Posts Tagged ‘Medicaid’
Tuesday, August 24th, 2010
Twenty percent of Americans visited a hospital emergency room in 2007, the most recent year for which the National Center for Health Statistics has data. That includes approximately 7.4 percent of the uninsured who visited the ER multiple times, as did 5.1 percent of people with private insurance. The most frequent ER visitors were Medicaid patients, with 15.3 percent reporting two or more visits in 2007. A total of 116.8 million ER visits were made that year.
One third of adults in fair or poor health visited the ER at least once during the year and are the patients most likely to use that facility. Patients over 65 reported more ER visits and described it as their customary source of healthcare. Approximately 25 percent of individuals aged 75 and older visited the ER at least once in 2007.
The big surprise? Contrary to conventional wisdom, the uninsured were not more likely to make non-emergency visits to the ER than other groups. Approximately 10 percent fall into the non-emergency category whether the patient had private insurance, Medicaid coverage or no insurance. Determining who visits the ER, the frequency and for what reasons requires examining complicated interactions among multiple factors - socioeconomic level, overall health, age, health insurance, access to healthcare and others.
“Our job is to provide the best numbers to inform policy and practice,” said Amy B. Bernstein of the National Center for Health Statistics. “If people are concerned about the use of emergency rooms and how to make their use more efficient or effective, they should have accurate information about who is actually using them - and not who they think is using them.”
Tags: emergency rooms, Medicaid, National Center for Health Statistics, private insurance, uninsured
Posted in Healthcare, Hospital Systems | No Comments »
Thursday, July 29th, 2010
The federal government has issued revised standards for the “meaningful use” of electronic medical records that will financially reward physicians and hospitals who adopt the new technology. According to the Department of Health and Human Services, physicians and hospitals could receive as much as $27 billion over the next decade if they put patients’ medical records on computer instead of paper. Physicians can be paid up to $44,000 under Medicare and $63,750 for Medicaid. Depending on their size, hospitals have the potential to receive millions of dollars. In 2015, hospitals and physicians face financial penalties under Medicare if they fail to use electronic medical records by the deadline.
Dr. Donald Berwick, the new administrator of the Centers for Medicare and Medicaid Services (CMS) said electronic medical records will lead to “better, smoother care, more reliable care.” Department of Health and Human Services (HHS) Secretary Kathleen Sebelius said “Only 20 percent of doctors and 10 percent of hospitals use even basic electronic health records.” Taking a slightly different perspective, Richard J. Umbdenstock, president of the American Hospital Association (AHA), said the new standards are an improvement over the rules initially proposed but was not convinced that doctors or hospitals would adopt the new technology.
Some physicians believe that using electronic medical records will reduce errors and save patients’ lives. The new standards are flexible and require physicians to meet 15 specific requirements, as well as another five selected from a list of 10 objectives. To fulfill the new standards, physicians will have to submit 40 percent of prescriptions electronically. “We are delaying some of the more ambitious requirements,” said Dr. David Blumenthal, the national coordinator for health information technology.
Tags: American College of Cardiology, American Hospital Association, Centers for Medicare and Medicaid Services, Department of Health and Human Services, Dr Donald Berwick, electronic medical records, Kathleen Sebelius, Medicaid, Medicare, Obama administration, President Barack Obama
Posted in Healthcare, Hospital Systems | No Comments »
Monday, July 26th, 2010
The federal government’s share of dollars spent on healthcare is expected to soar from five percent of the current GDP to approximately 10 percent by 2035. The increases are likely to continue unabated after that. These projections are based partly on the recently passed healthcare reform legislation, which is expected to increase federal spending in the next 20 years, according to the Congressional Budget Office’s (CBO) analysis, “The Long-Term Budget Outlook”.
“The retirement of the baby boom generation portends a significant and sustained increase in the share of the population receiving benefits from Social Security, Medical and Medicaid. Moreover, per-capita spending for healthcare is likely to continue rising faster than spending per person on other goods and services for many years,” according to the report. The CBO predicts that these factors will increase federal spending relative to the overall economy in the future. Only a major change in government policy will reverse this trend. Once all provisions of the new healthcare law are implemented in 2014, there is a strong possibility that federal spending will decrease by 2030. According to the CBO, reform could yield reduced spending over time.
Peter Orszag, director of the White House Office of Management and Budget, notes “CBO reiterates that the Affordable Care Act will reduce the deficit by more than $100 billion in the current decade and more than $1 trillion in the decade after that - which represents the most deficit reduction enacted since the 1990s.”
Tags: Congressional Budget Office, GDP, healthcare spending, Medicaid, Medicare, Patient Protection and Affordable Care Act, Peter Orszag, social security
Posted in Healthcare, Hospital Systems | No Comments »
Wednesday, July 14th, 2010
Facing a hostile approval process from Republicans in the Senate, President Barack Obama is making a recess appointment of Dr. Donald Berwick to head the Centers for Medicare and Medicaid Services (CMS), the agency that oversees Medicare and Medicaid.
