Archive for October, 2016


Feds Pick Targets for Health Insurance Open Enrollment

As part of a campaign to encourage more Americans to obtain health insurance during the open enrollment period of the federal insurance marketplace and state marketplaces, the Centers for Medicare & Medicaid Services has identified 15 large urban markets where it intends to focus a great deal of effort on encouraging people to obtain health insurance. Those markets are:

  • Atlanta, GA
  • Charlotte, NC
  • Chicago, IL
  • Dallas-Fort Worth, TX
  • Detroit, MI
  • Houston, TX
  • Miami-Fort Lauderdale, FL
  • Northern New Jersey
  • Orlando-Daytona-Melbourne, FL
  • Philadelphia, PA
  • Phoenix, AZ
  • Salt Lake City, UT
  • San Antonio, TX
  • Louis, MO
  • Tampa-St. Petersburg, FL

These areas are being targeted, according to CMS, because of past successes during open enrollment; because they still have significant numbers of uninsured people; and because they appear to present strong opportunities for meaningful enrollment increases.

Learn more about the planned outreach to the uninsured in these markets in this CMS news release.…

Medicare Invites More Docs to Join Quality Program

The Centers for Medicare & Medicaid Services has invited more clinicians to participate in its Quality Payment Program, one of the agency’s major value-based purchasing initiatives.

It will welcome new applications for medical practices and payers to participate in its Comprehensive Primary Care Plus (CPC+) and Next Generation Accountable Care Organization model for the 2018 performance year.

It also is offering participants in its Oncology Care Model an opportunity to take on two-sided risk in 2017.

Participation in all of these programs qualifies clinicians for Advanced APM status, which creates an opportunity to earn incentive payments of as much as five percent under Medicare’s Quality Payment Program.

See this CMS fact sheet for further information about the programs clinicians can join, what they would be expected to do, and the benefits they can earn by participating.…

Hospital Bad Debt Up in Ohio

While uncompensated care is down, bad debt is up at Ohio hospitals.

According to a new report from the Ohio Hospital Association, hospital bad debt rose in that state from $1.04 billion in FY 2013, when the state had not expanded its Medicaid program, to $1.23 billion in 2014, after Medicaid expansion had begun.


The increase was “…spurred by the growth in high deductible health plans,” the report states.

At the same time, what the association calls “charity care” fell from $1.03 billion to $809 million.

To learn more go here to Healing Ohio Communities, the Ohio Hospital Association’s 2016 community benefit report.…

PA Hospitals Reducing Readmissions, Mortality

Pennsylvania hospitals have seen a state-wide decrease in their mortality and readmission rates, according to new data released by the Pennsylvania Health Care Cost Containment Commission.

According to the new numbers, which cover hospital performance from January 1 through September 30 of 2015, hospital mortality rates fell for ten of the 16 conditions PHC4 tracks while readmissions fell for nine of the 13 conditions for which the agency collects data.

PHC4 estimates that this improved performance saved 3900 lives and avoided 2700 hospital readmissions.

For a closer look at the data PHC4 collected, the conditions it tracked, and a hospital-by-hospital, region-by-region, and state-wide look at hospital performance go here, to the PHC4 web site, to find a summary of the report, the news release that accompanied its publication, and three separate reports with all of the numbers and findings.


Medicare’s Primary Care Demonstration Shows Promise

Medicare’s Comprehensive Primary Care Initiative produced encouraging results during its second year: 95 percent of the participating medical practices met their quality requirements and four out of the seven participating regions generated nearly $58 million in savings and will share those savings with Medicare.

In addition, the 481 participating medical practices reduced their overall admissions and readmissions rates, scores well on patient satisfaction surveys and quality measures, and surpassed national benchmarks in a number of areas, including preventive health measures.

The program will expand in 2017 with 14 new regions participating in Comprehensive Primary Care Plus, an enhanced version of the original program.

Learn more about the program’s 2015 results, the savings participating practices will share, and CMS’s plans for 2017 in this CMS blog entry.…