Menu Close

Blog

CMS Angers Hospitals With Plans for Site-Neutral Rates in Outpatient Payment Rule

The CMS has responded to calls to eliminate patient satisfaction on pain management from Medicare’s value-based purchasing program. The agency angered hospitals, however, with plans to stop paying their off-campus facilities the same as hospital-based outpatient departments.

Both policies are included in the proposed rule for the 2017 Hospital Outpatient Prospective Payment System issued Wednesday.

The CMS’ actuary has estimated that so-called site-neutral payments for ambulatory care, which Congress called for a 2015 spending bill, would save Medicare about $500 million in 2017. The American Hospital Association quickly issued a harshly worded statement criticizing the CMS for declining to include support for hospital outpatient departments.

The AHA was among several prominent healthcare associations that had called on the Obama administration to stop incorporating patients’ responses to pain-management questions in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) in the value-based purchasing program. HCAHPS results are a significant factor in how hospitals fare under value-based purchasing, and providers have complained the program gives them a financial incentive to over-prescribe painkillers to keep patients happy.

Read the full article here.

Insurers, Pushing for Higher Rates, Challenge Key Component of Health Law

For several years, the Obama administration has urged state insurance regulators to use tools provided by the Affordable Care Act to hold down health care premiums.

Now federal officials will have a chance to practice what they preach as they confront big increases proposed in several states where they are responsible for reviewing rates.

Federal officials defer to the insurance commissioners in 46 states deemed to have “effective rate review” programs. But in Missouri, Oklahoma, Texas and Wyoming, the federal government is in charge of reviewing rates.

And those reviews create an exquisite political challenge, spotlighting a pocketbook issue that affects millions of voters.

In Texas, Blue Cross and Blue Shield is requesting rate increases of nearly 60 percent for 2017. In Oklahoma, Blue Cross and Blue Shield has proposed increases that average 49 percent. And in Missouri, Humana has filed for a 34 percent increase. All three carriers say they have lost money on many policies sold to individuals and families under the Affordable Care Act.

Federal officials have urged states to be aggressive in reviewing rates, but it is not clear how aggressive federal officials will be. Michael A. Rhoads, the deputy commissioner of the Oklahoma Insurance Department, said he doubted that federal officials would significantly pare back rates requested in his state, given that insurers had lost money on their exchange business and several had left the Oklahoma marketplace.

Read the full article here.

Younger Seniors Amass More End-Of-Life Care Than Oldest Americans, Study Finds

Americans in their 80s and 90s are not the ones amassing the largest medical bills to hold off death, according to a new analysis that challenges a widely held belief about the costs of end-of-life care.

Younger seniors — those with potentially longer expectancies — are.

Medicare claims data for 2014 for beneficiaries who died the same year shows that average Medicare spending per person peaked at age 73 — at $43,353, the Kaiser Family Foundation reported Thursday. That compared with $33,381 per person for 85-year-olds and among 90-year-olds, $27,779 per person. (KHN is an editorially independent program of the foundation.)

“This is a pattern we weren’t really expecting to see,” said Juliette Cubanski, the associate director of the program on Medicare policy for the Kaiser Family Foundation.

Kaiser researchers said their findings suggest that providers, patients and their families may favor more costly, lifesaving care for younger seniors, and turn to hospice care when patients are older.

“It kind of goes against the notion that doctors are throwing everything including the kitchen sink at people at the end of life regardless of how old they are,” Cubanski said.

Medicare covered eight of 10 people in the U.S. who died in 2014, establishing it as the largest insurer of medical care provided at the end of life, according to the Kaiser report.

Medicare spent an average of $34,529 on each of them, and most of that money (51 percent) went to inpatient hospital expense. The rest was spent mostly on skilled nursing facilities, home health care and hospice (23 percent) or physicians (13 percent) or medication, 6 percent. Overall, the largest portion, 31 percent, of per capita spending for all beneficiaries goes to inpatient hospital expenses.

Read the full article here.

Despite Increasing Insurance Coverage, “Troubling” Healthcare Gaps Persist, Analysis Finds

The Houston Chronicle  (7/14, Deam) reports the Commonwealth Fund’s 2016 Local Healthcare Scorecard, released Thursday, “reviewed 306 population centers…to gauge the availability and quality of care, costs, obesity rates, repeat hospitalizations and insurance coverage.” The report found that “while access to health care and insurance coverage has improved in the United States, troubling gaps persist…that have been toughest on poor Americans.” The article highlights the report’s “puzzling” finding that many are going with a consistent primary care provider.

The Syracuse (NY) Post-Standard  (7/14, Mulder) says the report found “upstate New York is one of the easiest places in the nation to get health care.” The article breaks down the results of the analysis for Syracuse and Buffalo.

Many Don’t Find Healthcare Affordable Under ACA. An analysis piece in Politico  (7/13) reports on the “a new and different health care purgatory” under the Affordable Care Act: people who are insured but “can’t afford their out-of-pocket bills.” Part of the reason is that “plans have shifted more costs to consumers through deductibles,” copays, and co-insurance; these costs can “keep people out of the system entirely.” Additionally, “prescription drugs are now the fastest growing category of medical costs, and there’s nothing in the health law that allows the government to push back.” Meanwhile, some people make too much money for ACA subsidies but can’t afford health insurance on their own, or the subsidy isn’t enough to make deductibles and copays affordable. Finally, bills from out-of-network physicians aren’t covered by the caps on out-of-pocket expenses, “and many insurance plans sold on the health law’s exchanges have extraordinarily narrow networks of doctors and hospitals.”

Read the full article here.

Healthcare Spending Growth Rate Rises Again in 2015

Government agencies, companies and consumers spent a lot more on healthcare in 2015 than the prior year. It’s another result of the U.S. reducing its uninsured rate to historic lows through healthcare reform, which has spurred demand for more hospital services, clinic visits and prescription drugs.

The U.S. healthcare system spent $3.2 trillion in 2015, or almost $10,000 for every person, according to the latest federal projections. It’s a 5.5% increase from 2014—still a lot lower than the annual growth rates from decades ago, but a tick higher than the 5.3% increase recorded in 2014 and above the rates seen in the immediate aftermath of the Affordable Care Act and the Great Recession. Government economists also reaffirmed their prediction that national health spending will grow by 5.8% each year on average over the next decade.

However, healthcare still represents an outsized part of the economy: 17.8% of gross domestic product in 2015, and that will increase to 20.1% by 2025, CMS actuaries estimated, as more people age into Medicare and need more healthcare. That has economists worried that not enough is being done to slow down healthcare spending, which averts funding from things like education and transportation.

“It’s a lower rate of spending (in 2015), but once you move that over to real spending net of inflation, it’s still significantly above the growth of tax revenues and GDP and wage growth,” said Thomas Getzen, a health economist at Temple University in Philadelphia. “Even at 5.5% growth, if wages are going up 2.5%, you’re in trouble.”

Read the full article here.