A sharp critic of the way healthcare is delivered in the United States, Berwick believes the system is inefficient and lacks an efficient information-sharing apparatus. In addition to his practice and academic work, Berwick is the founder of the Institute for Health Care Improvement, a think tank that focuses on “cultivating promising concepts for improving patient care and turning those ideas into action.”
Berwick, a Harvard-educated pediatrician and Harvard Medical School professor, believes in improving the quality of healthcare so physicians are rewarded for better outcomes rather than on a per-procedure basis. Although it’s unlikely that this idea could be applied to the whole medical profession, Medicare and Medicaid are large enough that changing the traditional way healthcare is delivered would echo throughout medicine. Together, Medicare and Medicaid cover 100 million Americans - approximately one-third - and accounted for $750 billion of federal spending in 2009. According to the Congressional Budget Office, that totals 20 percent of the federal budget.
“Many Republicans in Congress have made it clear in recent weeks that they were going to stall the nomination as long as they could, solely to score political points,” according to Dan Pfeiffer, White House Communications Director. “But with the agency facing new responsibilities to protect seniors’ care under the Affordable Care Act, there’s no time to waste with Washington game-playing.”
Tags: Affordable Care Act, Congressional Budget Office, Donald Berwick, Harvard Medical School, Healthcare delivery system, Medicaid, Medicare, President Barack Obama, recess appointement, Senate
Posted in Healthcare | No Comments »
Tuesday, July 6th, 2010
Nearly three-fourths of kids on Medicaid who live in nine states failed to undergo all required medical, vision and hearing screenings, according to a report from the Department of Health and Human Services’ Office of the Inspector General (OIG).
After studying Medicaid children living in Arkansas, Florida, Idaho, Illinois, Missouri, North Carolina, North Dakota, Texas, Vermont and West Virginia, the OIG determined that 2.7 million - approximately 76 percent - had not had their required Medicaid Early and Periodic Screening, Diagnostic and Treatment tests (EPSDT). Considered vital medical screenings for Medicaid recipients under the age of 21, these test overall health, vision and hearing. Even when children did have some EPSDT screenings, 60 percent did not undergo at least one required test.
The OIG report suggested that the Center for Medicare and Medicaid Services (CMS) require states to:
- Report the number of healthcare screenings performed on children.
- Work in partnership with other states and providers to develop effective strategies to encourage participation in screenings.
- Educate and incentivize Medicaid recipients about the importance of these tests.
- Identify and provide information on how to increase participation in comprehensive medical screening.
According to CMS, the agency needs “to assess the effect that the new data-collection requirements might have on states’ financial resources.” Additionally, it must take into account “the difficulty states might have in obtaining data on services that are provided outside traditional provider settings.”
Tags: Center for Medicare & Medicaid Services, Department of Health and Human Services, health screenings, hearing tests, Medicaid, Office of the Inspector General, vision tests
Posted in Healthcare | No Comments »
Tuesday, June 29th, 2010
President Barack Obama is expanding payment recapture audits as a means of fighting waste and abuse in government programs such as Medicare and Medicaid. The presidential memorandum will direct federal agencies to “expand and intensify” the use of audits, such as those performed by recovery audit contractors and Medicaid integrity contractors. The initiative will extend the scope of such audits beyond fee-for-service payments into other government contracts. The president also will support bipartisan legislation to expand the authority of government agencies to direct recaptured funds toward audits.
The announcement follows an executive order issued by President Obama in November, 2009, that directed the government to aggressively control improper payments, which were said to equal $98 billion. Fully $54 billion of that was attributed to Medicare and Medicaid and reflect an estimate of payments made in error, duplicate billing and even fraud.
Aimed at the political middle and designed to rally support for healthcare reform, the proposal would employ private auditors whose sophisticated computer systems can scan Medicare and Medicaid billing records for patterns of false claims. The auditors would get to keep some of the dollars recovered. According to the White House, a Medicare pilot program recovered approximately $900 million for taxpayer between 2005 and 2008.
Tags: fraud, Medicaid, Medicare, President Barack Obama, recovery audit contractors
Posted in Healthcare, Hospital Systems | No Comments »
Thursday, June 24th, 2010
Starting in September, the approximately five million Americans under the age of 19 who have pre-existing medical conditions cannot be denied health insurance coverage. The healthcare reform law also gives these patients expanded physician choices because many previously had to rely on government programs such as Medicaid. Children account for approximately nine percent of the 57.2 million Americans under the age of 65 who have pre-existing conditions.
Although Congress wanted to implement this section of the bill immediately instead of waiting until September 23, some private insurers are showing signs of stepping up to the plate and providing coverage as soon as the Obama administration issues regulations on final implementation. According to Illinois Insurance Director Michael McRaith, “It would not surprise me if insurers would undertake this earlier.”
