In addition to the difficulties people continue to experience when trying to purchase health insurance via the federal exchange/marketplace, hospitals also can expect to weather some difficulties as more people become insured through the federal/state exchanges. The health insurance exchanges resulted from a provision of the Affordable Care Act. It was anticipated that each […]
We don’t often report on early proposals from federal lawmakers, but this one captured our attention. It seems the Senate Finance Committee and the House Ways and Means Committee have a bipartisan draft proposal to repeal the Medicare Sustainable Growth Rate (SGR) formula and freeze current payment levels for 10 years. (“Key Committees Release Bipartisan […]
Most major health insurance carriers offer Medicare Advantage plans, and the plans have been a lucrative line of business until recently. Because of recent sequestration cuts and rate reductions in the Affordable Care Act (ACA), Medicare Advantage plans will see payment reductions of billions of dollars ($135 billion in cuts over the next 10 years […]
Some states have reported a surge in Medicaid enrollments as part of the Affordable Care Act’s (ACA’s) push to expand insurance coverage, despite the reported IT problems in the federal and some state-operated exchanges. The ACA expanded Medicaid coverage to all residents with household incomes up to 138 percent of the poverty level. However, […]
Although the drama in Washington, D.C. has dominated the health industry news (because of the focus on the Affordable Care Act), there has been life (and news) as normal. Of particular interest to us over the last week has been legal action, or the threat of legal action, by providers against insurers over rate cuts […]
This week’s newsletter comes a few days earlier than usual because we want our subscribers to have a full picture of the impact of the government shutdown on public health. Thanks to the American Health Lawyers Association, we can present a summary. The shutdown began on October 1, resulting from the Senate’s vote to […]
The Centers for Medicare & Medicaid (CMS) announced this week it will delay Recovery Audit Contractor (RAC) audits of the “two-midnight” rule for 90 days. The 2014 Inpatient Prospective Payment System (IPPS) Final Rule released in August finalized the “two-midnight” rule, under which hospital inpatient admissions that span at least two midnights qualify as appropriate […]
Health spending growth through 2013 is expected to remain slow—3.8 percent—because of the sluggish economic recovery, continued increases in cost-sharing requirements for the privately insured and slow growth for public programs, according to federal actuaries and economists who published their projections in the September issue of Health Affairs. They note, however, that “improving economic […]
The Recovery Audit Contractor (RAC) program, established in 2003 through the Medicare Modernization Act and implemented in 2010, has had wide ranging effects for both hospitals and patients. Its purpose is to identify and recover improper Medicare payments paid to healthcare providers under fee-for-service Medicare plans. But claims of skewed incentives—RACs are paid on a […]
New special publications from Moody’s Investors Service highlight the continuing deterioration of patient volume in not-for-profit hospitals and the impact of that decline on overall performance. As hospitals transition from a fee-for-service to a value-based model they will experience significant disruption that will continue to impact performance in 2013 and in the coming years. Admissions […]