Noteworthy News

Archive for June, 2012


States Experimenting With Medicaid

Many states are responding to continuing budget pressures and the anticipated 2014 Affordable Care Act expansion of Medicaid eligibility by attempting to develop new ways to serve their Medicaid population. The primary vehicle for such experimentation is the section 1115 Medicaid waiver, which gives states limited authority to operate outside established federal Medicaid guidelines. States are using this flexibility to test new approaches to serving their Medicaid population:  new enrollment procedures, new eligibility criteria, new cost-sharing requirements, new uses of managed care, and new models for service delivery and payment. Many urban safety-net hospitals may find themselves operating under such [&hellip

The Language of Medicaid

Enhanced medical homes.  Global bundling.  Risk-based managed care. The list goes on. Current efforts to find new, better, and more economical ways to serve the Medicaid population have given rise to a new language:   the language of Medicaid in the 21st century.  Some of the terms used in today’s policy discussions are old, some are new, and some are not nearly as self-explanatory as they might seem. The Kaiser Commission on Medicaid and the Uninsured has compiled a glossary of these terms – a useful tool in an environment in which the federal government and state governments are constantly producing [&hellip

Proposed ER Criteria Could Hurt Urban Hospitals

Criteria that seek to measure the effectiveness of hospital emergency department operations could be disadvantageous to large urban hospitals, according to a recent report. New “throughput” measures endorsed by the National Quality Forum fail to reflect the different conditions that large urban hospitals face, according to the article “Exogenous Predictors of National Performance Measures for Emergency Department Crowding,” published recently in the Annals of Emergency Medicine.  The article noted that evaluating hospital ER operations based on measures such as waiting time and length of stay fails to reflect circumstances and conditions beyond hospitals’ control. If such criteria were ever to [&hellip

Oregon to Test New Approach to Medicaid

The federal government is giving the state of Oregon $2 billion to experiment with a new approach to serving the state’s Medicaid population. Under the Oregon approach, each of the state’s cities will have a coordinated care organization under which hospitals, doctors, and other providers serve Medicaid patients.  Outreach workers will coordinate the services providers deliver and ensure that patients receive the care they need in a timely manner.  In theory, having all of these providers and organizations working together will keep patients healthier and reduce health care costs – especially the high cost of hospitalization. The state’s governor, a [&hellip

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