Archive for November, 2016


Social Determinants and Health Care

Amid growing recognition that social factors play at least much a role in the health of communities as medical care, growing attention is being paid to how best to address those social determinants in a health care system.

With increasing use of alternative delivery models such as accountable care organizations, some approaches place health care at the heart of a hub-and-spoke model to address population health, supported by functions such as affordable housing, home health care, job training, and more. Another approach places community organizations at the hub of care models, with the health care system as a spoke feeding into that hub.

A recent article on the Health Affairs Blog explores the hub-and-spoke approach to addressing the social determinants that play such a major role in population health. Go here to read the blog article “Defining The Health Care System’s Role In Addressing Social Determinants And Population Health.”…

HHS OIG Previews 2017 Interests

The Office of the Inspector General of the U.S. Department of Health and Human Services has published a document presenting the areas on which it intends to focus in 2017.

Among the Medicaid issues on which the OIG will focus are delivery system reform incentive (DSRIP) payments, Medicaid ACOs, Medicaid provider taxes, Medicaid overpayments, and states’ risk assignment for providers that serve only Medicaid populations.

For Medicare, the OIG will look at many issues, including ACOs, hospital wage data, the two-midnight rule, outlier payments, a comparison of provider-based and free-standing clinics, and more.

And the OIG will examine long-term-care issues such as skilled nursing facility reimbursement, skilled nursing facilities and avoidable hospitalizations, inpatient rehabilitation facility payments, and more.

The OIG also will look at quality oversight in ambulatory surgery centers.

For a more detailed look at the OIG’s 2017 investigatory plans, go here to see its 2017 work plan.…

FAQ on New Medicaid Managed Care Rule

The Centers for Medicare & Medicaid Services has published an FAQ on the new regulation that governs the use of managed care when serving Medicaid and CHIP populations.

Go here to find that FAQ and other links to other resources for learning more about the new Medicaid managed care regulation.…

Retail Clinics Don’t Reduce Demand for ER Services

The presence of retail medical clinics near hospitals does not reduce the demand for low-acuity services at those hospitals’ emergency room.

Or so reports a new study published in the Annals of Emergency Medicine.

Contrary to what was expected amid the proliferation of retail medical clinics – there were only a little more than 100 such clinics in 2006 but more than 2000 today – patients are not choosing those clinics instead of hospital ERs for low-acuity medical needs.

An important qualifier is that only about 60 percent of such retail clinics accept Medicaid, but most clinics are located in places with high proportions of privately insured patients and relatively small numbers of Medicaid and uninsured patients.

Go here, to the web site of the Annals of Emergency Medicine, to read the article “Association Between the Opening of Retail Clinics and Low-Acuity Emergency Department Visits.”…

MedPAC Still Unhappy With Doc Pay

Despite the recent regulation implemented by the Centers for Medicare & Medicaid Services to prevent hospitals from continuing to acquire physician practices so they can receive higher outpatient payments than those physicians receive in private practice, members of the Medicare Payment Advisory Commission appear to think that more needs to be done to equalize physician payments regardless of where they provide outpatient services.

Or so MedPAC commissioners discussed during their public meeting in Washington, D.C. last week.

One commissioner observed that physicians appear to become less productive when their practice is acquired by a hospital. Others noted the added costs to Medicare when patients are treated at a hospital-based outpatient facility rather than a private physician’s office. In general, MedPAC members seemed “unimpressed” that CMS’s recent regulation alone will be enough to address the problem and that a better approach would be to reduce or eliminate the pay differentials between the two types of providers. MedPAC staff pointed to the $1.6 billion Medicare spent in 2015 on “evaluation and management “payments only to practices owned by hospitals.

Learn more about what MedPAC’s commissioners think about this issue and what they might do to try to address in this CQ Roll