What Would Block Grants or Limits on Per Capita Spending Mean for Medicaid?

http://www.commonwealthfund.org/publications/issue-briefs/2016/nov/medicaid-block-grants

ABSTRACT

Issue: President-elect Trump and some in Congress have called for establishing absolute limits on the federal government’s spending on Medicaid, not only for the population covered through the Affordable Care Act’s eligibility expansion but for the program overall. Such a change would effectively reverse a 50-year trend of expanding Medicaid in order to protect the most vulnerable Americans.

Goal: To explore the two most common proposals for reengineering federal funding of Medicaid: block grants that set limits on total annual spending regardless of enrollment, and caps that limit average spending per enrollee.

Methods: Review of existing policy proposals and other documents.

Key findings and conclusions: Current proposals for dramatically reducing federal spending on Medicaid would achieve this goal by creating fixed-funding formulas divorced from the actual costs of providing care. As such, they would create funding gaps for states to either absorb or, more likely, offset through new limits placed on their programs. As a result, block-granting Medicaid or instituting “per capita caps” would most likely reduce the number of Americans eligible for Medicaid and narrow coverage for remaining enrollees. The latter approach would, however, allow for population growth, though its desirability to the new president and Congress is unclear. The full extent of funding and benefit reductions is as yet unknown.

9 ways hospitals can reduce debt

http://www.healthcaredive.com/news/9-ways-hospitals-can-reduce-debt/430488/

Healthcare reform has had a dramatic impact on hospital reimbursement. While millions of Americans are now insured under the Affordable Care Act, high-deductible health plans can leave patients cash-strapped after expensive episodes of care. Sometimes, patients can’t pay for the services they receive, pushing up bad debt at hospitals. At the same time, hospitals are dealing with lower reimbursements and a shift from inpatient to outpatient care, leaving some with property and beds that are no longer financially productive.

Take Community Health Systems for example. Burdened with $15 billion in debt , the Franklin, TN-based hospital chain sold a four-hospital joint venture and spun off 38 hospitals into a separate entity, Quorum Health Corp., earlier this year. Recently, the system inked deals to sell an additional 17 hospitals.

According to Patrick Pilch, head of BDO Consulting’s healthcare advisory practice, many hospitals and health systems don’t have a complete handle on what their costs of care are and they’re losing money as a result. “Understanding your costs of care as well as your cost of capital is imperative,” he tells Healthcare Dive. “Then align that to a future strategy. That’s where you’re going to pull your way out of debt.”

Hospitals should look at their assets, business plan, market and supply chain and then see how those align with their capital strategy, Pilch says. With interest rates expected to rise, non-investment grade hospitals will have a harder time getting capital. “If you have a lot of capital that’s not performing well, you’re in a bit of a state right now,” he adds.

Here are nine ways hospitals can work on debt:

MultiCare plans to acquire Spokane health system

http://www.bizjournals.com/seattle/blog/health-care-inc/2016/11/multicare-plans-to-acquire-spokane-health-system.html

MultiCare Health System is acquiring Spokane's Rockwood Health System. This is the fifth partnership/merger/acquisition announced this month the health care industry in Washington continues to consolidate.

MultiCare Health System plans to purchase the assets of Rockwood Health System in Spokane from subsidiaries of a Tennessee-based health system.

Financial details of the agreement were not disclosed. The deal, which was announced Thursday, is expected to close in the first quarter of 2017.

This is the fifth partnership/merger/acquisition announced this month as the health care industry in Washington state continues to consolidate.

Rockwood Health System includes Deaconess and Valley Hospitals as well as Rockwood Clinic. Those facilities will become part of the MultiCare system, which includes five hospitals, 15 urgent care centers in the Puget Sound region as well as 11 RediClinics located inside select Rite Aid stores. MultiCare is also in the process of opening seven new urgent care clinics it announced in June. It calls these higher-end clinics Indigo Urgent Care.

Community hospitals: What’s your long-term game plan?

http://www.beckershospitalreview.com/facilities-management/community-hospitals-what-s-your-long-term-game-plan.html

Related image

The volume of hospital M&A deals has doubled over the past six years, with fewer and fewer community hospitals still going it alone. For the remaining holdouts, they are at an important juncture: Should they continue fighting for independence or join a larger system?

This heavily-debated question is at the core of many board meetings. While the answer is unique to each institution, in either scenario, the community hospital that proactively controls its own destiny — instead of losing that control to market forces — can come out ahead.

Whether the future holds independence or acquisition, here is what leadership needs to know to position their hospitals for future growth.

What does it take to stay independent?
For efficient facilities with ample cash on hand, there’s an understandable allure to remaining independent. After all, the board of directors at a community hospital is typically made up of individuals from the local area who can continue to focus exclusively on addressing the needs of the local community rather than answer to a distant corporate team.

