Modifying Medicare’s Benefit Design Could Reduce Federal Spending But With Cost Tradeoffs for Beneficiaries
by The Kaiser Family Foundation
Revamping traditional Medicare’s benefit design and restricting “first-dollar” supplemental coverage could reduce federal spending, simplify cost sharing, protect against high medical costs, decrease out-of-pocket spending for many beneficiaries, and provide more help to those with low incomes — but would be unlikely to achieve all of these goals simultaneously, finds a new analysis by the Kaiser Family Foundation.
The analysis, which draws upon policy parameters put forth by the Congressional Budget Office, the Medicare Payment Advisory Commission and other organizations, examines a general approach to reforming Medicare that has been a focus of Congressional hearings and featured in several broader debt reduction and entitlement reform proposals, including the House GOP health plan released last week.
Total Medicaid and CHIP Enrollment as of March 2016
This monthly report on state Medicaid and Children’s Health Insurance Program (CHIP) data represents state Medicaid and CHIP agencies’ eligibility activity for the calendar month of March 2016. This report measures eligibility and enrollment activity for the entire Medicaid and CHIP programs in all states, reflecting activity for all populations receiving comprehensive Medicaid and CHIP benefits in all states, including states that have not yet chosen to adopt the new low-income adult group established by the Affordable Care Act. This data is submitted to CMS by states using a common set of indicators designed to provide information to support program management and policy-making related to application, eligibility, and enrollment processes.
New Health, United States Spotlight Infographic, Spring 2016
The second Health, United States Spotlight from the National Center for Health Statistics is now available online. This infographic features data on health status and determinants, including the leading causes of death among working-age adults, diabetes prevalence among adults aged 20 and over, substance use among adolescents aged 12–17, as well as asthma attacks and allergic reactions among children aged 5–17.
Medicare Will Use Private Payor Prices to Set Payment Rates for Clinical Diagnostic Laboratory Tests Starting in 2018
On June 17, the Centers for Medicare and Medicaid Services (CMS) released a final rule implementing Section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA), requiring laboratories performing clinical diagnostic laboratory tests to report the amounts paid by private insurers for laboratory tests. Medicare will use these private insurer rates to calculate Medicare payment rates for laboratory tests paid under the Clinical Laboratory Fee Schedule (CLFS) beginning Jan. 1, 2018. The final rule includes provisions to ease administrative burdens for physician office laboratories and smaller independent laboratories.
Unified post-acute payment system within reach, MedPAC tells Congress
by Emily Mongan
A unified, site-neutral payment system for post-acute care is well within reach, the Medicare Payment Advisory Commission said Wednesday in a report to Congress.
MedPAC was required to create a plan for unified post-acute payments spanning skilled nursing facilities, home health agencies, inpatient rehabilitation facilities and long-term care hospitals by the Improving Medicare Post-Acute Care Transformation Act.
In its June 2016 Report to the Congress, MedPAC said that plan is “feasible” and would help level profitability across different lengths of stay and types of patients.
Facing the Facts on Federal Entitlements: A Case for Reform
by NIHCM Foundation
Recent budget projections from the Congressional Budget Office (CBO) indicate that the two major entitlement programs – Social Security and Medicare – will account for almost 40 percent of all federal spending this year. Additionally, federal revenues will cover only 86 percent of federal outlays, leaving us with a $534 billion deficit for the year.
CMS to initiate Medicare home health pre-claim review in five states
by AHA News Now
The Centers for Medicare & Medicaid Services yesterday announced a pre-claim review demonstration for all Medicare fee-for-service home health services in Illinois, Florida, Texas, Michigan and Massachusetts. Start dates will be determined in the coming months, but will be no earlier than Aug. 1 in Illinois, Oct. 1 in Florida, Dec. 1 in Texas, and Jan. 1 in Michigan and Massachusetts, the agency said. Under the three-year demonstration, the home health provider, billing entity or beneficiary will be encouraged to submit to the relevant Medicare Administrative Contractor a request for pre-claim review, along with relevant documentation, within 30 days of the beneficiary’s first treatment and before submitting the final claim.
The age-adjusted death rate remained higher in 2015 than in 2014 (729.5 and 723.2, respectively)
In 2015 (12-month period ending with the fourth quarter of 2015), the crude death rate for all causes was 841.9 per 100,000 population, an increase from 823.6 in 2014. The age-adjusted death rate remained higher in 2015 than in 2014 (729.5 and 723.2, respectively).
For 2015, the crude death rate for all causes was 920.1 in the first quarter, 822.5 in the second quarter, 790.6 in the third quarter, and 835.6 in the fourth quarter. The rates for the first three quarters of 2015 were higher than the rates for the same quarters of 2014 (871.9, 802.2, and 773.9, respectively). However, the death rate for the fourth quarter of 2015 was lower than the rate for the fourth quarter of 2014 (847.0). The age-adjusted death rate for the first three quarters remained higher in 2015 (800.0, 714.3, and 684.7, respectively) than in 2014 (769.6, 706.9, and 679.1, respectively), and the rate for the fourth quarter remained lower in 2015 (719.1) than in 2014 (735.8).
For First Time in Modern Era, Living With Parents Edges Out Other Living Arrangements for 18- to 34-Year-Olds
by Richard Fry
Share living with spouse or partner continues to fall
Broad demographic shifts in marital status, educational attainment and employment have transformed the way young adults in the U.S. are living, and a new Pew Research Center analysis of census data highlights the implications of these changes for the most basic element of their lives – where they call home. In 2014, for the first time in more than 130 years, adults ages 18 to 34 were slightly more likely to be living in their parents’ home than they were to be living with a spouse or partner in their own household.
Study: U.S. spends more on mental disorders than any other condition
by AHA News Now
U.S. health expenditures for mental disorders exceeded spending for every other medical condition in 2013 at $201 billion, according to a study published online this week by Health Affairs. Spending for heart conditions and trauma were the next highest, at $147 billion and $143 billion, respectively, followed by cancer and pulmonary conditions, at $122 billion and $95 billion. About 40% of spending for mental disorders was for institutionalized populations. “Spending on mental disorders tends to be underestimated in other sources because institutionalized populations are excluded,” the authors said.
Now that ICD-10 is in full swing, we are seeing a lot of activity with providers, payers, consultants and regulators who need to understand how Acute Inpatient and Long Term Care Hospital claims "behave" when the claim is coded in ICD-10. This includes both prospective and retrospective review of claims scenarios to understand MS-DRG grouping. This article offers a basic primer on MS-DRG grouping logic, and research techniques for using related MediRegs Coding Suite tools. If you'd like a personalized training on these tools, or a demonstration of them in action to see if they are a good fit for your research scenarios, please let us know!
OVERVIEW OF THE FY 2016 IPPS FINAL RULE: SUMMARY OF CALCULATION ELEMENTS
New Health Analytics, a national healthcare software developer and data analytics firm, is pleased to announce that it has released a special report with an concise review of the FY 2016 Hospital Inpatient Prospective Payment System (IPPS) Final Rule recently posted by the Centers for Medicare & Medicaid Services.