Archive for September, 2016


CMS Updates Long-Term-Care Regulations

For the first time in more than 25 years, the federal government has updated regulations that govern long-term care facilities that serve Medicare and Medicaid patients.

As described in a news release from the Centers for Medicare & Medicaid Services, the new regulation is

…targeted at reducing unnecessary hospital readmissions and infections, improving the quality of care, and strengthening safety measures for residents in these facilities.

Among other changes, the regulation strengthens the legal rights of nursing home residents, ensures that staff has the right skills and training to provide person-centered care, and improves care planning.

Go here to see a news release describing the new regulation, here to see a CMS blog post on its release, and here to see the regulation itself.…

Foundation Looks at Care for High-Need, High-Cost Patients

In a new issue brief, the Commonwealth Fund has identified what it views to be six key elements for improving care for high-need, high-cost patients – those who consume disproportionate amounts of health care. They are:

  • Promote value-based payments
  • Improve value-based payment design and implementation
  • Allow payments for non-medical services
  • Assist clinicians in adopting best practices
  • Prioritize health information exchange
  • Support ongoing presentation

Learn more about what these options are and why they are important in the Commonwealth Fund issue brief “Tailoring Complex Care Management for High-Need, High-Cost Patients.”…

The Role of Patient Experience in Medicare’s Value-Based Purchasing Program

Medicare’s value-based purchasing program adjusts payments to hospitals based in part on the experience of hospitals’ patients. That experience is measured through performance on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and accounts for 30 percent of hospitals’ value-based purchasing adjustment.

A new report in the journal Health Affairs takes a closer look at the three components of hospital performance – achievement, improvement, and consistency – and explains the impact of all three on payments to hospitals. Go here to see the article “Understanding The Role Played By Medicare’s Patient Experience Points System In Hospital Reimbursement.”…

MACPAC Looks at Medicaid DSH

With Medicaid disproportionate share payments (Medicaid DSH) facing future reductions, the agency charged with advising Congress on Medicaid and Children’s Health Insurance payment and access matters is considering what changes the federal supplemental Medicaid payment program might need.

At a recent meeting in Washington, D.C., the Medicaid and CHIP Payment and Access Commission discussed the changing role and purpose of Medicaid DSH as more Americans obtain health insurance through private or public sources. MACPAC commissioners noted that hospital uncompensated care is falling, especially in states that have taken advantage of the Affordable Care Act to expand their Medicaid programs.

A new Medicaid DSH formula set to be used for FY 2018, based more heavily than the current formula on the number of uninsured people in individual states, is expected to result in larger-than-average reductions for hospitals in Medicaid expansion states.

Among the steps commissioners discussed were examining how hospitals use their Medicaid DSH funds; considering how any changes in the distribution of Medicaid DSH funds might affect other parts of states’ health care systems; and the role states should play in determining the allocation of Medicaid DSH funds.

For a closer look at the issue and MACPAC’s deliberations, see this …

Medicare Readmissions Down Almost Everywhere

Hospitals in 49 of the 50 states have reduced their Medicare readmissions since the federal health care program introduced its readmissions reduction program in 2010.

Only hospitals in Vermont have failed to cut readmissions.

Nationally, readmissions fell more than five percent in 43 states and more than ten percent in 11 states. Overall, readmissions fell 100,000 in 2015 alone compared to 2010 and have fallen 565,000 since 2010.

As the program ages more medical conditions are being subjected to the readmissions reduction program’s requirements. In the coming year, the Centers for Medicare & Medicaid Services estimates it will penalize 2500 hospitals $538 million for failing to reduce their readmissions.

Learn more about CMS’s efforts to reduce readmissions among Medicare patients in this entry on the CMS Blog.…