Noteworthy News

Archive for January, 2014

 

Retail Recruiting During Wholesale Times

While most observers keep an eye on state-wide and national health insurance enrollment figures in search of leaps in the tens and even hundreds of thousands of people, the process of enrolling low-income adults in state Medicaid programs for which they are newly eligible is a much slower and more difficult process. If national progress can be viewed as change on a wholesale scale, then enrolling the homeless is a retail effort with results measured one by one. In urban areas across the country, outreach workers are visiting shelters, food pantries, and alleyways in search of candidates for Medicaid coverage.  [&hellip

The Time May Have Arrived for a Permanent “Doc Fix”

Congress appears serious about addressing a long-running problem:  the need for an annual “Medicare doc fix” to address the problem stemming from the use of the sustainable growth rate formula, or SGR, to determine Medicare payments for physician services. For years, application of the SGR called for reductions in Medicare payments to doctors, forcing Congress to apply temporary patches to the problem – and to find ways to pay for those patches. Now, however, Congress appears intent on doing away with the SGR and fixing the problem once and for all. But what exactly is the problem, what will it [&hellip

Safety-Net Hospitals Hurt More by Readmissions Reduction Program

Hospitals that care for large numbers of low-income seniors are disproportionately harmed by Medicare’s hospital readmissions reduction program, according to a new study. According to the study, Both patient dual-eligible status and a hospital’s dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended [&hellip

Medical Homes Model Showing Potential

The “medical homes” model for providing health care is showing promise as a way of reducing the cost of care, reducing utilization of unnecessary medical services, improving access to care, and improving population health. These are among the findings in a meta-study by the Patient-Centered Primary Care Collaborative.  The study brings together findings from 21 studies published between August of 2012 and last December. Medical homes are a major component of accountable care organizations, which are viewed as another important tool in addressing rising health care costs and improving the quality of care delivered.  Many urban safety-net hospitals are pursuing [&hellip

Providers Receive Expanded Authority to Extend Presumptive Medicaid Eligibility

While hospitals and providers in 33 states have long enjoyed the ability to extend presumptive eligibility for Medicaid to children or pregnant women, that authority is now being extended in some states to any adults whose income appears likely to fall below 138 percent of the federal poverty level. The extension of this authority comes via the Affordable Care Act, which also offers states the option of expanding Medicaid eligibility for their residents.  Individual states decide whether to extend this authority, which is typically wielded by hospitals, schools, clinics, other providers of care to the Medicaid and CHIP population, Head [&hellip

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