Archive for April, 2016


Data-Sharing Could Help Address “High-Fliers”

A new study suggests that hospitals might better serve frequent emergency room patients if they share data with one another.

According to a new report in the journal JAMA Internal Medicine, nearly 70 percent of “high-fliers” – patients known to make repeated visits to hospital ERs – visited more than one hospital ER in a study of patients who had more than five ER visits in Maryland in 2014. As a result, individual hospitals may not have a complete picture of such patients’ medical issues and the frequency with which they are turning to hospitals for care – a problem that could detract from individual hospitals’ attempts to find better ways to serve such patients.

A possible solution, the study suggests, is better information-sharing among hospitals.

To learn more about the study and its implications for efforts to reduce overuse of hospital ERs, go here to find the JAMA Internal Medicine study “The Adequacy of Individual Hospital Data to Identify High Utilizers and Assess Community Health.”…

CMS Unveils New Medicaid Managed Care Regulation

For the first time in more than 20 years, the federal government is introducing major changes in how it regulates Medicaid managed care.

The Centers for Medicare & Medicaid Services describes the 1425-page rule as aligning Medicaid managed care with other health insurance programs, updating how states purchase managed care services, and improving beneficiaries’ experience with Medicaid managed care.

To learn more about what CMS has proposed, go here to see the rule itself.

Go here to see CMS’s news release accompanying the new regulation.

Go here to (under the link “final rule”) to find nine fact sheets summarizing key aspects of the new regulation.

And go here for a commentary on the new rule and the context in which it was released by CMS acting administrator Andy Slavitt.


CMS Proposes Nursing Home Payment Changes

Nursing homes would soon be compensated by Medicare through a value-based purchasing program under a new proposal from the Centers for Medicare & Medicaid Services.

Under the proposal, released as part of CMS’s annual proposed regulation governing how Medicare will pay for skilled nursing care in the coming fiscal year, Medicare’s payment system would rely more on value-based payments and achieving performance benchmarks beginning in federal FY 2019.

According to CMS,

The proposed policies in the proposed rule continue to shift Medicare payments from volume to value. The Administration has set measurable goals and a timeline to move the Medicare program, and the health care system at large, toward paying providers based on the quality, rather than the quantity of care they provide to their patients. The Administration met the goal of tying 30 percent of Medicare payments to care provided in alternative payment models ahead of schedule and is continuing this momentum to reach the goal of tying 50 percent of payments to care provided in alternative payment models by the end of 2018. This proposed rule includes policies that advance that vision and support building a health care system that delivers better care, spends health care dollars more

Agency Pursues Innovation in Medicare

The Next Generation ACO Model.

The Nursing Home Value-Based Purchasing Demonstration.

The Bundled Payments for Care Improvement Initiative.

The Medicaid Incentives for he Prevention of Chronic Diseases Model.

These and many other Medicare demonstration programs and models are the product of the Center for Medicare and Medicaid Innovation, a division within the Centers for Medicare & Medicaid Services created by the Affordable Care Act to support the development and testing of innovative approaches to health care payment and service delivery.

The New York Times recently took a look at the agency: what it does, how it works, and how its efforts have fared so far. Find the Times profile here.…

Disabled Losing Services Under Medicaid Managed Care?

Disabled Medicaid recipients who have long received long-term services and supports from their states’ Medicaid fee-for-services programs are losing vital services when those states move them into Medicaid managed care programs.

Or so concludes the National Council on Disability in a new report.

Traditionally, even states that employed managed care to serve much of their Medicaid population continued to serve the disabled through fee-for-service programs, but in the past dozen years 16 states have moved such individuals into managed care, raising the number of disabled beneficiaries in Medicaid managed care programs from 105,000 in 2004 to nearly 400,000 in 2012.

Critics suggest that Medicaid managed care organizations are unfamiliar with the needs of their new, disabled members and deny them access to services they need.

The National Council on Disability, a federal agency that advises Congress on issues involving individuals with disabilities, reached this conclusion after research that included public forums in ten states.

To learn more about how the growing use of managed care is affecting disabled Americans, go here to see the National Council on Disability report Medicaid Managed Care Community Forums: Final Report.…