CMS proposed Monday a new mandatory bundled payment program for heart attacks and bypass surgeries that includes changes to the existing Comprehensive Care for Joint Replacement Model as part of its larger goal to shift Medicare from quantity to quality incentives.
Here are 10 things to know about the proposed rule.
http://www.healthcarefinancenews.com/news/c-suite-feels-ripple-effect-medicaid-expansion-study-says
Medicaid expansion is making a difference as to whether hospitals are investing in clinics, new equipment and hiring new staff, or looking at the status quo and layoffs, according to a recent report by Georgetown University Health Policy Institute.
Hospitals in Medicaid expansion states have realized a drop in uncompensated care; an increase in institutional financial security; new community efforts to integrate and improve care; and innovative programs to expand access to specialists, according to the study.
CEOs who head hospitals in both expansion and non-expansion states said they saw a drop in uninsured rates in expansion states that was not as dramatic in non-expansion states.
This has translated to a decline in uninsured patient stays by close to 40 percent. Non expansion states reported a decline of 2.9 percent.
Nineteen states have yet to expand their Medicaid programs under theAffordable Care Act, and a new study from the Robert Wood Johnson Foundation shows just how much enrollment would increase if they did: 7.8 to 8.8 million, while the number of uninsured would decline between 4.1 and 5 million, the research found.
That’s in addition to about 6.9 million people who would be subtracted from the ranks of the uninsured under the major coverage provisions of the ACA.
More than half of these people would be in three states: Texas (1.2 million), Florida (877,000), and Georgia (509,000). More than four-fifths of the uninsured people gaining Medicaid eligibility would be adult without children, while about 48 percent of the uninsured gaining eligibility would be white non-Hispanic; 52 percent are working either full- or part-time.
Two of the nation’s largest insurers are reaching out to doctors as they prepare to offer health coverage to low-income residents in California’s Medicaid program.
UnitedHealth and Aetna plan to join Medi-Cal managed care in San Diego and Sacramento counties beginning next year, pending final state approval.
Their participation shows that “Medi-Cal is a good business to be in,” said Stan Rosenstein, a consultant with Health Management Associates and a former Medi-Cal administrator. “Insurers are recognizing that with Medi-Cal covering a third of Californians, [they] really can’t ignore it.”
http://khn.org/news/five-health-issues-presidential-candidates-arent-talking-about-but-should-be/
References to the Affordable Care Act — sometimes called Obamacare — have been a regular feature of the current presidential campaign season.
For months, Republican candidates have pledged to repeal it, while Democrat Hillary Clinton wants to build on it and Democrat Bernie Sanders wants to replace it with a government-funded “Medicare for All” program.
But much of the policy discussion stops there. Yet the nation in the next few years faces many important decisions about health care — most of which have little to do with the controversial federal health law. Here are five issues candidates should be discussing, but largely are not:
http://khn.org/news/hospital-finance-measure-on-california-ballot-may-stump-voters/
California voters will be asked to weigh in this November on a hospital financing measure so politically and financially complicated that they might be tempted to avoid it altogether.
The initiative, Proposition 52, would make permanent the “Hospital Quality Assurance Fee,” which the state collects from private hospitals to bring in additional federal dollars for Medi-Cal, California’s version of the federal Medicaid health care program for the poor. The federal government matches money that California puts up to fund Medi-Cal services.
The dollars generated by the fee are used to fund hospital services and children’s health care under Medi-Cal, and the ballot measure would help ensure the money is not diverted by lawmakers for other uses.
Hospitals like the fee, which has been in place since 2009, because it gives them a big financial boost in what they say is an underfunded government health program. In the 2015-2016 fiscal year, hospitals received an additional $3.5 billion to pay for services they provided to Medi-Cal patients, according to the state Legislative Analyst’s Office.
The Republican National Convention pulled up stakes after it concluded yesterday, but a visitor to the convention floor says that the Affordable Care Act is here to stay.
In an interview with CBS This Morning, Cleveland Clinic Chief Executive Officer Toby Cosgrove, M.D., said that it was unlikely that the ACA would be uprooted, even if Republican Donald J. Drumpf is elected President and there are GOP majorities in both houses of Congress.
“I don’t think you will see something now six years into the process totally dismantled,” Cosgrove said, adding that the healthcare reform law has led to insurance coverage for 20 million more Americans. Cosgrove suggested that it was more likely that the ACA would undergo continuing improvements such as “more wellness activities.”
HENRY KOTULA 