CBO: Hospitals’ future finances depend on increasing productivity

http://www.healthcaredive.com/news/cbo-hospitals-future-finances-depend-on-increasing-productivity/426036/

  • A new analysis from the Congressional Budget Office (CBO) has recognized that changes in laws and regulations, prompted primarily by the ACA–notablyreduced Medicare payment updates and expanded insurance coverage–can be expected to significantly impact hospitals’ future finances.
  • To help provide a sense of the impacts, the CBO’s working paper predicted hospitals’ profit margins, and the share of hospitals that could lose money in 2025 under several different scenarios.
  • The researchers noted that they provided a wide range of estimates due to “substantial uncertainty” around the predictions and how hospitals will respond to the pressures of the federal healthcare law.

Aetna faces probe over ‘politically motivated’ Obamacare exit

http://www.healthcaredive.com/news/aetna-faces-probe-over-politically-motivated-obamacare-exit/426035/

  • A group of senators is seeking answers from Aetna about its abrupt decision to leave the ACA marketplaces following the DOJ’s challenge to the company’s proposed $37 billion merger with Humana.
  • The letter came Thursday from Senators Elizabeth Warren (D-Mass.), Bernie Sanders (I-Vt.), Edward J. Markey (D-Mass.), Sherrod Brown (D-Ohio), and Bill Nelson (D-Fla.).
  • While other insurers have also scaled back their ACA participation, the probe into Aetna comes in response to a letter from Aetna CEO Mark Bertolini in which the company is perceived to have directly threatened the government that it would leave the exchanges if the merger was not approved.

Aetna’s Bertolini counters accusation of power play against DOJ

http://www.healthcaredive.com/news/aetnas-bertolini-counters-accusation-of-power-play-against-doj/426236/

Image result for aetna

http://www.courant.com/news/connecticut/hc-bertolini-senators-20160912-story.html

  • Aetna CEO Mark Bertolini has responded to a letter from a group of senators who accused the company last week of exiting the majority of its ACA markets as a ploy against the federal government for challenging Aetna’s proposed merger with Humana.
  • Bertolini dismissed the senators’ arguments as”unfounded accusations,” the Hartford Courant reported.
  • Aetna spokesman T.J. Crawford told the Courant the company had not received a response from the senators.

AHA urges CMS to withdraw Medicaid DSH proposal

http://www.beckershospitalreview.com/finance/aha-urges-cms-to-withdraw-medicaid-dsh-proposal.html

Image result for hospital revenue cycle management initiatives

Click to access 160914-cl-medicaid-dsh.pdf

The American Hospital Association submitted a letter Tuesday to CMS, asking the agency to withdraw a proposed rule to include third-party payments when calculating the hospital-specific limitation on Medicaid disproportionate share hospital payments.

In its proposal, CMS says the rule is simply a clarification on existing policy.

“Specifically, the rule would make clearer in the text of the regulation that uncompensated care costs include only those costs for Medicaid eligible individuals that remain after accounting for payments received by hospitals or on behalf of Medicaid eligible individuals, including Medicare and other third-party payments that compensate the hospitals for care furnished to such individuals,” the proposed rule states.

In the letter to CMS, the AHA argues the proposed rule is more than a clarification and actually establishes new policy. According to the AHA, CMS proposed the rule to avoid potentially unfavorable rulings in cases pending in federal court that address the DSH payment calculation.

Medicare audits up 936% in last 5 years

http://www.beckershospitalreview.com/finance/medicare-audits-ups-936-in-last-five-years.html

OR Efficiencies

http://www.racmonitor.com/rac-enews/2150-medicare-audits-drg-downcoding-in-hospitals-algorithms-substituting-for-medical-judgment-part-i.html

This is how the presidential election is shaping the ongoing drug price debate

This is how the presidential election is shaping the ongoing drug price debate

Change Capsule Pill Filled with Word on Balls

In this year’s presidential campaign, health care has taken a back seat. But one issue appears to be breaking through: the rising cost of prescription drugs.

The blockbuster drugs to treat hepatitis C as well as dramatic price increases on older drugs, most recently the EpiPen allergy treatment, have combined to put the issue back on the front burner.

Democrat Hillary Clinton just issued a lengthy proposal to address what her campaign calls “unjustified price hikes for long-available drugs.” That’s in addition to a broader proposal to address high drug prices the campaign put out last fall.
Republican Donald Trump, meanwhile, has said little about health care since announcing his candidacy in 2015, but he has several times called for a change in law to allow Medicare to negotiate drug prices for the population it serves.

