court rule against the federal government in the case of King v. Burwell. A ruling in that case is expected in the very near future.

Go here to see the letter from HHS Secretary Sylvia Burwell to Pennsylvania Governor Tom Wolf authorizing the state to move ahead with development of its state-based exchange.…

Variations on Medicaid Expansion

While most states that have taken advantage of the Affordable Care Act’s Medicaid expansion have simply expanded their existing Medicaid programs to incorporate the newly eligible, six states have taken a different path, pursuing what are known as section 1115 waivers – waivers of formal Medicaid requirements – to expand their Medicaid programs in different ways.

Typically, those different ways involve coverage modeled on private sector insurance practices, including requiring the newly eligible to choose from among approved managed care plans on the private market; the elimination of some traditional Medicaid benefits; the imposition of work requirements and higher premiums; and more.

In the new report Medicaid Expansion, The Private Option and Personal Responsibility Requirements: The Use of Section 1115 Waivers to Implement Medicaid Expansion Under the ACA, the Urban Institute takes a close look at the six states that have taken this alternative path. In addition, the Commonwealth Fund has published “The Promise and Pitfalls of Alternative State Approaches to Medicaid Reform,” a commentary on the efforts of the states that have followed this alternative path.…

Patient Satisfaction Survey Results Misleading?

A new report from a non-partisan bioethics institute suggests that the patient satisfaction surveys that Medicare uses as part of its value-based purchasing program may not be providing the kind of information on which Medicare payments should be based.

According to the Hastings Center report “Patient-Satisfaction Surveys on a Scale of 0 to 10: Improving Health Care, or Leading It Astray?” the surveys appear to blend patient satisfaction with their experience while hospitalized with the quality of care they received during that hospitalization and that “Good ratings depend more on manipulable patient perceptions than on good medicine.”

Currently, patient satisfaction is a major component of Medicare’s value-based purchasing program and hospitals can be rewarded or penalized based on their patients’ satisfaction as measured in surveys. The report notes that “The current institutional focus on patient satisfaction and on surveys designed to assess this could eventually compromise the quality of health care while simultaneously raising its cost.”

Find the complete study here, on the web site of the Hastings Institute.…

Administration Tallies Cost of Failure to Expand Medicaid

A new report by the Council of Economic Advisors offers an estimate of the impact of the failure of 22 states to expand their Medicaid program as authorized by the Affordable Care Act.

Among its findings:

  • 4.3 million people who could have been insured will not be in 2016.
  • An additional one million people would have a regular source of clinical care.
  • An additional 163,000 women between the ages of 50 and 63 would have received mammograms.
  • 393,000 fewer people would experience symptoms of depression.
  • 5200 fewer people would die.
  • 193,000 fewer people a year would face catastrophic, out-of-pocket medical expenses.
  • 611,000 fewer people would have trouble paying their regular bills because of their medical expenses.
  • The 22 states would have received an additional $29 billion in federal money in 2016 alone.
  • Hospitals in states that did not expand their Medicaid programs would have provided $4.5 billion less in uncompensated care in 2016.

To learn more about these findings, go here to see the White House report Missed Opportunities: The Consequences of State Decisions Not to Expand Medicaid.…