Let’s just go nuts reading about all the places Medicaid expansion is on the ballot while we wait for the results to come in tonight. We will get back to our normal 3 article summary for the MMMRs next week..
If you haven’t — Vote!
We scour the internets for Medicaid jobs listings to save you time.
In this packet –
Enjoy a few highlighted articles related to this month’s News Focus Theme.
In this edition:
2018 11 05- Medicaid Curator – Patient Engagement
From stories collected week of Oct 29, 2018
In this issue..
Billions In ‘Questionable Payments’ Went To California’s Medicaid Insurers And Providers
California’s Medicaid program made at least $4 billion in questionable payments to health insurers and medical providers over a four-year period because as many as 453,000 people were ineligible for the public benefits, according to a state audit released Tuesday….
Massachusetts Health Care Company Owner Charged with Tax Fraud
Two Weymouth, Massachusetts women are facing charges of tax evasion in connection to a home health care company they co-owned in Boston. Sheila O’Connell, 33, and Hannah Holland, 51, were both charged with one count of conspiracy to defraud the United States and three counts of aiding and assisting in the preparation of false tax returns….
Albuquerque psychiatrist over-medicated hundreds of children in his care
Unlike many doctors, Albuquerque psychiatrist Edwin Bacon Hall, 74, accepted patients on Medicaid and saw them in a timely manner. He often treated foster children, who were sent his way with the approval of their legal guardian, the Children Youth and Families Department (CYFD)….
Nurse pleads guilty to stealing opioid drugs while at Johnson County care facility
A Johnson County nurse has pleaded guilty to stealing opioid drugs while working at a residential care facility in Gardner, Kan. Jeremy Keith Bailey pleaded guilty Thursday in Johnson County District Court to possession of a controlled substance, theft and Medicaid fraud….
Prosecutors dismiss health care fraud charges against Dr. Roland Chalifoux
WHEELING, W. Va. (WTRF) – A three and a half year legal battle in West Virginia’s Northern District Court has come to an end. In what the U.S. Attorney’s office is calling a “rare move,” federal prosecutors motioned to dismiss pending charges of health care fraud against Dr. Roland Chalifoux, Jr. Dr. Chalifoux, 58, was indicted in June 2017 in a 32 count indictment that alleged crimes ranging from health care fraud, wire fraud, and mail fraud. He was alleged to have wrongfully billed insurers, including Medicaid, for visits at which he was not present…
Audit: Ohio Medicaid paid $90.5 million to deceased people; owes feds $38 million
Ohio Medicaid paid out $90.5 million in coverage to individuals who had already been deceased, an audit by the Office of the Inspector General claims. After the federal audit analyzed a random sample size, it estimated that Ohio Medicaid failed to recover $51.3 million of those funds; $38 million of which were part of the federal share, which Ohio Medicaid owes back to the federal government….
Mississippi man pleads guilty to misusing mother’s money
JACKSON, Miss. (AP) — A Mississippi man has pleaded guilty to spending his mother’s money on himself, rather than paying her medical bills. WLBT-TV reported that 62-year-old Steven Adkins of Madison pleaded guilty Monday to one felony count of exploitation of a vulnerable person. Adkins was sentenced to 10 years in prison….
Austin psychologists convicted in multiple charges after fraud investigation
AUSTIN — A federal jury on Monday convicted two Austin-area psychologists on numerous charges after a fraud investigation at their establishment, Psychological A.R.T.S., P.C. After a three-week-long trial, the jury convicted Dr. William Joseph Dubin, 73, and his son, Dr. David Fox Dubin, 33. William was found guilty of one count of conspiracy to pay and receive health care kickbacks, and two counts of offering to pay and paying illegal kickback, while his son was found guilty of one count of conspiracy to commit health care fraud, one count of health care fraud and aiding and abetting health care fraud, and one count of aggravated identity theft….
Nursing home settlement involves former owner of Hagerstown facility
BALTIMORE — The former owner of a nursing home north of Hagerstown was the defendant in a lawsuit settled last week with the state attorney general’s office. NMS Healthcare agreed to pay $2.2 million to the attorney general’s Medicaid Fraud Control Unit, and the company and its owner, Matthew Neiswanger, are prohibited from operating in Maryland, according to the settlement….