Here are five reasons why this issue is back — and why it is so difficult to solve.

California Moves to Allow Undocumented Immigrants to Buy Insurance

In a move that is sure to draw the ire of Republicans, California officials are asking the Obama administration this week to approve a plan that would allow undocumented immigrants to buy health insurance on the state’s public exchange.

Officials say that up to 30 percent of the state’s two million undocumented adults could be eligible for the program, and that roughly 17,000 people are expected to participate in the first year, if the plan is approved. But the proposal faces serious hurdles in Washington, where it must be approved by both the Treasury and the Health and Human Services Departments.

During debates over health care in his first term, and again when Congress considered an immigration overhaul in 2013, President Obama made it clear that health insurance subsidies under the Affordable Care Act would not go to immigrants who are living in the United States illegally. And two provisions of the health care law limit coverage to residents who are here legally. But advocates of California’s initiative argue that the plan should be approved under what is known as an “innovation waiver,” which allows states to have provisions of the federal law modified, because no federal dollars will be used to fund the program.

 

Studies: Employer Costs Slow As Consumers Use Less Care, Deductibles Soar

http://khn.org/news/studies-employer-costs-slow-as-consumers-use-less-care-deductibles-soar/?utm_campaign=CHL%3A+Daily+Edition&utm_source=hs_email&utm_medium=email&utm_content=34365867&_hsenc=p2ANqtz-8KEto_GP9_uQqUz3i-mPzdbfQDEppu8jP4OnWeCEXc0J1QCOvNd0hi84YGIhj1horx7qHfq8_4658aqWRUhtoQ9n9XQQ&_hsmi=34365867

Pocketbook pain: Workers’ contributions to health-plan premiums have been rising faster than their pay. Deductibles have risen even more. (Courtesy of Kaiser Family Foundation)

Employer health insurance expenses continued to rise by relatively low amounts this year, aided by moderate increases in total medical spending but also by workers taking a greater share of the costs, new research shows.

Average premiums for employer-sponsored family coverage rose 3.4 percent for 2016, down from annual increases of nearly twice that much before 2011 and double digits in the early 2000s, according to a survey by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

But 3.4 percent is still faster than recent economic growth, which determines the country’s long-run ability to afford health care.

And the tame premium increases obscure out-of-pocket costs that are being loaded on employees in the form of higher deductibles and copayments. Another new study suggests those shifts have prompted workers and their families to use substantially fewer medical services.

For the first time in Kaiser’s annual survey, more than half the workers in plans covering a single person face a deductible of at least $1,000. Deductibles for family plans are typically even higher.

How companies are quietly changing your health plan to make you pay more

https://www.washingtonpost.com/news/wonk/wp/2016/09/14/the-quiet-change-to-insurance-plans-thats-making-health-care-more-expensive-for-patients/?_hsenc=p2ANqtz–a1tLHuuWbLDRr3vfl_vZWfJIr1163X7jwzsY9F5bjKZH9j8pjJ07N0ZJpCrTMnoGIXnIr7TqG7dAsJwyjClgznOWyIg&_hsmi=34365867&utm_campaign=CHL%3A%20Daily%20Edition&utm_content=34365867&utm_medium=email&utm_source=hs_email

Rich hospital, poor hospital divided by politics and a river

http://www.chicagotribune.com/news/sns-wp-blm-health-states-972aeae8-7a71-11e6-8064-c1ddc8a724bb-20160914-story.html

Image result for rich hospital poor hospital divided by a river and politics

When hospital executive Jeanette Wojtalewicz visits CHI Health’s Mercy Council Bluffs facility across the Missouri River in Iowa, she sees the new clinics and doctors’ offices partly paid for by the state’s decision to expand Medicaid to thousands of residents.

Back on her side of the river is CHI Health’s Creighton University Medical Center in Omaha, Nebraska, a state that opposed making more low-income people eligible for the government health-insurance program. While Mercy thrives about seven miles away, Creighton is cutting 250 beds to raise efficiency amid slumping financial results.

“There’s not a big geographical difference, but because of the regulations, there are big differences in the numbers,” said Wojtalewicz, chief financial officer at CHI Health, a 15-facility, nonprofit hospital system.

President Barack Obama’s Patient Protection and Affordable Care Act is as divisive as ever six years after its passage, with Republicans including presidential candidate Donald Trump vowing to repeal it. Yet as critics focus on the legislation’s insurance mandates and penalties, the biggest impact has come from Medicaid expansion, a decision made at state level.