Noteworthy News

Archive for March, 2013


MedPAC May Look at Readmissions Policy

The new federal policy that penalizes hospitals for “excessive” readmissions of Medicare patients may need reconsideration. Or so believes MedPAC, the independent federal agency that advises Congress on Medicare payment issues. Under a program launched in 2010 but that began affecting hospitals last October, Medicare assesses financial penalties against hospitals that have what it believes to be “excessive” readmissions of patients suffering from a limited group of medical problems.  The penalties, up to one percent of hospitals’ base Medicare payments, will eventually rise to two percent of those payments.  Since the program’s introduction, many hospitals have successfully reduced their readmission [&hellip

“Observation Status” Draws Attention

Members of Congress are taking a closer look at hospital “observation status” in which patients occupy regular hospital beds for a short period of time yet have not technically been admitted to the hospital. Medicare patients designated with this status can be left with large hospital bills and lack of coverage for needed post-acute services.  Many such patients have no idea they were never actually admitted to the hospital. The financial implications of observation can be especially troublesome for patients served by urban safety-net hospitals, many of whom have limited means with which to pay unexpected medical bills or to [&hellip

Feds Still Overpaying Medicare Advantage Plans

As a result of hospital coding practices, Medicare is still overpaying Medicare Advantage plans. Or so says the U.S. Government Accountability Office (GAO). According to the new GAO report Substantial Express Payments Underscore Need for CMS to Improve Accuracy of Risk Score Adjustments, the impact of coding differences from 2010 through 2012 was greater than Medicare’s adjustment for such coding and as a result, Medicare overpaid Medicare Advantage plans at least $3.2 billion during that period.  The GAO recommends a number of steps to help Medicare improve its risk score adjusting practices. Find a summary of the GAO report and [&hellip

Fewer Uninsured: How it Happened

An increase in people insured by public programs spurred a drop in the uninsured rate from 18.5 percent to 18 percent in 2011 according to a new report. Much of that decrease was driven uninsured adults who became eligible for Medicaid and children who were enrolled in their state’s Children’s Health Insurance Program (CHIP). In addition, the Affordable Care Act provision that enabled young adults between the ages of 19 and 25 to receive coverage under their parents’ health insurance plan led to an increase in the insured rate in that age group. Learn more about these and the other [&hellip

Oregon Blazes New Path to Medicaid Savings

Reducing Medicaid costs without cutting eligibility, eliminating benefits, or slashing provider payments? Led by a governor who also is a physician, the state of Oregon is doing exactly that with use of what it calls Medicaid coordinated care organizations and is on target to save $7 billion over the next decade. How is Oregon doing it and what lessons might its efforts offer to states in which urban safety-net hospitals care for so many Medicaid patients?  Learn more in this Politico article

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