NJ Comptroller: Illegal Medicaid Amnesty Deals Cut in Lakewood Case
A discrepancy has emerged in the office of the New Jersey state comptroller between the controller, Phillip J. Degnan and three levels of managers who work for him. The issue is in regards to the repayment of Medicaid fraud to taxpayers. Degnan said that one of his employees went rogue by discounting $2.7 million on the repayment while the managers said the office knew about the already knew about the arrangements…
Two home health agency owners and two employees convicted for roles in $3.7 million home health fraud scheme
Washington, DC, October 30, 2018—A federal jury found two home health owners and two employees guilty today for their roles in a scheme to bill Medicare and Medicaid for over $3.7 million in charges when the owners had previously been excluded from participating in federal health-care benefit programs…
Bridgeport Woman Pleads Guilty To Medicaid Fraud
BRIDGEPORT, CT — A woman accused of defrauding the state through identity theft of Medicaid patients. Nikkita Chesney, 45, of Bridgeport pleaded guilty to one count of health care fraud and one count of aggravated identity theft. She admitted to stealing the identity information of 150 Medicaid clients from her employer and using about half that information to file false billings to Medicaid, according to the U.S. Attorney District of Connecticut. She said her co-conspirators also falsely billed Medicaid…
Auditor: DSHS failed to catch, report employee welfare fraud
OLYMPIA — A Department of Social and Health Services supervisor who was one of Kitsap County’s top welfare cheats over the past 10 years was able to rip off the system because the process the department used to determine her eligibility was not “effectively performed.”…
2 people convicted for million dollar welfare fraud in Louisiana
BATON ROUGE, La. (LADOJ) – Two individuals have been convicted for a welfare fraud scheme costing Louisiana over $1 million. Lanice Stamps, 39 of New Orleans, pled guilty to one count of Felony Theft and was ordered to pay $1,059,709.76 towards restitution for the money stolen and $300,000 to the MFCU in civil monetary penalties. She was also ordered to execute a mortgage to repay the State for Medicaid monies she used to pay her home mortgage…
Suffolk doctor charged in drug-testing scam, state AG’s office says
A Suffolk doctor who owns a laboratory cheated state Medicaid out of nearly $1 million in a four-year drug-testing scam, the state attorney general’s office said Tuesday. Edwardo M. Yambo, 70, of Lake Grove, stole $939,000 between 2012 and 2016 by “routinely” submitting bills for drug testing services that his laboratory did not or could not perform and for services that were not medically necessary, according to Attorney General Barbara D. Underwood. For example, instead of charging for one test on a patient, he often charged the state’s healthcare program for low-income residents for 11 nonexistent tests, said agency spokesman Jordan Carmon…
Man pleads guilty to medicaid fraud
JACKSON, Miss (WJTV) – Steven Adkins of Madison will spend 10 years in prison after pleading guilty to spending his mother’s money instead of paying her medical bills. Adkins, 62, was sentenced Monday to 10 years on one felony count of exploitation of a vulnerable person by Madison County Circuit Court Judge William Chapman. An investigation by the Attorney General’s Medicaid Fraud Control Unit found that Adkins depleted his mother’s funds in excess of $30,000 between March and December 2017….
State Attorney Brings Medicaid Fraud Charges Against Waterbury Man
A 49-year-old Waterbury man has been arrested and charged with a scheme to defraud Medicaid of nearly $2,800 by allegedly claiming to provide at-home care to an elderly disabled man who was actually in a nursing home. Investigators arrested Albert Haddad and charged him Friday with one count each of health insurance fraud and first-degree larceny by defrauding a public community. Haddad was released on a $15,000 bond and is scheduled to appear in Hartford Superior Court Nov. 6. Both charges are Class B felonies punishable by up five years in prison…
BESHEAR: JEFFERSON COUNTY COUPLE CHARGED WITH ALLEGED NEGLECT/ABUSE, MEDICAID FRAUD
A Jefferson County couple is facing six felony counts of alleged abuse and neglect of a vulnerable Kentuckian, and theft and fraud of the Kentucky Medicaid Program, according to Attorney General Andy Beshear….
Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2zqq6nM
For optimist readers- http://bit.ly/2zmJimb
WELCOME, MRS. MAYHEW- After bringing some predictability to the Maine Medicaid budget, Mary Mayhew was tapped to head Medicaid efforts at the federal level earlier this month. Her official title will be CMS Deputy Administrator. Congratulations, Mary!
BADGES? WE DON’T NEED NO STINKIN’ BADGES- If you thought CMS was holding the phone on work requirements while the KY lawsuit sorts out, you were wrong. CMS approved Wisconsin’s request to add a work requirement feature to its Medicaid benefits package. Also important- Wisconsin is a non-expansion state (many work requirements resisters have been holding out hope that CMS won’t approve work requirements in non-expansion states). CMS did not approve the state’s request to add drug testing requirements for members, but they did allow them to ask bennies about risky health behaviors as part of coverage determinations.
