Noteworthy News

Archive for January, 2016


Challenges In Determining Effectiveness of Dual-Eligible Programs

The federal government is encountering challenges in evaluating the effectiveness of programs designed to serve low-income elderly patients served by both Medicare and Medicaid – patients known as dual-eligibles. Or so concludes the U.S. Government Accountability Office in a new report. With the dually eligible accounting for 35 percent of total Medicare and Medicaid expenditures, the Centers for Medicare & Medicaid Services’ “Financial Alignment Initiative” has worked to find new and better ways to care for such individuals. Such efforts have been plagued, however, by challenges in locating such individuals at times because they are often part of a transient [&hellip

Report on Social Risk Factors in Medicare Payments

As Medicare continues to move toward making provider payments based on patient outcomes rather than services provided, the National Academies of Sciences, Engineering, and Medicine has issued a new report on the potential impact of socio-economic factors on those patient outcomes. The report, commissioned by the U.S. Department of Health and Human Services, is based on a literature search and identifies five socio-economic risk factors that could affect Medicare patient outcomes and quality measures: socio-economic status; race, ethnicity, and cultural context; gender; social relationships; and residential and community context. HHS asked the Academies to look into this issue because of [&hellip

New Medicaid Enrollees Cost Less to Serve

Contrary to fears that the long-time uninsured who became eligible for Medicaid under Affordable Care Act eligibility expansion would turn to providers with a long litany of expensive-to-treat medical problems, preliminary data suggests that such individuals are actually less costly to treat than the average Medicaid recipient. Preliminary data released by the Centers for Medicare & Medicaid Services based on claims data from the first quarter of 2014 – the first time period after Medicaid expansion began in some states – found that the average new adult Medicaid enrollee cost $4513 to serve, as opposed to the $7150 it cost [&hellip

NAUH Urges MedPAC to Reconsider Medicare DSH Proposal

At their December meeting, members of the Medicare Payment Advisory Commission discussed the possibility of recommending to the Centers for Medicare & Medicaid Services that Medicare calculate a portion of eligible hospitals’ Medicare disproportionate share hospital payments (Medicare DSH) using the Medicare cost report’s S-10 form. That form seeks to capture how much uncompensated care hospitals provide. NAUH has long opposed the use of the S-10 to calculate the uncompensated care portion of Medicare DSH payments and wrote to MedPAC asking the commissioners not to make such a recommendation to CMS. In making this argument, NAUH cited the lack of [&hellip

Medicare Expands ACO Participation

121 new organizations will be participating in Medicare accountable care organization programs, the Centers for Medicare & Medicaid Services announced this week. 100 new ACOs will join the 150 already participating in the Medicare Shared Savings Program, which rewards organizations that reduce their growth in health care costs while meeting quality performance standards. Of the 250 overall participants, 39 will also participate in a new ACO Investment Model that will provide pre-paid shared savings to encourage the formation of new ACOs in rural and underserved areas. Another 21 ACOs will participate in the Next Generation ACO Model, a new initiative [&hellip

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