Noteworthy News

Archive for December, 2014


Access to Medicaid Services

A commentary in the New England Journal of Medicine by noted Medicaid expert and advocate Sara Rosenbaum examines the issues of access to Medicaid services, the effect of adequate (or inadequate) Medicaid reimbursement on that access, and the role the federal government and public policy can play in enhancing access to care for low-income Medicaid recipients. Find that commentary here. &nbsp

MedPAC Moves Toward Recommending Site-Neutral Payments for Rehab Services

The independent agency that advises Congress on Medicare payment issues is likely to recommend that Congress require Medicare to implement site-neutral payments for some rehabilitation services. During last week’s meeting of the Medicare Payment Advisory Commission (MedPAC), members received a briefing from their staff that compared the costs and efficacy of treatment for conditions currently treated at both inpatient rehabilitation hospitals and skilled nursing facilities.  Based on this presentation, MedPAC is leaning toward recommending to Congress that research be undertaken to identify specific medical conditions that can be treated effectively at either type facility and then make Medicare payments for [&hellip

MedPAC Considers FY 2016 Pay Boost for Inpatient, Outpatient Payments

Medicare payments to hospitals for inpatient and outpatient care could rise 3.25 percent in the coming fiscal year. At least that is what members of the Medicare Payment Advisory Commission (MedPAC) discussed recommending to Congress when they met last week in Washington. During MedPAC’s two-day public meeting, members discussed recommending to Congress a 3.25 percent increase in Medicare inpatient and outpatient payments in FY 2016.   They will vote on their recommendation at their next meeting. A presentation to MedPAC members by their staff also offered a number of observations about Medicare services: Demand for hospital services is stable. With hospital [&hellip

Medicaid Primary Care Fees to Plummet

Payments to primary care physicians who serve Medicaid patients will fall an average of 42.8 percent beginning next year when the Affordable Care Act’s two-year increase in those payments ends. In some states – California, Florida, Illinois, New Jersey, New York, and Pennsylvania – they will decline more than 50 percent. The cuts are even greater than the reductions in Medicare payments that Congress had to intervene to prevent because of the Medicare sustainable growth rate formula (the so-called Medicare doc fix). The temporary fee increase was included in the Affordable Care Act to attempt to induce more primary care [&hellip

Unemployment Plays Major Role in Hospital Readmissions

A new study has found that employment status is the leading socioeconomic indicator of hospital readmissions for patients who have suffered heart attacks, heart failure, and pneumonia. Using 2011 and 2012 data from the Centers for Medicare & Medicaid Services, researchers examined readmissions for these conditions based on nine factors that constitute what is known as the Community Needs Index:  elderly poverty, single parent poverty, child poverty, lack of health insurance, minority, no high school, renting, unemployment, and limited English.  Their analysis found that only employment status and lack of high school education were statistically significant predictors of hospital readmissions [&hellip

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