Hospital Uncompensated Care Unchanged in 2017

Despite a modest increase in the uninsured rate, hospital uncompensated care in 2017 was $38.4 billion, essentially the same as it was in 2016 and down from the all-time high of $46.8 billion in 2013.

This comes from an American Hospital Association survey that also found that in 2017,

  • hospital admissions and inpatient days rose modestly
  • hospital outpatient visits and surgeries increased
  • emergency room visits declined
  • the proportion of for-profit hospitals declined
  • the number of rural hospitals fell

Learn more in the Healthcare Dive article “Uncompensated care costs flat in 2017 despite uptick in uninsured.”

Medicaid MCOs Skimping on Care?

Medicaid MCOs may be skimping on care, according to a recent Kaiser Health News report.

According to Kaiser, for-profit companies that sub-contract with Medicaid managed care organizations to review requests for services often deny care to Medicaid patients to save money for the MCOs that employ them and to benefit themselves financially.

The Kaiser article presents examples of companies that have been identified engaging in such practices, explains how they go about their work, and outlines the dangers to Medicaid recipients posed by such practices.

Learn more in the Kaiser Health News article “Coverage Denied: Medicaid Patients Suffer As Layers Of Private Companies Profit.”

CMS Revamps Medicare ACO Program

The federal government seeks to pursue greater savings and an accelerated approach to value-based care through an overhaul of its programs for Medicare accountable care organizations.

The Centers for Medicare & Medicaid Services’ new “Pathways to Success” program seeks to speed up the process of providers assuming risk for costs and outcomes through the following changes from the agency’s current approach.

  • A reduction in how long participating ACOs can remain in the program without assuming some responsibility for their spending.
  • Modifications that CMS hopes will encourage physician groups to remain independent of hospitals and health systems.
  • Greater flexibility to innovate in exchange for participating in performance-based risk.
  • Permission to offer new incentives to patients to take greater responsibility for their own health.
  • Incorporation of regional spending differences when setting individual ACOs’ target spending and to foster greater alignment with Medicare Advantage programs.

Learn more about CMS’s new Pathways to Success Program for Medicare ACOs by reading this program announcement and the regulation detailing how the ACO program will change.…

Readmissions Program Failing Some Heart Patients?

The 30-day mortality rate has risen for heart failure patients since Medicare’s hospital readmission reduction program was implemented.

According to a new study published in JAMA, the 30-day mortality rate for heart failure patients rose 0.49 percent between 2007-2010 and 2010-2012 and another 0.52 percent between 2010-2012 and 2012-2015.

Similar results were not found for the other types of patients whose readmission rates are measured under the program:  patients who were hospitalized for heart attacks, heart bypass surgery, pneumonia, chronic obstructive pulmonary disease, and hip or knee replacement.

The heart failure findings, though, raise the question of whether performance under the readmissions reduction program is a true barometer of the quality of care individual hospitals provide.

Learn more about the study, its findings, and their implications in the study “Association of the Hospital Readmissions Reduction Program With Mortality Among Medicare Beneficiaries Hospitalized for Heart Failure, Acute Myocardial Infarction, and Pneumonia,” which can be found here, on the JAMA web site.…

CMS to Create New Office for Regulatory Reform

In 2019 the Centers for Medicare & Medicaid Services intends to create a new office to address regulatory reform.

CMS administrator Seema Verma recently announced her intention to create this office, but other than saying its priority would be to reduce regulatory burden, offered no details.

See a brief notice about the new office here.…