Noteworthy News

Archive for November, 2016


Social Determinants and Health Care

Amid growing recognition that social factors play at least much a role in the health of communities as medical care, growing attention is being paid to how best to address those social determinants in a health care system. With increasing use of alternative delivery models such as accountable care organizations, some approaches place health care at the heart of a hub-and-spoke model to address population health, supported by functions such as affordable housing, home health care, job training, and more. Another approach places community organizations at the hub of care models, with the health care system as a spoke feeding [&hellip

FAQ on New Medicaid Managed Care Rule

The Centers for Medicare & Medicaid Services has published an FAQ on the new regulation that governs the use of managed care when serving Medicaid and CHIP populations. Go here to find that FAQ and other links to other resources for learning more about the new Medicaid managed care regulation

HHS OIG Previews 2017 Interests

The Office of the Inspector General of the U.S. Department of Health and Human Services has published a document presenting the areas on which it intends to focus in 2017. Among the Medicaid issues on which the OIG will focus are delivery system reform incentive (DSRIP) payments, Medicaid ACOs, Medicaid provider taxes, Medicaid overpayments, and states’ risk assignment for providers that serve only Medicaid populations. For Medicare, the OIG will look at many issues, including ACOs, hospital wage data, the two-midnight rule, outlier payments, a comparison of provider-based and free-standing clinics, and more. And the OIG will examine long-term-care issues [&hellip

Retail Clinics Don’t Reduce Demand for ER Services

The presence of retail medical clinics near hospitals does not reduce the demand for low-acuity services at those hospitals’ emergency room. Or so reports a new study published in the Annals of Emergency Medicine. Contrary to what was expected amid the proliferation of retail medical clinics – there were only a little more than 100 such clinics in 2006 but more than 2000 today – patients are not choosing those clinics instead of hospital ERs for low-acuity medical needs. An important qualifier is that only about 60 percent of such retail clinics accept Medicaid, but most clinics are located in places [&hellip

MedPAC Still Unhappy With Doc Pay

Despite the recent regulation implemented by the Centers for Medicare & Medicaid Services to prevent hospitals from continuing to acquire physician practices so they can receive higher outpatient payments than those physicians receive in private practice, members of the Medicare Payment Advisory Commission appear to think that more needs to be done to equalize physician payments regardless of where they provide outpatient services. Or so MedPAC commissioners discussed during their public meeting in Washington, D.C. last week. One commissioner observed that physicians appear to become less productive when their practice is acquired by a hospital. Others noted the added costs [&hellip

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