Verdict: Medicaid Expansion Improved Care and Access

A new review of studies published since the Affordable Care Act’s Medicaid expansion has concluded that expansion improved care, access to care, and coverage in states that expanded their Medicaid programs.

Among the improvements cited by studies are:

  • greater use of primary care
  • more preventive health visits
  • more behavioral health care
  • shorter hospital stays
  • fewer avoidable hospital admissions
  • reduced access problems
  • reduced reliance on hospital ERs as a primary source of care
  • improved monitoring and compliance rates for patients with diabetes and hypertension
  • higher rates of screening for prostate cancer and Pap smears

In addition, hospitals provided less uncompensated care and had better margins.

Learn more in the Health Affairs study “The Effects Of Medicaid Expansion Under The ACA:  A Systematic Review,” which can be found here, or go here for a Healthcare Dive summary of the study.…

CMS Reports on Medicaid Long-Term Care Spending

The Centers for Medicare & Medicaid Services has issued a report on FY 2016 spending for Medicaid-covered long-term services and supports.  The highlights of the $167 billion in state and federal spending include:

 

  • Home and community-based services have accounted for almost all Medicaid long-term services and supports growth in recent years.
  • Home and community-based services spending increased 10 percent in FY 2016, greater than the five percent average annual growth from FY 2011 through 2015.
  • Institutional spending remained close to the FY 2010 amount.
  • Institutional service spending decreased two percent in FY 2016 following an average annual increase of 0.3 percent over the previous five years.
  • Long-term services and supports provided through managed care continued to grow as states expanded their use of managed long-term services and supports delivery systems.
  • Managed long-term services and supports spending amounted to $39 billion in FY 2016, a 24 percent increase from $32 billion in FY 2015.

Learn more about Medicaid spending and trends for long-term care and long-term services and supports in the new CMS report “Improving the Balance: The Evolution of Long Term Services and Supports, FY 1981-2014,” which can be found here.…

CMS Introduces Medicaid “Scorecard”

The Centers for Medicare & Medicaid Services has unveiled a “scorecard” through which interested parties will be able to monitor outcomes for state Medicaid programs, state CHIP programs, and CMS itself while also comparing the performance of states to one another.

The purpose of the scorecard, according to CMS, is “to modernize the Medicaid and CHIP program through greater transparency and accountability for the program’s outcomes.”

CMS also explained that

The first version of the Scorecard includes measures voluntarily reported by states, as well as federally reported measures in three areas: state health system performance; state administrative accountability; and federal administrative accountability. The metrics included in the first Scorecard reflect important health issues such as well child visits, mental health conditions, children’s preventive dental services, and other chronic health conditions. The Scorecard represents the first time that CMS is publishing state and federal administrative performance metrics – which include measures like state/federal timeliness of managed care capitation rate reviews, time from submission to approval for Section 1115 demonstrations, and state/federal state plan amendment processing times.

It is not clear at this time how CMS will use the scorecard or what its value might be.

Learn more about the new CMS …

Review: Telehealth Shows Mixed Results

A federal review of the use of telehealth services suggests that such services may be appear useful in helping to improve care and reduce costs under certain conditions but are less useful in others.

According to a draft currently under review by the Agency for Health Care Research and Quality,

  • Remote intensive care unit (ICU) consultations likely reduce ICU mortality and ICU length of stay (LOS); specialty telehealth consultations likely reduce the time patients spend in the emergency department; and remote consultations for outpatient care likely improve access and a range of clinical outcomes (moderate strength of evidence in favor of telehealth).
  • Findings with lower confidence are that telehealth consultations may: reduce inpatient LOS and costs; may improve outcomes and reduce costs for emergency care due to fewer transfers; and may reduce outpatient visits and costs due to travel (low strength of evidence in favor of telehealth).

On the other hand,

  • Current evidence reports no difference in overall hospital LOS with remote ICUs, no difference in clinical outcomes with inpatient telehealth specialty consultations, no difference in mortality but also no difference in harms with telestroke consultations; and no difference in satisfaction with outpatient telehealth consultations (low strength of evidence of

Study Raises Questions About Progress Toward Reducing Readmissions

A new study suggests that the reduction in hospital readmissions of recent years may not be as meaningful a reflection of improved quality of care as some observers believe.

According to a new study published in the New England Journal of Medicine, at the same time that hospitals have reduced their readmissions of Medicare patients in response to penalties imposed through Medicare’s hospital readmissions reduction program, the rate of readmission of patients who are hospitalized for observation stays after visiting the emergency room has increased 35 percent.  This increase in readmissions for observation stay patients comes at a time, moreover, when hospitals are making far greater use of observation stays to serve emergency patients than they did in the past.

Learn more about these new findings and their potential implications in the study “Excluding Observation Stays From Readmission Rates – What Quality Measures are Missing,” which can be found here, or go here for a Fierce Healthcare summary.

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