Archive for May, 2017


The Prospect of a Medicaid Work Requirement

Over the past three years a dozen states have proposed establishing a work requirement for eligibility for their Medicaid programs and in its proposed FY 2018, the Trump administration has called for extending the ability to impose such a requirement to all states.

But how would a Medicaid work requirement work?  To whom would it apply and what kinds of work might satisfy such a requirement for the approximately 22 million Medicaid recipients (out of 76 million total recipients) to whom it might apply?

A new Commonwealth Fund report looks at these and other issues.  Go here to find the article “What Might a Medicaid Work Requirement Mean?”…

Medicare Delays New and Expanded Bundled Payment Programs

Medicare has delayed the launch of its mandatory Medicare Cardiac Rehabilitation Incentive Payment program until January 1.

It also has delayed the expansion of its Comprehensive Care for Joint Replacement program through a new Surgical Hip and Femur Fracture Treatment program.  Originally scheduled to begin on May 20 and then pushed back to July 1, now it, too, will not begin until January 1.

Medicare’s Acute Myocardial Infarction program and Coronary Artery Bypass Graft program will still begin on July 1.

For further information, see this Federal Register notice announcing the delays.


New Book Addresses Social Risk Factors in Medicare

In the new book Accounting for Social Risk Factors in Medicare Payment, the National Academies of Sciences, Engineering, and Medicine addresses the question of what social risk factors might be worth considering in Medicare value-based payment programs and how those risk factors might be reflected in value-based payments.

The book, the culmination of a five-part NASEM process, focuses on five social risk factors:

  • socio-economic position
  • race, ethnicity, and cultural context
  • gender
  • social relationships
  • residential and community context

Addressing such factors in Medicare value-based payments, the book finds, can help achieve four important goals:

  • reduce disparities in access, quality, and outcomes
  • improve the qualify and efficiency of care for all patients
  • foster fair and accurate reporting
  • compensate provides fairly

Doing so also can help prevent five types of unintended consequences from a failure to address social risk factors in Medicare payment policy:

  • providers avoiding patients with social risk factors
  • reducing incentives to improve the quality of care for patients with social risk factors
  • underpaying providers that serve disproportionately large numbers of patients with social risk factors
  • a perception of different medical standards for different populations
  • obscuring disparities in care and outcomes

Learn more about social risk factors and their potential …

MedPAC Testifies Before Congress

Last week Mark Miller, executive director of the Medicare Payment Advisory Commission, testified before the House Ways and Means Committee’s Health Subcommittee.

In his testimony, Miller summarized and explained some of the key points MedPAC made in its March report to Congress, including:

  • why MedPAC believes most post-acute-care payments are too high;
  • why Medicare needs to reduce the incentives for hospitals and doctors to deliver more services;
  • why it recommended no FY 2018 payment increases for long-term acute-care hospitals, ambulatory surgical centers, and skilled nursing facilities and reductions of payments for home health care providers and inpatient rehabilitation facilities;
  • why Congress should not be concerned about hospitals’ negative Medicare margins;
  • why new steps are needed to evaluate the performance and adequacy of payments to free-standing emergency rooms and ambulatory surgical faculties;
  • why current payments to ambulatory surgical centers, outpatient dialysis facilities, and physicians are adequate; and
  • more.

Miller also chastised federal officials for not embracing MedPAC’s recommendations sooner, saying that adopting those regulations would have saved Medicare billions of dollars.

MedPAC is an independent agency that advises Congress on Medicare payment issues.  While its recommendations are binding neither on Congress nor the administration, its views are highly influential and often …

Medicare’s Costs Can Be High for Low-Income Beneficiaries

Despite enjoying Medicare coverage, low-income seniors can still spend a significant portion of their limited income on costs Medicare does not cover.

According to a new study published by the Commonwealth Fund, more than 25 percent of Medicare beneficiaries spend at least 20 percent of their income on health care – on things like premiums, cost-sharing, prescriptions, and dental and vision care, long-term care, and other services not covered by the federal program.  These costs pose a problem for many because nearly half of all Medicare participants have incomes below the federal poverty level, which is slightly less than $24,000 a year for a single person.  More than five million Medicare beneficiaries have no supplemental coverage, such as a Medigap plan or a Part D prescription drug plan, thereby increasing their out-of-pocket health care costs.

Learn more about the out-of-pocket costs for which Medicare beneficiaries are responsible and how it affects them financially, and especially how it affects low-income Medicare beneficiaries financially, in the report “Medicare Beneficiaries’ High Out-of-Pocket Costs:  Cost Burdens by Income and Health Status,” which can be found here, on the Commonwealth Fund’s web site.…