Repayments and Refunds: Estimating the Effects of 2014 Premium Tax Credit Reconciliation
by Cynthia Cox, Anthony Damico, Gary Claxton, Rosa Ma, Larry Levitt
In January 2014, the Affordable Care Act (ACA) began making federal premium tax credits available to eligible individuals who purchased health coverage through exchanges, or Marketplaces. These subsidies are a centerpiece of the law and are designed to provide financial assistance to millions of Americans who could not otherwise afford health coverage.
Characteristics of Hospital Stays for Super-Utilizers by Payer, 2012
by H. Joanna Jiang, Ph.D., Audrey J. Weiss, Ph.D., Marguerite L. Barrett, M.S., and Minya Sheng, M.S.
A large proportion of health care resources in the United States are consumed by a relatively small number of individuals. Approximately one-fourth of U.S. health care expenses are incurred by 1 percent of the U.S. population, and half of expenses are incurred by 5 percent of the population. In contrast, half of the U.S. population incurs only 3 percent of total health care expenses. Those few individuals who consume a large share of health care resources have been dubbed super-utilizers. Super-utilizers have become the focus of strategies aimed at reducing their disproportionate use of the health care system by improving the delivery and management of their care.
The Government Accountability Office yesterday appointed one new member and five existing members to three-year terms on the Medicare Payment Advisory Commission, and designated the commission chair. The new member is Susan Thompson, R.N., senior vice president of integration and optimization for UnityPoint Health and CEO of UnityPoint Health-Fort Dodge (IA) health system. The reappointed members are Alice Coombs, M.D., critical care specialist and anesthesiologist at South Shore Hospital, Weymouth, MA; Jack Hoadley, research professor at Georgetown University’s Health Policy Institute in Washington, DC; David Nerenz, director of the Center for Health Policy and Health Services Research at Henry Ford Health System in Detroit; Rita Redberg, M.D., professor of clinical medicine, University of California at San Francisco Medical Center; and Craig Samitt, M.D., global provider practice leader for consulting firm Oliver Wyman’s Health and Life Sciences Practice. Commissioner Francis “Jay” Crosson, M.D., will chair the panel. He serves on the National Advisory Council of the Agency for Healthcare Research and Quality and spent 35 years as a physician and physician executive at Kaiser Permanente in Oakland, CA.
News Item - 05/22/2015
Measuring and reporting performance on indicators of patient safety and quality have contributed to some marked improvements in recent years, according to the newly released 2014 National Healthcare Quality and Disparities Report from the Agency for Healthcare Research and Quality (AHRQ).
Released with the report is a new Chartbook on Patient Safety that summarizes trends across key patient safety measures, offers downloadable slides, and includes a data query tool with access to all data tables.
On a national level, the safety and quality of health care is improving, especially for care delivered in hospital settings and for measures that are publicly reported to the Centers for Medicare & Medicaid Services (CMS). Hospital care was safer in 2013 than in 2010, with 17 percent fewer harms to patients and an estimated 1.3 million fewer hospital-acquired conditions, 50,000 fewer deaths, and $12 billion in cost savings over 3 years (2011, 2012, and 2013). One potentially deadly type of hospital-acquired infection, central line-associated bloodstream infections for medical and surgical patients, declined at an average annual rate of more than 10 percent per year.
Despite these dramatic improvements, 121 adverse events per 1,000 hospitalizations occurred in 2013, and rates of post-operative acute kidney injury or complication of diabetes worsened over the 2000 to 2012 period.
Quality of care measures that are publicly reported to CMS’ Hospital Compare Web site show continued improvement. Several measures dealing with recommended care for hospital patients with pneumonia and heart conditions have achieved an overall performance level of 95 percent, the report found. Because further opportunities for improvement are limited at this level of performance, these measures will not be tracked in future reports.
Quality, while improving, remains far from optimal. Across a broad array of measures, recommended care is delivered only 70 percent of the time, according to the report. Only half (52 percent) of patients with hypertension have it controlled, while 76 percent of adults are regularly screened for high cholesterol.
Major disparities also persist in quality and safety of care, the report found. For about one-third of the patient safety measures tracked in the report, people in poor households received worse care than people in high-income households, and Blacks and Asians received worse care than Whites.
Although patient safety initiatives typically focus on inpatient hospital events, adverse events also occur in outpatient settings. One such measure, which tracks the rate of potentially inappropriate prescription medications among adults age 65 and older, found overall improvement. Between 2002 and 2012, the percentage of adults who received potentially inappropriate prescription drugs decreased overall for all racial and ethnic groups and for all income groups. Poor adults had the largest percentage decrease, from 23 percent in 2002 to 11 percent in 2012.
AHRQ’s National Quality and Disparities Report and Patient Safety Chartbook provide detailed evidence of the progress that has been made and the work that remains to create a health system that promotes the National Quality Strategy’s priorities of patient safety, person-centered care, care coordination, effective treatment, healthy living, and affordable care.
News Item - 05/21/2015
Press Ganey presses play on Wall Street
by Michael Sandler
Press Ganey Holdings stock began trading Thursday on the New York Stock Exchange, and closed at $27.50 per share.
The patient-satisfaction measurement firm based in South Bend, Ind., announced Tuesday that 8.9 million shares would be sold at $25 per share, before underwriting discounts. All of the common stock is being offered by Press Ganey. The company's shares will be traded under the ticker symbol PGND.
HHS seeks to have 85 percent of Medicare fee-for-service payments in value-based purchasing categories 2 through 4 by 2016 and 90 percent by 2018
Improving the quality and affordability of care for all Americans has always been a pillar of the Affordable Care Act, alongside expanding access to such care. The law gives us the opportunity to shape the way health care is delivered to patients and to improve the quality of care system-wide while helping to reduce the growth of health care costs.
When it comes to improving the way providers are paid, we want to reward value and care coordination – rather than volume and care duplication. In partnership with the private sector, the Department of Health and Human Services (HHS) is testing and expanding new health care payment models that can improve health care quality and reduce its cost.