But a lean and high-volume operation today just isn’t a strong enough indicator to choose independence for the long term. Leadership must consider broader questions that take into account a host of internal and external factors:

‘Somewhere in between’: Finding the balance between quality and the bottom line

http://www.beckershospitalreview.com/finance/somewhere-in-between-finding-the-balance-between-quality-and-the-bottom-line.html

Values-GeneralLeadership

As healthcare continues its shift from fee-for-service to value-based care, hospitals and health systems are working steadily to try and improve quality while reducing costs. However, striking a balance between the two can be challenging.

At the Becker’s Hospital Review 5th Annual CEO + CFO Roundtable on Nov. 8 in Chicago, healthcare experts discussed how their entities balance rewarding physicians for quality and clinical activity in what is still primarily a fee-for-service environment.

“We’re not totally in a fee-for-service environment. We’re not totally in a value-based care environment. We’re kind of somewhere in between,” said Patrice M. Weiss, MD, executive vice president and CMO of Roanoke, Va.-headquartered Carilion Clinic. “In the past, the two were felt to be mutually exclusive, but recent models of care have demonstrated that quality of care can be delivered in a low-cost model.”

While the shift from fee-for-service to value-based care is slightly slower in coming to her organization’s region, they are preparing, according to Dr. Weiss.

Carilion is a nonprofit organization with a network of hospitals, primary and specialty physician practices and other complementary services. The health system offers physicians a base salary, as well as a Tier 1 bonus and a Tier 2 bonus. The Tier 1 bonus is based on scorecard measures, which include quality metrics, patient experience metrics and operating margin.

“We have found we’ve been able to reduce the cost by using evidence-based medicine, standardization of care and appropriateness of testing and imaging,” Dr. Weiss said. “This reduced utilization has not reduced the quality of care or outcomes but has reduced the cost of care, thereby positively affecting our operating margin. So improving quality care and reducing the cost of care are not mutually exclusive.”

Physician-led, cost-reducing initiatives and physician engagement have been primary drivers in achieving reduced costs and improved quality, according to Dr. Weiss. For instance, Carilion has a significant physician-led initiative on early elective inductions or deliveries. This initiative, which was based on national guidelines, resulted in less utilization of obstetrical resources at an earlier gestational age.

CFOs explain changing role, see collaboration key as healthcare changes

http://www.healthcarefinancenews.com/news/cfos-explain-changing-role-see-collaboration-key-healthcare-changes?mkt_tok=eyJpIjoiTlRBeU5EUTRNemMxTmpabSIsInQiOiJqTlZNaWFSY2Vid2c4T3JEeU1FNlkwOFwvcmp0U21idDZBU0w2NWZzTWM5Y0RDQWoxYzdLRjdKUkh4WFhvakZcL014Wk50eHR6ZnkybmY3VnNsOXBISElhS2FpazdXbW5LNWZiT2tKOVpRYzcwPSJ9

Image result for CFO changing role

While the old image of a healthcare chief financial officer centered on accounting, budgeting and overseeing the financial operations in general of a healthcare system, changes to the industry are turning that idea on its head. As clinical quality and technological prowess now have direct effects on the financial health of a hospital, the modern CFO must have a far more overreaching set of skills to perform at the highest level in their jobs.

To illustrate that, Healthcare Finance spoke to three CFOs in the field about how they got to the top and how that role has evolved during their tenures. All of them said the job demands more strategizing, collaboration and concern over quality than ever before.

Value-based care will likely continue under Trump

http://www.fiercehealthcare.com/finance/value-based-care-will-likely-continue-under-trump-administration?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiWVRsaVpESTVOVGN5TW1ZeCIsInQiOiJ4SUR1VG42K1ltRHorVmE5QUgwZ1A5ZGJMMjhDZ1g0Um4rczVTZVVFMHBGYkVZQjVKTGlBekduM005OEVuTklVdmdyMmNOakx2NVNYOTh3TVpNV0ZHXC9ydndRSTZDMTIrNEw0QlVTb2J6V0E9In0%3D

Doctor talking to senior patient and her husband

Despite President-elect Donald Trump’s campaign promises to repeal the Affordable Care Act, industry experts say value-based care initiatives will likely continue under the new White House administration.

Healthcare finance takes the spotlight

Although it’s likely that certain aspects of the ACA will change, demand for value-based care will not go away, write NewYork-Presbyterian Hospital’s Emme L. Deland, senior vice president and chief strategy officer, and Jonathan Gordon, director of NYP Ventures, in a post for NEJM Catalyst.

“At the moment, it seems likely that healthcare financing will get more attention than healthcare delivery under the new administration,” they write.

François de Brantes, executive director for the Health Care Incentives Improvement Institute, agrees, writing in a separate post for NEJM Catalyst that the bipartisan Medicare Access and CHIP Reauthorization Act will help fuel the movement away from fee-for-service payments.

