Medicare and Medicaid Disproportionate Share Hospital Payments: Proposed Rules
Posted by Nikki Hurt 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…
CBO report addresses characteristics, spending and policies for duals
Posted by Nikki Hurt 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.
CMS releases additional hospital spending data
Posted by Nikki Hurt 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.
CBO releases new report describing budgetary impact of the ACA
Posted by Nikki Hurt 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…
CMS releases data on hospital charges
Posted by Nikki Hurt 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.
Brookings proposes reforms to save hundreds of billions in health care
Posted by Nikki Hurt 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.
CMS releases annual hospital IPPS rule
Posted by Nikki Hurt 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.
Impact of FY 2014 proposed budget on health
Posted by Nikki Hurt on April 15, 2013
Below is a brief outline regarding how the proposed budget for FY 2014 will impact health-related agencies, including the services and responsibilities therein. Specific line items provide the amount allocated to the agency or service, and in some instances, a justification for the rationale as to why that amount was proposed. Overall, the president allocated $949.9 billion to the US Department of Health and Human Services (HHS). Other key appropriations include funding for the Affordable Care Act’s (ACA) Exchanges, funds for mental health research and treatment, and changes in the delivery of Medicare and Medicaid to save hundreds of billions of dollars over the next decade.
GAO report finds ACA cost controls not enough to account for increased spending
Posted by Michal McDowell on February 27, 2013
The Government Accountability Office (GAO) yesterday released a report on the long-term costs of the Affordable Care Act (ACA). The report found that the long-term fiscal outlook depends largely on whether elements in the ACA designed to control cost growth are sustained. As federal health care spending is expected to continue growing faster than the economy over the next 75 years, the federal budget is on an unsustainable path, even with ACA measures intended to curb cost growth. Yesterday, at a Senate Budget Committee hearing, ranking member Jeff Sessions (R-Alabama), said the report showed the ACA will increase the deficit by $6.2 trillion over the next 75 years.
ACA cost curbing provisions include reduced payments from Medicare and Medicaid, the creation of a 15-member Independent Payment Advisory Board to make recommendations to reduce Medicare costs, and new taxes to pay for the health care expansion.
GAO releases report on high risk government programs
Posted by Michal McDowell on February 15, 2013
The Government Accountability Office (GAO) yesterday released an update regarding high risk government programs. In the report, GAO detailed 30 high risk areas, including Medicare and Medicaid.
GAO assigned Medicare as a high risk area because while the program covered beneficiaries at an estimated cost of $555 billion, the program reported improper payments estimated to be more than $44 billion. GAO identified several opportunities to modify Medicare to streamline program operations. Such opportunities include…