Archive for March, 2019


ACA Repeal Would Drive Up Uninsured, Uncompensated Care

At the same time that the Trump administration announced that it has asked a federal court to repeal the entire Affordable Care Act, the Urban Institute has published a report detailing the potential impact of the health care reform law’s repeal.

According to the Urban Institute report, repealing the entire Affordable Care Act would add almost 20 million Americans to the ranks of the uninsured.  Medicaid and CHIP enrollment would fall by 15.4 million people and millions of others would lose the tax credits they used to purchase insurance.  Some would purchase insurance with limited benefits and individual plan premiums would rise while others would go uninsured.

In addition, repeal of the Affordable Care Act would lead to an 82 percent increase in hospital uncompensated care, to more than $50 billion.  About half of the states would see the amount of uncompensated care provided by their hospitals double, the Urban Institute estimates.

Learn more from the Healthcare Dive article “Killing ACA would lead to huge spikes in uncompensated care” and from the Urban Institute report State-by-State Estimates of the Coverage and Funding Consequences of Full Repeal of the ACA.


Feds Seek More EHR in Post-Acute-Care Settings

Electronic health records may find their way into more post-acute-care settings as a result of a request for information published by the Centers for Medicare & Medicaid Services.

In the RFI, CMS notes that EHR adoption has been slow in the post-acute sector and asks stakeholders what it can do to accelerate the adoption of technology designed to facilitate communication among caregivers.

While EHR adoption has occurred in other areas, its use is less common in the post-acute sector, and even when used, it is used more for record-keeping than for communication among providers.

EHR use and interoperability among acute-care hospitals was funded through an economic stimulus bill, the American Recovery and Reinvestment Act of 2009, which made funding available through Medicare and Medicaid, but that effort focused primarily on acute-care hospitals and physician practices, leaving post-acute-care providers and others behind.  Now, CMS appears to be seeking to play catch-up in the post-acute sector and with this RFI is asking participants in that sector both how it can provide meaningful incentives for them to make greater use of EHR and how it can measure interoperability in that sector in the future.

Learn more from the article “CMS focuses on post-acute

A New Trend: Tying Insurance Payments to Medicare Rates?

There may be a growing movement to tie some hospital payments directly to Medicare rates.

Montana started doing it two years ago, linking payments for hospital services provided to state employees to Medicare rates.  Oregon will start a similar program this fall.

And now, North Carolina is laying plans for a similar approach while Delaware is considering doing so.

Montana is paying an average of 234 percent of Medicare hospital rates.  Oregon will pay 200 percent of Medicare rates.  North Carolina is talking about paying Medicare rates plus 82 percent, with extra money for rural hospitals.

Such an approach could lead to a number of possibilities.  Officials in North Carolina believe it will lead to reduced out-of-pocket health care costs for state employees and their families.  Some hospitals believe the reduced revenue associated with serving public employees will threaten their very existence – especially in rural areas and areas with large concentrations of state workers.

Hospitals have long maintained that Medicare underpays them, so the question arises:  is 82 percent on top of Medicare rates enough?  Is 200 percent of Medicare rates enough?

Another question:  if these programs work, or appear to work, will self-insured companies seek to follow suit?  …

Mixed Verdict: Home Health Leads to More Readmissions But Lower Costs

Readmission rates are greater for patients discharged from hospitals to home health care than they are for those discharged to skilled nursing facilities but home health services cost so much less than nursing homes that home health saves money even with the higher numbers of hospital readmissions.

This is one of the major findings of a new study comparing differences in outcomes for patients who are admitted to skilled nursing facilities upon discharge from the hospital to those for patients who go direct home and receive home health services.

The study also found no meaningful differences in patient mortality or functional outcomes.

Readmissions from home health are 5.6 percent greater than those from skilled nursing facilities but with the much lower cost of home health services, Medicare saves, on average, more than $5400 over the first 60 days after discharge when patients are discharged to home health services rather than nursing homes.

Hospitals, it appears, prefer to discharge patients to nursing homes – perhaps, the study’s authors suggest, because of concern for their own readmission rates, which are subject to review and penalty under Medicare’s hospital readmissions reduction program.  Also, relatively few hospitals participate in alternative payment models that encompass …

HHS Chief Derides Medicare Wage Index System

U.S. Department of Health and Human Services Secretary Alex Azar criticized the current Medicare area wage index system during a hearing of the Senate Finance Committee last week.

Reminding senators that he told them last year that they need to revise the system and warning that HHS’s ability to change it is limited without legislation, Azar referred to the system as an “absurdity” as individual senators pointed out what they view to be inequities in the system that hurt hospitals in their own states.

Medicare’s area wage index system adjusts Medicare payments to hospitals based on geographic differences in the cost of labor.

Learn more about the criticisms that Azar and Senate Finance Committee members registered about Medicare’s area wage index system in the Modern Healthcare article “Azar calls out ‘absurdity’ in Medicare wage index.”