Noteworthy News

Archive for April, 2014


Report Questions Fairness of Medicare Quality and Incentive Programs

A draft technical report by the National Quality Forum has called into question the fairness of Affordable Care Act Medicare programs that seek to provide financial incentives to hospitals that meet selected quality care standards and penalize those that fail to meet those standards. According to the report, which was commissioned by the Obama administration, these programs unfairly penalize hospitals that care for especially large numbers of low-income seniors. The report notes, according to the New York Times, that Low-income people may be unable to afford needed medications or transportation to doctor’s offices and clinics, the panel said. If they [&hellip

OIG Recommends Site-Neutral Payments for Some Medicare Outpatient Surgery

The Centers for Medicare & Medicaid Services’ (CMS) Office of the Inspector General (OIG) has recommended that Medicare introduce site-neutral payments for low-risk and no-risk surgical procedures that could be performed in ambulatory surgical centers instead of hospital outpatient facilities. By lowering Medicare payments for procedures that could be performed in ambulatory surgical centers instead of more costly hospital outpatient departments, Medicare could save $15 billion from 2012 through 2017 while beneficiaries could save another $3 billion in cost-sharing payments, the report concluded. Medicare rejected the recommendation in part because it did not include clinical criteria for determining which surgical [&hellip

Medicare Risk Adjustment Methodology Questioned

Medicare should perform risk adjustment of payments to hospitals and insurers based on socioeconomic considerations or the overall health of populations rather than on the medical conditions of patients, according to a new study. Analysts at the Dartmouth Atlas Project compared the current methodology, which adjusts risk, and therefore payments, based on the underlying medical condition of Medicare patients, to several other risk adjustment methodologies and found that socioeconomic considerations – that is, the poverty of the region in which patients live – and the overall health of regional populations is a better approach to payment risk adjustment. Risk adjustment [&hellip

Community Factors Influence Readmissions, Study Says

A new study reports that a variety of factors, including several linked to socio-economic status, account for 58 percent of the variation in the rate of Medicare hospital readmissions at the county level. Among those factors are low employment, living alone, inability to afford care, the supply of primary care providers and specialists, access to post-discharge nursing home care, and more. The study found that The evidence shows that after accounting for patient-risk factors (done by the risk- standardization of the publicly reported rates) and community socioeconomic factors (such as income and employment levels), as well as accounting for hospital [&hellip

Medicaid Growth Doesn’t Mean Increased ER Use

A new study has found that increased enrollment in Medicaid does not necessarily result in increased use of hospital emergency rooms. Nor does it necessarily contribute to difficulty obtaining care. According to a study of ten states that eased their Medicaid eligibility requirements between 2000 and 2009, emergency room use among Medicaid patients decreased, as it did in those states that did not ease their eligibility requirements, and the proportion of Medicaid patients reporting difficulty getting access to care declined in expansion states while remaining unchanged in states that did not expand. This is an issue that urban safety-net hospitals [&hellip

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