Archive for February, 2019


Protections Overlooked as Medicaid Reforms are Implemented

In its eagerness to help states introduce changes in their Medicaid programs and reduce administrative burdens, the Centers for Medicare & Medicaid Services is ignoring regulatory requirements designed to understand and measure the impact of those changes on beneficiaries.

According to an analysis by the Los Angeles Times, many states seeking to implement Medicaid work requirements have not projected how many of their beneficiaries would be affected by those requirements nor have they projected how many beneficiaries who are removed from the Medicaid rolls will gain employment after losing their Medicaid benefits.  Both projections are required under Medicaid regulations adopted in 2012, which call for states to assess the anticipated impact of proposed policy changes when seeking federal permission to implement such changes.

Similarly, many states have not proposed commissioning independent assessments to determine the impact of the Medicaid changes they have implemented with CMS’s approval – another requirement under 2012 regulations.

When pressed to explain its failure to enforce these regulations, according to the Times, CMS said only that regulations “…do not require that states provide precise numerical estimates of coverage impacts…” and that it is developing strategies for states to evaluate the impact of new work …

Hospital Prices Lead Rise in Health Care Costs, Study Finds

A new study has concluded that rising hospital prices, not increased utilization, is primarily responsible for rising health care costs.

Overall, according to a new analysis by the Health Care Cost Institute, health care costs continue to rise despite declining health care utilization.

Among the report’s findings:

  • Hospital prices are rising faster than physician prices.
  • ER prices rose more than twice as much as ER utilization in 2017.
  • Increases in spending for psychiatric services outpaced increases in utilization of those services.
  • Inpatient spending rose 10 percent between 2013 and 2017 even though inpatient utilization fell five percent during that period.
  • Over that same period, outpatient surgery prices rose 14 percent while utilization declined four percent.

The report also found that health insurance prices are rising faster than wage growth.

Learn more about trends in health care costs and utilization from the Health Care Cost Institute analysis “2017 Health Care Cost and Utilization Report.”

Government More Effective Than Private Sector at Controlling Health Care Costs

For the past dozen years, Medicare and Medicaid have done a better job of controlling rising health care costs than private insurers.

Since 2016, according to a new report from the Urban Institute, private insurers’ costs per enrolled member have risen an average of 4.4 percent a year.  By contrast, Medicare costs have risen an average of 2.4 percent per enrollee and Medicaid costs have risen just 1.6 percent per enrollee.

The primary driver of Medicare cost increases has been prescription drug spending.  For Medicaid the primary driver has been physician services and administrative costs.  For private insurers, the main reason for increasing costs has been spending for hospital care.

Learn more about the differences in cost containment in these different sectors and the implications of those differences in the Urban Institute report “Slow Growth in Medicare and Medicaid Spending Per Enrollee Has Implications for Policy Debates.”

New Study Zeroes in on ER Use

A new study has concluded that more than four million emergency room visits a year are for chronic medical problems that, if treated more effectively at the primary care level, could have been avoided.

And that those more than four million visits cost $8.3 billion a year.

According to a new analysis performed by Premier, Inc., more than 24 million ER visits a year are by patients with six chronic medical conditions:  asthma, chronic obstructive pulmonary disease, diabetes, heart failure, hypertension, and behavioral health problems.  Thirty percent of those visits, the study concluded, could have been prevented with better care at the primary care and care management levels.

The study also suggests strategies for improving that primary care and care management.

Learn more about the Premier study in the Healthcare Dive article “EDs could save $8.3B annually with better primary care, study finds.”