Reductions in Medicare Hospital Readmissions: Real or Illusory?

Source: Lehigh Valley Hospital-Muhlenberg

Hospital readmissions pose serious risks to patients, especially to Medicare patients who are older and typically sicker than other patients. Hospital stays increase the risk of infection and medication error, put patients through physical and psychological stress (i.e. being woken up multiple times a night, falls on the way to the bathroom), and increase Medicare expenditures. Under the Hospital Readmission Reduction Program (HRRP) created by the Affordable Care Act, hospitals are penalized by Medicare if beneficiaries are readmitted (to any hospital) within 30 days of discharge. The goals of the HRRP are to:

  1. Improve care transitions
  2. Reduce the burden of readmission for Medicare beneficiaries
  3. Reduce the cost of readmissions to the taxpayer
Continue reading “Reductions in Medicare Hospital Readmissions: Real or Illusory?”

Thousands Lose Medicaid as Arkansas Implements First 1115 Work Requirement Waiver

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Source: access.arkansas.gov via Bloomberg News

It’s 7am and I’m sitting in bed with too many beverages (coffee, water, smoothie–gotta get those leafy greens in) and too many tabs open (embryology review, TeamRads, Twitter, and multiple newspaper homepages). And oh yeah, my second anatomy exam is this afternoon.

But what I’m actually stressing about how thousands of low-income Arkansas residents no longer have Medicaid coverage. 

Continue reading “Thousands Lose Medicaid as Arkansas Implements First 1115 Work Requirement Waiver”

A Tale of Medicare Payment Models: From Volume to Value

Yes, it costs a lot of money to become a doctor. And yes, you will likely get paid a lot of money once you are a doctor. So it was surprising that a recent survey of internal medicine providers found that nearly two-thirds of respondents lacked familiarity with MACRA, the Medicare Access and CHIP Reauthorization Act of 2015, which fundamentally alters how doctors are paid for caring for Medicare beneficiaries.

In 2017, Medicare spending accounted for 15 percent of all federal spending and is projected to increase to 18 percent by 2028. Medicare benefits payments cost $702 billion in 2017 (up from $425 billion in 2007). Add in our aging population (by 2035, there will be more Americans older than 65 than kids under 18) and costly medical advancements that can sustain and prolong life, and we’re looking at a serious problem. [The solvency of the Medicare trust fund is a hot issue on the Hill.]In one attempt to rein in Medicare spending, MACRA shifts a growing percentage of physician payment from a volume-based model to a value-based model. MACRA has four main provisions: (1) repeal of the sustainable growth rate (SGR), which determined Medicare Part B reimbursement rates; (2) change how Medicare rewards providers for value over volume; (3) streamline various quality programs under the Merit-based incentive program (MIPS); and (4) give bonus payments for participation in eligible alternative payment models (APM).

Continue reading “A Tale of Medicare Payment Models: From Volume to Value”

Impact of Proposed Medicare Payment Changes on Chronic Care Management

In 2015, Medicare beneficiaries (65 and older) accounted for only 15% of the population but 34% of annual healthcare expenditures. Medicare spending steadily increases as beneficiaries age, in part due to the management of multiple chronic conditions (MCC) that require primary and specialist care, medication, and/or hospitalization, among other health expenses. MCC, or comorbidities, affect nearly one in four Americans. Chronic conditions include physical conditions (i.e. arthritis, cancer, hypertension, high cholesterol) and mental/cognitive conditions (i.e. dementia, depression, substance abuse) that last longer than one year and require continual medical attention and/or impact daily activities. According to a recent RAND report, 81% of those over 65 have MCC, including nearly two-thirds of Medicare beneficiaries.

Continue reading “Impact of Proposed Medicare Payment Changes on Chronic Care Management”