Archive for April, 2019


Bureaucratic Requirements May Be Driving Medicaid Enrollment Decline

State eligibility redetermination processes may be pushing down Medicaid enrollment nation-wide.

Last year, national Medicaid enrollment fell 1.5 million, more than half of them children, and according to a new report from Families USA, much of that decline may be attributable to the challenging eligibility redetermination requirements imposed on Medicaid-eligible individuals by some states.

Those requirements include a 98-page packet that Tennessee sends to individuals seeking to retain their Medicaid eligibility; Arkansas’ limit of 10 days to respond to requests for information to redetermine eligibility; and Missouri’s decision to discontinue using data from other public safety-net programs to redetermine eligibility.

Others point to an improving national economy and new Medicaid work requirements as the primary causes of declining Medicaid enrollment.

Learn more in the Families USA report “The Return of Churn: State Paperwork Barriers Caused More Than 1.5 Million Low-Income People to Lose Their Medicaid Coverage in 2018.”

Adverse Selection May Explain Rising ACO Costs

Hospital ACO costs are rising because of the sicker patients they attract, a new study suggests.

According to researchers at University of Wisconsin Health, patients served by traditional Medicare or by physician-led accountable care organizations often switch to hospital-led Medicare ACOs as they encounter health problems, bringing those hospital-led ACOs sicker patients than those otherwise served by such organizations.  As a result, the per patient costs of hospital-led Medicare ACOs often rise more than those of the costs of traditional Medicare and physician-led ACOs.  Often, these shifts are encouraged by patients’ medical specialists.

Hospital-led Medicare ACOs have been criticized for their failure to control rising costs but this adverse selection may explain that failure, researchers found.

Learn more in the Health Affairs study “Hospital ACO costs are rising because of the sicker patients they attract, a new study suggests.”


Readmissions Program Changes Produce New Outcomes

Many hospitals are faring better under Medicare’s hospital readmissions reduction program since changes in that program were implemented earlier this fiscal year.

According to a new study, safety-net, academic, and rural hospitals have enjoyed improved performance under the program since Medicare began organizing hospitals into peer groups based on the proportion of low-income patients they serve rather than simply comparing individual hospital performance to that of all other hospitals.

While the current fiscal year is still under way, it appears that safety-net hospitals will enjoy a collective decline of $22 million in Medicare readmissions penalties while 44.1 percent of teaching hospitals and 43.7 percent of rural hospitals will face smaller penalties than last year.

Learn more about the readmissions reduction program and how changes in that program have significantly altered its outcomes in the JAMA Internal Medicine study “Association of Stratification by Dual Enrollment Status With Financial Penalties in the Hospital Readmissions Reduction Program.”


CMS Posts Proposed FY 2020 Inpatient Regulation

Medicare would change its wage index system, raise inpatient fees, increase funding for Medicare disproportionate share hospital payments (Medicare DSH), enhance payments for new technologies, and make minor modifications in its hospital readmissions reduction, value-based purchasing, and hospital-acquired condition program if a proposed regulation published this week is ultimately adopted.

The Centers for Medicare & Medicaid Services has published its proposed FY 2020 Medicare inpatient prospective payment system regulation:  its plan for paying acute-care hospitals for Medicare-covered inpatient services in FY 2020.  The 1800-page regulation calls for major changes in Medicare’s wage index system – changes CMS says would “…address the disparities between high and low wage index hospitals…”  It would do so by increasing the wage indexes of many rural hospitals, regardless of their actual wage costs, and pay for those increases by reducing the wage indexes of high-index hospitals, again regardless of their actual wage costs.

The proposed regulation also would raise inpatient payments to hospitals 3.2 percent in the coming year.  In addition, it would add $216 million to its pool of money for Medicare DSH uncompensated care payments – an increase necessitated by this year’s increase in the number of uninsured Americans – while modifying the …

Primary Care Accounts for Little Medicare Spending

Spending for primary care services accounts for only about two percent of Medicare fee-for-service spending, a new study has found.

Even when the concept of primary care is expanded to include services provided by nurse practitioners, physician assistants, geriatricians, and gynecologists, all of whom bill for primary care services, that figure rises only to 4.88 percent.

The proportion of primary care spending falls as Medicare beneficiaries age, a reflection of their greater consumption of specialist, hospital, and surgical care as they get older.

Primary care spending was even lower among Medicare-eligible African-American, Native American, Medicaid-eligible seniors, and individuals with chronic medical conditions and lower than that for non-Medicare patients.

Learn more in the Rand Corporation study “Primary Care Spending in the Fee-for-Service Medicare Population,” which appeared in JAMA Internal Medicine.…