Leading the News
Hospitals With “Significant Market Power” Can Determine How Much Insurers Pay Them, Paper Concludes.
Modern Healthcare Share to (5/9, Kacik, Subscription Publication) reports “insurers pay widely varying prices for the same procedures at the same hospitals, indicating that insurers’ bargaining leverage influences healthcare prices, according to an updated healthcare economics paper Share to to Twitter.” The article says this was one of the new conclusions of “a Commonwealth Fund-backed paper that used actual claims data from three national insurers to explain how hospitals get paid.” The piece adds that hospitals which have “significant market power can dictate how much they will get paid – about 12.5% higher prices for monopoly hospitals than those in markets with four or more competitors – and the form of their contracts with insurers.”
Legislation and Policy
CMS May Soon Unveil Rule Which Limits How Long ACOs Can Stay In One-Sided Risk Models.
Healthcare Informatics Share to (5/9, Leventhal) says recently, CMS Administrator Seema Verma observed that “‘upside-only’ ACOs (accountable care organizations) that do not take on downside risk have not generated enough results to date,” and it appears “a CMS rule is forthcoming that could shorten the duration ACOs can stay in one-sided risk models.” The article says Verma’s comments “aligned with what HHS (the Department of Health & Human Services) Secretary Alex Azar said at AHIP’s (America’s Health Insurance Plans) National Health Policy Conference in March.” However, “Verma went into more detail this week, noting that downside-risk ACOs have achieved significant savings to Medicare, ‘while upside-only ACOs are increasing Medicare spending, and the presence of these upside-only tracks may be encouraging consolidation in the market place, reducing competition and choice for our beneficiaries.’”
CMS To Delay Cuts To Reimbursement For Rural Medical Equipment Suppliers.
Modern Healthcare Share to (5/9, Dickson, Subscription Publication) reports that CMS is planning “to delay a series of cuts that this year would have hit providers of durable medical equipment in rural areas.” The change would give providers $290 million more in revenue for the rest of this year. According to CMS Administrator Seema Verma, “This action will help Medicare beneficiaries in rural areas continue to access life-sustaining durable medical equipment, like oxygen equipment.”
Public Health and Private Healthcare Systems
Louisiana To Notify About 37,000 Elderly, Disabled People That They Could Lose Medicaid Coverage.
The CBS Evening News (5/9, story 7, 2:10, Glor) reported “tens of thousands of elderly and disabled” Medicaid beneficiaries in Louisiana could soon lose their “benefits because of a state budget shortfall of more than half a billion dollars.” CBS’ David Begnaud said state Rep. Jay Cameron Henry, R-District 82, “told us Republicans may be willing to pass a tax” Gov. John Bel Edwards “wants, but it would be another band aid on the state’s long-term financial wound.” For his part, Edwards has called the cuts “so catastrophic, we shouldn’t contemplate them.”
The New Orleans Times-Picayune Share to (5/9, Clark) reports that some “37,000 elderly and disabled Louisiana residents…face losing their Medicaid benefits after July 1 due to a $648 million state budget shortfall.” The state’s “Department of Health is expected to start sending out notifications this week.” Officials say they must notify recipients of this possibility even if they ultimately find a way to provide the funding. The article adds that “about 20,000 people living in nursing homes, thousands of people with disabilities living in group homes and those who receive home health care assistance” are among those who would be impacted.
The AP Share to (5/9, Deslatte) reports that the notices will be sent starting on Thursday. They represent the state’s “first official warning to residents of nursing homes and group homes that they could face eviction in less than two months because of proposed Medicaid spending cuts included in the House-backed version of next year’s budget.”
CMS To Make Selecting Medicare Coverage Options Easier.
Modern Healthcare Share to (5/9, Dickson, Subscription Publication) says CMS is moving “to make it easier to sort through Medicare coverage options, after a report said its current search options were badly presented and confusing and could lead some to make poor plan selections.” The agency “will tweak Medicare.gov before open enrollment starts on Oct. 15, making changes to help beneficiaries understand their coverage options, CMS Administrator Seema Verma said Wednesday during a Medicare Advantage and Prescription Drug Plan Conference.” She is quoted as saying, “CMS is undertaking several consumer-friendly improvements for Medicare Open Enrollment so that people with Medicare can make an informed choice between original Medicare and Medicare Advantage.”
Medicare Advantage Insurer Launching Program To Deliver In-Home Primary Care To Sickest Seniors.
Modern Healthcare Share to (5/9, Livingston, Subscription Publication) reports Clover Health, which offers Medicare Advantage plans, “is betting on home healthcare as the key to better health outcomes and lower spending.” The company “is rolling out a program to deliver in-home primary care to their sickest seniors in hopes of reducing emergency room visits and hospitalizations.” This move is considered “part of a wider trend of health insurance companies increasingly shifting care away from hospitals in favor of lower-cost ambulatory centers and home healthcare services.”
Uninsured Rate Rising After Years Of “Dramatic” Declines, Data Show.
The Huffington Post Share to (5/9, Young) reports that following years of “dramatic” drops in the percentage of uninsured consumers, “a direct result of the Affordable Care Act’s coverage provisions,” that “trend is beginning to reverse,” according to a new analysis conducted by Gallup and digital health company Sharecare. Data show the share of uninsured Americans rose to 12.2 percent in 2017 from 10.9 percent in 2016. The article says the 2017 figure “represented a decline of nearly 7 percentage points from 2013, the year before the Affordable Care Act’s Medicaid expansion and subsidies for private health insurance came online and the year with the highest rate in Gallup’s polling history.” The analysis also revealed that “the uninsured rate increased in 17 states last year, and it was the first year since 2014 that at least one state didn’t experience a decline in those without health insurance.”
Also in the News
Health Insurers Trying To Contain Rising Healthcare Costs.
Bloomberg BNA Share to (5/9, Hansard) reports on efforts by health insurers to lower costs, spotlighting Blue Cross Blue Shield’s Blue Distinction Total Care program, a value-based care program that has kept cost increases to five percent – below the national average of 6.2 percent – for its 19 million members. Kari Hedges, senior vice president of commercial markets for the Blue Cross Blue Shield Association, called it “a start in the direction of trying to move the cost trend in health care.”