Archive for November, 2015


Medicare’s Bundled Payments Challenge

Now that the U.S. Department of Health and Human Services has set a target of making 50 percent of all Medicare payments through alternative payment systems by the end of 2018, one of those alternative systems, known as “bundled payments,” is receiving a great deal of attention.

Medicare’s Bundled Payments for Care Initiative (BCPI) is testing four models for making such payments: one that addresses care provided in the hospital and three that address post-discharge services.

In a new article titled “Bundled Payments for Care Improvement Initiative,” the journal Health Affairs takes a closer look at these four models, how they work, what they seek to accomplish, and how early BCPI efforts have fared. Find that article here.…

Financial Performance Mixed for PA Non-General Acute-Care Hospitals

Pennsylvania’s non-general acute-care hospitals are generally in good financial health, although their financial performance varied in FY 2014.

According to a new report published by the Pennsylvania Health Care Cost Containment Council, in FY 2014

  • psychiatric hospital operating margins rose from 8.29 percent to 9.87 percent
  • long-term acute care hospital operating margins fell from 5.77 percent to 5.24 percent
  • rehab hospital operating margins decreased from 12.93 percent to 12.74 percent
  • specialty hospital operating margins more than doubled, from 5.25 percent to 11.38 percent

For a closer look at the financial performance of non-general acute-care hospitals, find links to the report Non-General Acute Care Hospitals – Volume Three here, on the web site of the Pennsylvania Health Care Cost Containment Council.…

Feds Seek to Regulate Narrow Networks

Amid concerns that low-cost health plans are reducing their provider networks to contain costs at the expense of access to care for their members, the Centers for Medicare & Medicaid Services (CMS) is proposing new guidelines to limit how much those provider networks can be narrowed.

According to a CMS fact sheet,

To protect consumer access to health care providers and delivery organizations, the proposal asks states to establish a provider network adequacy standard for health plans in the federal Marketplace, subject to minimum criteria that CMS will establish at a later date, with a default time and distance standard otherwise. CMS is evaluating additional efforts to support transparency and informed consumer decision-making as it relates to provider network adequacy, and is requesting comment on whether designated network strength – for instance, indicating whether a plan has a broad number of doctors or health facilities in their network to choose from or not – could improve the consumer experience in future years.

The proposed regulation also would require insurers to

…count certain out-of-pocket expenses on unexpected out-of-network services towards a policy holder’s annual out-of-pocket maximum, if the service was performed at an in-network facility and advance notice was not provided.

Feds OK Medicaid Money for Housing

The Obama administration has informed state Medicaid programs that they may use federal Medicaid money to help the chronically homeless obtain housing.

While a June bulletin to state Medicaid directors technically only clarified existing policy, it signaled states that the administration will be receptive to Medicaid waivers that propose using Medicaid funding to help the homeless obtain housing.

Increasingly, state Medicaid programs have been finding that helping the homeless with housing is a key to improving their physical and behavioral health and can offer later savings as the individuals who have received such assistance live more stable lives, especially as more homeless people qualify for Medicaid benefits in states that have expanded their Medicaid programs.

To learn more about why officials believe housing is an important part of addressing the health care needs of the homeless and how some programs attempt to provide such assistance, see this Stateline report.…

OIG Reveals 2016 Plans

The U.S. Department of Health and Human Services’ Office of the Inspector General (OIG) has published its work plan for the 2016 fiscal year.

In 2016, the OIG will continue to examine all aspects of HHS endeavor, including Medicare, Medicaid, hospital services, public health activities, and more. In the coming year it will continue a number of hospital-focused projects while also focusing more on health care delivery, health care reform, alternative payment methodologies, and value-based purchasing initiatives.

Among the OIG’s planned Medicare projects in 2016 – some of them continued from the past and some of them new, quoted directly from the work plan – are:

  • Hospitals’ use of outpatient and inpatient stays under Medicare’s two-midnight rule. We will determine how hospitals’ use of outpatient and inpatient stays changed under Medicare’s two-midnight rule, as well as how Medicare and beneficiary payments for these stays changed, by comparing claims for hospital stays in the year prior to the effective date of the two-midnight rule to stays in the year following the effective date of that rule. We will also determine the extent to which the use of outpatient and inpatient stays varied among hospitals.
  • Analysis of salaries included in hospital cost