Posted on June 13, 2013
For thirty years, the Medicare and Medicaid programs have furnished additional payments to hospitals that furnish a disproportionate share of services to low income populations. Despite the fact that the two disproportionate share hospital (DSH) programs share a common mission, they function differently in terms of how the funds actually move to hospitals and in the formulas used to make DSH payments. The Affordable Care Act makes significant adjustments in both DSH programs beginning in 2014 in anticipation of a significant expansion in the proportion of people who have health insurance coverage. With the United States Supreme Court’s decision in 2012 in NFIB v Sebelius, which permits states to opt out of the Medicaid expansion without risking the loss of federal funding for their existing Medicaid programs, the downward DSH payment adjustments become an even more significant matter for hospitals that treat large volumes of low income patients…
Interview of Phyllis Borzi, Assistant Secretary of Labor of the Employee Benefits Security Administration (EBSA), United States Department of Labor
Posted on June 11, 2013
Recently, Sara Rosenbaum, the Hirsh Professor of Health Law and Policy at the GW Department of Health Policy, had an opportunity to interview Phyllis Borzi, the federal official in charge of overseeing the Employee Benefits Security Administration (EBSA), for Health Reform GPS. EBSA is an agency of the United States Department of Labor responsible for administering, regulating and enforcing the provisions of Title I of the Employee Retirement Income Security Act of 1974 (ERISA), and the agency is playing an important role in the implementation of the Affordable Care Act….
Posted on June 7, 2013
The Congressional Budget Office (CBO) published a report describing the characteristics and costs associated with dual-eligible beneficiaries. A dual-eligible beneficiary, or dual, is someone that is eligible to receive benefits from both Medicare and Medicaid. Dual-Eligible Beneficiaries of Medicare and Medicaid: Characteristics, Health Care Spending, and Evolving Policies uses data from 2009 to examine the different payment systems used in both Medicare and Medicaid to pay for dual benefits, as well as methods by federal and state governments to integrate the payments systems and better coordinate care for this growing population.
Posted on June 3, 2013
In an expansion to the hospital charges data released last month, the Centers for Medicare and Medicaid Services (CMS) provided data describing charges for 30 different outpatient procedures. The data include charge estimates for Ambulatory Payment Classification Groups, which are paid under the Medicare Outpatient Prospective Payment System. Presented data are hospital-specific and report charge values collected during calendar year 2011.
Posted on May 20, 2013
The Centers for Medicare and Medicaid Services (CMS) released a final rule that requires Medicare Advantage (MA) and Medicare Part D issuers to comply with the medical loss ratio (MLR), which states that these issuers must spend 85% of their premium revenues on patient services. The MLR permits only 15% of this revenue to be spent on organization administrative and overhead costs. MA and Part D issuers are required to submit data to CMS that allows consumers to use the sponsor’s MLR as a measure of efficiency. If the plan sponsors do not meet the MLR requirements, they will be subject to financial penalties, enrollment sanctions, and potential contract termination if issuers repeatedly miss the minimum MLR requirement.
Posted on May 15, 2013
The Congressional Budget Office (CBO), in conjunction with the Joint Committee on Taxation (JCT), issued updated budget projections for fiscal years 2014-2023, which include updated impact estimates of the insurance provisions in the Affordable Care Act (ACA). Slower than anticipated growth in health care spending, particularly in programs such as Medicare and Medicaid, is one of several factors that influenced the revised estimates…
Posted on May 8, 2013
In an effort to increase health care affordability and transparency, the Centers for Medicare and Medicaid Services (CMS) published data pertaining to hospital charges for the 100 most common services provided during Medicare inpatient stays. With more than 163,000 entries, the data released by CMS indicated wide variation in costs, both across the country and within similar regions. For instance, a joint replacement procedure can cost $5,300 in Ada, Oklahoma, while a similar procedure may cost upwards of $223,000 in Monterey Park, California. Similarly, heart failure treatments can cost anywhere between $9,000 and $51,000 in Jackson, Mississippi. To further promote the spirit of the Affordable Care Act (ACA), the US Department of Health and Human Services (HHS) will also be offering grants for entities to collect and analyze medical pricing and reimbursement data to aid consumers in their health care decision-making and promoting cost-effective care.
Posted on April 30, 2013
The Brookings Institution recently released a study that indicates how value-based payments and small, conscientious quality improvements to both the private and public insurance sectors can significantly reduce health care costs in the future. Bending the Cure: Person-Centered Health Care Reform, describes how such changes could save the federal government $300 billion over the next 10 years and more than $1 trillion over the next 20 years. Brookings finds that moving to patient-centered care is the ultimate means by which future cost savings can be achieved. For a specific example, the study proposes that Medicare should move away from the fee-for-service model and embrace comprehensive payment organizations.
Posted on April 29, 2013
The Centers for Medicare and Medicaid Services (CMS) released a proposed rule of more than 1400 pages describing the new Medicare payment schedule for 2014. The annual Acute Care Hospital Inpatient Prospective Payment System (IPPS) rule proposes that general acute-care hospitals will see a payment increase of 0.8% and long-term care hospitals will see their payments rise by 1.1%. Pursuant to the Affordable Care Act (ACA), the NRPM also details the new penalty program for hospitals that do not reduce nosocomial infections, adding hip and knee implants and chronic obstructive pulmonary disorder to the 30 day readmission penalty program. Another component of the proposed rule alters Medicare disproportionate share hospital (DSH) payments. Additional payments to each hospital will be made based upon its percentage of the total uncompensated care rendered at all DSH hospitals at a given time, ultimately reducing overall DSH payments by 0.9%. Furthermore, hospitals that do not participate in the Hospital Inpatient Quality Reporting (IQR) Program will be subject to additional penalties.
Comments will be due by June 25th, 2013.
Posted on April 25, 2013
On April 9th, the Senate Finance Committee held a confirmation hearing for Marilyn Tavenner to be the Administrator of the Centers for Medicare and Medicaid Services (CMS). Committee members submitted additional questions to Tavenner post-hearing on topics ranging from consumer outreach in state insurance Exchanges to pediatric dental services. Health Reform GPS has compiled a list of the Affordable Care Act related questions submitted by the Senate Finance Committee members. The list contains the name of the Senator asking the question, the question number, and the relevant ACA topic addressed.