Archive for February, 2016


Hospitals Not Using Observation Status to Avoid Readmissions Penalties

Hospitals are not moving returning patients to observation status to avoid incurring financial penalties under Medicare’s hospital readmissions reduction program, according to new study published in the New England Journal of Medicine.

Since that program’s inception, more than 3300 hospitals have reduced the rate at which they readmit Medicare patients within 30 days of their discharge from the hospital. A moderate increase in the classification of Medicare patients in observation status led some critics to suggest that observation status was being used to avoid penalties for readmissions.

The study disagrees, concluding that

we found a change in the rate of readmissions coincident with the enactment of the ACA, which suggested that the Hospital Readmissions Reduction Program may have had a broad effect on care, especially for targeted conditions. In the long-term follow-up period, readmission rates continued to fall for targeted and nontargeted conditions, but at a slower rate. We did not see large changes in the trends of observation-service use associated with the passage of the ACA, and hospitals with greater reductions in readmission rates were no more likely to increase their observation-service use than other hospitals.

For a closer look at the study, the methodology employed, and …

Cutting ER Visits: Harder Than Expected

The first two years of major expansion of access to health insurance under the Affordable Care Act did not produce the significant reduction in hospital ER visits that many expected.

Or so reports a new study from the Centers for Disease Control and Prevention.

According to the CDC, even though eight million people gained health insurance under the health reform law in 2013 and 2014, ER visit rates changed little.

Still, the CDC survey found some progress: visits among Medicaid patients and the uninsured fell slightly, although Medicaid patents still frequent hospital ERs more than the privately insured.

Among those who did visit the ER, many said their primary care practice was not open at the time or that the ER was the only provider to which they felt they had access to care. In addition, many who made ER return visits reported doing so because of local government reductions of behavior health services options.

Learn more about changing rates of ER visits during the first years under the Affordable Care Act in this Fierce Healthcare article or go here to see the CDC report Reasons for Emergency Room Use Among U.S. Adults Aged 18–64: National Health Interview Survey, 2013

Medicaid Implications of the President’s FY 2017 Proposed Budget

The National Association of Medicaid Directors has published a detailed memo outlining how President Obama’s proposed FY 2017 would affect Medicaid.

See that memo here.…

States Mull New Health Care Reforms

Starting in 2017, individual states may seek permission from the federal government to pursue alternative approaches to aspects of the Affordable Care Act.

Late last year the Obama administration published proposed guidance outlining how states can pursue so-called innovation waivers and the limits their efforts will face.

State waivers, for example, must ensure that alternative coverage is at least as comprehensive and affordable as that offered under the reform law; they cannot add to the federal deficit; they must cover comparable numbers of people; and they cannot use Medicaid waiver savings to offset any increased costs associated with their alternative approaches.

So far, only a few states have indicated that they will be seeking such waivers.

The Commonwealth Fund has published an article about innovations waivers, their limits, and their potential; go here to see the article “Innovation Waivers and the ACA: As Federal Officials Flesh Out Key Requirements for Modifying the Health Law, States Tread Slowly.” To see the proposed federal guidance on waivers, read the Federal Register notice here.…

States Not Excluding Medical Transportation Services

When the Affordable Care Act made non-emergency medical transportation optional for adults newly eligible for Medicaid under the reform law, there was widespread concern that many states would choose not to offer the service as a way of saving money.

Those fears have proven unfounded.

According to the U.S. Government Accountability Office, only three of 30 states surveyed have chosen not to make non-emergency medical transportation a covered Medicaid benefit.   Of those states, Iowa has concluded that the lack of the benefit has not impeded access to medical services and Indiana plans to conduct such an assessment in the near future.

For a closer look at this issue, see the GAO report Efforts to Exclude Nonemergency Transportation Not Widespread, but Raise Issues for Expanded Coverage.…