Archive for December, 2017


Medicare Penalizes Hospitals for Avoidable Injuries, Illnesses

Medicare is reducing payments to 751 hospitals because of the high rate at which their patients have suffered avoidable injuries and illnesses while in the hospital.

The penalties come under Medicare’s Hospital-Acquired Condition Reduction Program, which was established by the Affordable Care Act.

Among the penalized hospitals,

  • more than half were penalized last year as well
  • 115 are academic medical centers – about one-third of all such facilities
  • more than one-third of all safety-net hospitals were penalized

Learn more about the program, the penalties, and why the penalties were assessed in this Kaiser Health News report.…

Medicaid Directors Meet

The National Association of Medicaid Directors held its fall conference recently outside Washington, D.C.

This is an important event at which policy-makers and policy experts meet to discuss Medicaid programs, trends, challenges, and opportunities.

Many of the materials used during that conference are now publicly available, including video clips from speeches by CMS Administrator Seema Verma and others and presentations on a number of subjects, including:

  • delivering care across rural and frontier America
  • Medicaid’s role in supporting community engagement and economic mobility
  • busting the silos of physical and behavioral health care
  • alternative payment models and addressing the social determinants of health
  • early intervention in behavioral health
  • the opioid epidemic
  • pediatric innovations in Medicaid

Go here for links to the speeches and presentations offered at the conference.



The non-partisan legislative branch agency that advises Congress, the administration, and the states on Medicaid and CHIP-related issues met recently in Washington, D.C.

The following is the Medicaid and CHIP Payment and Access Commission’s own summary of its meeting.

The December 2017 meeting of the Medicaid and CHIP Payment and Access Commission began with a brief update on the State Children’s Health Insurance Program (CHIP). Although federal funding for the CHIP expired at the end of September, legislation to renew funding was still pending in Congress. The Commission then heard from a panel discussing state tools to manage drug utilization and spending in Medicaid. Panelists included Renee Williams, director of clinical pharmacy services for TennCare; Doug Brown, Magellan Rx Management’s vice president for Medicaid drug rebate management; and John Coster, director of the Center for Medicaid and CHIP Services Division of Pharmacy at the Centers for Medicare & Medicaid Services. At the final morning session, Commissioners reviewed a draft March 2018 report chapter on streamlining Medicaid managed care authorities. The Commission voted to approve recommendations to Congress, but deferred action on a third recommendation for further discussion at its upcoming January 2018 meeting.

In the afternoon, MACPAC staff previewed highlights

Reduced Hospitalizations and Improved Care for High-Risk Patients Not Driving ACO Savings

Medicare savings reported in the early years of the Medicare Shared Savings Program are not coming from reduced hospitalizations of high-risk Medicare patients or even through better coordination of care for those patients.

Instead, Medicare accountable care organization savings are coming mostly from better and more coordinated care for low-risks Medicare ACO participants.

These surprising findings are reported in the article “Medicare ACO Program Savings Not Tied To Preventable Hospitalizations Or Concentrated Among High-Risk Patients,” which can be found in the December 2017 edition of the journal Health Affairs.  Find a link to that article here.…

Medicaid Discovery: More Services Can Reduce Costs

States that invest additional money addressing the social service needs of their highest-cost Medicaid patients are finding that the savings they gain from doing so exceed the cost of providing the social services.

Often, by as much as two dollars of savings for every one dollar spent.

With relatively small numbers of Medicaid patients consuming a significant portion of state Medicaid resources, providing additional social service assistance to such individuals can both improve their health and save money for the states according to a new report from the National Governors Association.  Most of these patients suffer from multiple medical problems, including substance abuse disorders and mental illness.  Providing housing assistance, in particular, has proven to be one of the biggest money-saving services.  The additional assistance also has drastically reduced emergency room visits and costs.

These findings are drawn from the results achieved by ten states and Puerto Rico that are participating in a national pilot program.

Learn more about what the state’s are doing and the results they are producing in the National Governors Association report “Building Complex Care Programs:  A Road Map for States,” which can be found here.…