Ryan now has the muscle to phase out Medicare — within months

http://www.sfgate.com/politics/article/Ryan-now-has-the-muscle-to-phase-out-Medicare-10613139.php?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=37625118&_hsenc=p2ANqtz-8__03zRw-gu7XJrwOBmO6XYdGObArnMQTK9_dRrTgDh69s7q3OUq53AcYCfr9bwrtHj5mbLYOPIBBdQVoE_yCtdZWBTg&_hsmi=37625118

Image result for Ryan now has the muscle to phase out Medicare — within months

House Speaker Paul Ryan’s plan to phase out Medicare is nothing new. But now, under a Trump presidency and with both houses of Congress in Republican hands, it looks like he could finally make it happen, possibly within months.

Back in 2011, as a U.S. representative for Wisconsin’s 1st Congressional District, Ryan floated a plan to turn Medicare into a “premium support” program. The “premium support” would be a payment that would let you buy insurance from private insurers. But you won’t get full coverage.

As Josh Marshall acidly noted Sunday in a blog for TPM, “In any case, rather than Medicare you’ll have insurance from an insurance company, which everybody should love because haven’t you heard from your parents and grandparents how bummed they were when they had to give up their private insurance for Medicare?

“You’ll hear lots of people calling this ‘reform’ and other catchwords. But Medicare is a single payer, universal health care system. Replacing it with private insurance means getting rid of it. Even calling it ‘privatization’ masks what is really afoot.”

On Fox News Special Report on Thursday, Ryan was asked about entitlement reform. His answer:

“You have to remember, when Obamacare became Obamacare, Obamacare rewrote Medicare, rewrote Medicaid. If you are going to repeal and replace Obamacare, you have to address those issues as well. What a lot of folks don’t realize is this 21-person board called the IPAP is about to kick in with price controls on Medicare. What people don’t realize is because of Obamacare, Medicare is going broke, Medicare is going to have price controls because of Obamacare, Medicaid is in fiscal straits. You have to deal with those issues if you are going to repeal and replace Obamacare. Medicare has serious problems [because of] Obamacare. Those are part of our plan.”

Marshall says that’s false, and Ryan knows it. Instead of putting Medicare under deeper financial stress, the Affordable Care Act has had the opposite effect and actually extended Medicare’s solvency by over 10 years, he says.

According to Medicare’s trustees, the “Part A” trust fund — the costliest component of Medicare, covering hospitalization — is set to become insolvent in 2028. In 2009, before the passage of the Affordable Care Act, it was projected that fund would go broke in 2017.

Paul Ryan is determined to gut Medicare. This time he might succeed

http://www.latimes.com/business/hiltzik/la-fi-hiltzik-medicare-ryan-20161114-story.html?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=37625118&_hsenc=p2ANqtz-8op3UbE6wkf1QHSbmlOITUvS45OW4rFAoMDUSaFiNXpSZN2Afucl6wLeww-aou9CIZqsrb3AUTqQwZmAAU0vubnznweA&_hsmi=37625118

Image result for Paul Ryan is determined to gut Medicare. This time he might succeed

Bursting with the policymaking power that control of both houses of Congress and the White House gives Republicans, House Speaker Paul D. Ryan (R-Wis.) has lost no time in teeing up a favorite goal: gutting Medicare.

In an interview with Fox News Channel last Thursday, Ryan said: “Obamacare rewrote Medicare … so if you’re going to repeal and replace Obamacare, you have to address those issues as well. … What people don’t realize is that Medicare is going broke, that Medicare is going to have price controls. … So you have to deal with those issues if you’re going to repeal and replace Obamacare. Medicare has got some serious problems because of Obamacare. Those things are part of our plan to replace Obamacare.”

There’s no secret about what specifically Ryan has in mind. He intends to replace traditional Medicare, an efficient program offering guaranteed treatment and featuring rock-bottom administrative costs, with a privatized program. Seniors would get a federal voucher to help them pay premiums charged by commercial insurance plans. Ryan calls this system “premium support.”

The 1 thing about healthcare that needs to change: 4 executives weigh in

http://www.beckershospitalreview.com/hospital-management-administration/the-1-thing-about-healthcare-that-needs-to-change-4-executives-weigh-in.html

Self-Discovery

From the shift to value-based care to increased price transparency, the healthcare industry is in the midst of significant changes that are aimed at efficiently improving care. However, for that goal to be achieved, problems in the industry such as disparity in access to care and confusing billing systems still need to be addressed, according to healthcare executives.

In a panel discussion on Nov. 9 at the Becker’s 5th Annual CEO + CFO Roundtable in Chicago moderated by Rhoda Weiss, PhD, nationally recognized consultant, speaker, and author, four great minds in healthcare discussed the changes they would like to see in the industry, what gives them pride in their organizations and the issues that keep them awake at night.