Although there were some concerns that insurers might try to deny coverage to children with pre-existing conditions or set rates too high, Secretary of Health and Human Services Kathleen Sebelius sent a letter to Karen Ignani, CEO of America’s Health Insurance Plans directing the trade organization to comply with the new law. “To ensure there is no ambiguity on this point, I am preparing to issue regulations in the weeks ahead ensuring that the term ‘pre-existing condition exclusion’ applies to both a child’s access to a plan or to his or her benefits once he or she is in the plan,” Sebelius wrote.
“This is a confidence builder in what healthcare reform does,” said Ron Pollack, executive director of Families USA, a consumer health advocacy group that backed expanding healthcare coverage. “It’s a popular group to reach out to…and it’s not going to have as big of an impact on costs as, say, somebody between the ages of 56 and 64 who has multiple chronic conditions.”
Tags: America's Health Insurance Plans, Congress, Deparment of Health and Human Services, Families USA, healthcare reform, Karen Ignani, Kathleen Sebelius, Medicaid, Obama administration, pre-existing medical conditions
Posted in Healthcare, Hospital Systems | No Comments »
Thursday, June 10th, 2010
Healthcare reform could prove to be a mixed blessing for some hospitals because the law has the potential to negatively impact their bottom lines. According to a report entitled Will Healthcare Reform Alter the Landscape of the Emergency Department? conducted by IMA Consulting, the law may have an unintended consequence in that the newly insured might take advantage of both the Emergency Department (ED) and their sudden access to primary-care physicians. “One of the pieces of research that we looked at was that people who tend to have insurance - particularly Medicare and Medicaid - access the ED more than people who are uninsured,” according to Bob Gift, IMA Consulting Director. “This is possibly because they’re not necessarily stuck paying the entire bill.”
According to Gift, people who currently lack insurance tend to avoid the healthcare system, unless they use the ED. “New patients may think, I have insurance so ‘what the heck; I may as well go to the ED,’” he said. Because EDs are already operating at or above capacity and there’s a shortage of primary-care physicians, Gift believes that — if the law works correctly — patients are likely to use their new insurance coverage to access doctors and get care for health problems sooner rather than later. In a perfect world, this would cut the number of ED visits and reduce inpatient admissions. Time will tell whether health insurance encourages ED or primary-care physician visits.
“By opening enrollment to larger numbers of participants who heretofore didn’t have coverage, we may find that patients are accessing the system more freely than when they paid out of pocket - that’s what a number of folks who are looking at this tend to anticipate happening,” Gift said.
Tags: Emergency Department, IMA Consulting, Medicaid, Medicare, Patient Protection and Affordable Care Act
Posted in Healthcare, Hospital Systems | No Comments »
Thursday, May 27th, 2010
As healthcare reform is ushered in over the next few years, Medicaid will play a leading role in bringing coverage to as many as 20 million Americans who don’t have the resources to buy insurance on their own. “Medicaid is finally living up to its role of serving as the healthcare safety net for poor and lower-income individuals and families,” said Jennifer Tolbert, principal policy analyst with the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured.
Healthy adults under the age of 65 will qualify for Medicaid starting in 2014 if they earn $14,404 in current dollars for a single person or $29,326 for a family of four. That adds up to 133 percent of the federal poverty level. Most asset requirements will be abolished, so people who lose their jobs can get health coverage even if they own a home or have money saved for retirement. Bringing as many as 20 million people into the Medicaid system is a herculean task, even though four years have been set aside to make the changes necessary to make enrollment easier. Many Americans don’t even know that they will be eligible, and it is the states’ responsibility to inform them.
“We’re pretty busy, I can tell you that,” said Ann Kohler, director of health services with the American Public Human Services Association, which administers the National Association of State Medicaid Directors. “Many of my members opposed the bill and still do, frankly. But it is the law, and we’re working hard to get it implemented.” The most frequently cited obstacles include the fact that many doctors refuse to accept Medicaid payments because it doesn’t reimburse as much as private plans or Medicare. Additionally, filing claims involves significant paperwork and lengthy payment delays.
The federal government is sweetening the pot for physicians by increasing Medicaid payments for primary care to Medicare levels in 2013 and 2014. That may not be enough, though. Physicians prefer to avoid Medicaid patients because they tend to be sicker than insured patients, miss appointments and do not cooperate with treatment plans.
Tags: American Public Human Services Association, healthcare reform, Kaiser Family Foundation, Medicaid, Medicare, National Association of State Medicaid Directors, Robert Wood Johnson Foundation, uninsured Americans
Posted in Healthcare, Hospital Systems | No Comments »
The recently passed healthcare reform legislation includes provisions designed to enhance community pharmacists’ ability to advance patients’ outcomes. 