Archive for July, 2016


Hospital Uncompensated Care and Bad Debt Decline

Implementation of the Affordable Care Act has led to a decline in the amount of charity care hospitals provide.

It also had led to stabilization in the amount of bad debt hospitals incur.

According to a review by the Pittsburgh Post-Gazette of data submitted to the Centers for Medicare & Medicaid Services by more than 4500 hospitals, hospital charity care fell 13 percent, from 1.81 percent of net patient revenue in 2013 to 1.59 percent in 2014.

And hospital bad debt, which had risen for the three previous years, stabilized at 3.4 percent.

In general, hospitals performed better under both of these measures if they are located in states that expanded their Medicaid programs, as provided for in the Affordable Care Act.

Learn more about the findings of this analysis and how they are viewed by policy-makers and others in this Pittsburgh Post-Gazette news story.…

CMS: Major Savings In Fraud and Abuse Prevention

Fraud and abuse prevention and detection efforts saved Medicare nearly $42 billion over two years, according to the Centers for Medicare & Medicaid Services.

CMS reports that in FY 2013 and FY 2014 it saved $12.40 for every dollar it invested in fraud and abuse prevention and detection.

Much of that savings, the agency reports, is through using advanced analytics to do predictive modeling. Taking steps to prevent potentially fraudulent and improper payments, as opposed to a “pay and chase” approach to addressing fraud and abuse, accounted for 68 percent of savings in FY 2013 and 74 percent of savings in FY 2014.

Learn more about what CMS is doing to prevent and detect fraud and abuse and what its efforts are producing in this entry from the CMS blog.…

Free-Standing ERs Follow the Money

Operators of free-standing emergency facilities are most likely to establish such facilities in areas with especially high proportions of insured, high-income residents.

As a result, they are unlikely to contribute to any improvements in access to care for low-income people.

This was among the conclusions reached in a new study on the proliferation of free-standing emergency room operations.

Currently, the study noted, there are 360 such ERs in 30 states, up from 222 eight years ago; more than one-third of them are independent entities.

Learn more about the proliferation of free-standing emergency rooms and what this will and will not mean to access to care here, in the Annals of Emergency Medicine article Where Do Freestanding Emergency Departments Choose to Locate? A National Inventory and Geographic Analysis in Three States.…

ACA Slowly, Surely Improving Health Status

A new survey has found that the combination of Affordable Care Act-driven enhanced access to health insurance and improved performance by health care providers is producing better health status in communities across the U.S.

The survey looked at health status in 306 regional health care markets based on factors such as access to care, quality, avoidable hospital use, health care costs, and health outcomes found modest improvements in these areas and attributed those improvements to expanded access to health insurance and government quality programs introduced through the Affordable Care Act. The gains the survey documented occurred from 2011 through 2014.

To learn more about how the survey was administered and what it found and to see and compare health status in individual communities, go here to read the Commonwealth Fund report Scorecard on Local Health System Performance.…

Report to CMS on Risk Adjustment of Medicare Payments

The National Academies of Sciences, Engineering, and Medicine has issued its latest report to the Centers for Medicare & Medicaid Services on how to adjust Medicare payments to hospitals based on the socio-economic risk factors hospitals’ patients pose.

At the request of CMS, the Academies created an expert committee to

…identify criteria for selecting social risk factors, specific social risk fascinators Medicare could use, and methods of accounting for those factors in Medicare quality measurement and payment applications.

The committee created for this purpose viewed its goal to be 

…to guide the selection of social risk factors that could be accounted for in VBP [value-based purchasing] so that providers or health plans are rewarded for delivering quality care and value, independent of whether they serve patients with relatively low or high levels of social risk factors.

 Now, the committee has issued its third report to CMS, and in that report it offers three overarching considerations and five criteria to determine “whether a social risk factor should be accounted for in performance indicators used in Medicare VBP programs.” They are:

  1. The social risk factor is related to the outcome.
  • The social risk factor has a conceptual relationship with the