NEITHER DOES VIRGINIA- Sources say VA officials plan to submit a work requirements request to CMS by this Friday. Current proposal includes work/volunteer requirements (or job classes) and premiums up to $10/month. Many conservative lawmakers feel the new proposal is too watered down to matter, though.
POSSIBLY ALSO NEITHER DOES MISSISSIPPI- MS Medicaid officials are chatting it up with CMS now that the public comment period on their work requirements request has ended.
NEBRASKA VOTERS TO DECIDE EXPANSION AS WELL AS WHICH MODIFIERS SHOULD PAY ON 99213 CODES IN THE NEXT VERSION OF THE POLICY MANUAL- Initiative 427 puts Medicaid expansion in the hands of Nebraskans next Tuesday. I’m not concerned they are low-informed voters on the details of Medicaid. Not at all. Nothing to see here. Move along.
VERMA TROLLS MEDICARE-FOR-ALL MOB; THEY TAKE THE BAIT- Hey if Nebraskans who mostly probably don’t know the difference between Medicare and Medicaid can decide whether to double spending on it, why can’t the twitterverse tell CMS Administrator Verma (in the very polite ways we have come to expect from our leftist friends, of course) she was a terrible, doubleplus ungood person to tweet this in the spirit of Halloween. Remember, questions like “how would we pay for it?” and “does this even make basic logical sense?” don’t matter. All that matters is feelings and a deeply held conviction of a virtuous “resistance.”
OHIO MOVING UP HEP-C TREATMENT- Medicaid bennies in OH no longer have to wait until their Hep-C progresses to get specialty drugs. Starting Jan 1, OH will pay for treatment for any one diagnosed with Hep C. In tech speak, OH used to pay for patients with a Fibrosis Score (F score) of F2. Now the state will pay for all Fscores (starting at F0). Last year the state went from only paying for F4s to F2s.
CA PAID $4B OUT IN “QUESTIONABLE” PAYMENTS- Some pretty egregious examples in a recent state auditor’s report. Biggest findings – state kept paying MCOs and docs for services for 453,000 members who were ineligible for benefits. Worst example- an MCO got paid $383k for care for a member in LA County who had been dead for 4 years.
FINALLY, AFTER 300 YEARS, CMS APPROVES NC WAIVER- Congrats to the team that’s been working on bringing managed care to the state for the past few years!
FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Let’s start the ticker and see who wins this week’s award. Edwardo Yambo of Lake Grove, NY stole $939k for false lab claims. In addition to billing for claims his lab wasn’t even equipped to run, Mr. Yambo operated the lab without a director (a big no-no). Lanice Stamps and Tia Smiley of New Orleans were convicted this week for their $1.1M fraud in Louisiana using a bogus behavioral health company to steal from Medicaid. Bonus – both fraudsters were also Medicaid bennies. Not sure I have seen double-dipping on the provider and benny fraud side before. Nikkita Chesney of Bridgeport, CT plead guilty this week to using 150 stolen member IDs to file more than $1M in false claims. Celestine “Tony” Okwilagwe lead the way in convictions for a pretty large home health fraud in Dallas this week. Along with 3 of his buddies, Tony got popped for stealing $3.7M from Medicare and Medicaid. Special points on this one since 2 of these dudes had already been excluded from any federal health-care program for prior convictions. Matthew Neiswanger of Baltimore was in court last week and agreed to pay back $2.2M his nursing home stole from Medicaid. How did he do it? Evicting higher cost patients (sicker) and false claims. Joseph Dubin and David Dubin (father and son, a first for the follies) of Austin, TX were convicted of stealing $300k in a kickback scheme involving Medicaid psychology services. Fraudster and Sons paid another fraudster to refer Medicaid kids to their mental health services company. Lanice and Tia you win – I am just entranced by the double provider/member fraud angle! Plus, $1.1M is a pretty good take home. Taxpayers, you lose – about $8.2M in the stories covered in this paragraph. Work harder! Gotta pay for all that fraud somehow…
New content alert- The Medicaid Fraud, Waste and Abuse Curator Volume 1 is out. Includes links to the stories above and a lot more. Check it out here.
That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (clean your chimney, its that time already) and keep running the race (you know who you are).
FULL, FREE newsletter@ mostlymedicaid.com . News that didn’t make it and sources for those that did: twitter @mostlymedicaid .
Trystero: piyāṇan vahansē lōkayaṭa gaḷavannaṭa putrayā evū sēka.
Helping you consider differing viewpoints. Before it’s illegal.
Article 1:
Clay’s summary: Studies like this are strong support for the national Medicaid Quality Rating System (still to be implemented under the Mega Reg as of the time of writing)
Key Passage from the Article
A new report questions what metrics policy makers are using to evaluate whether or not children enrolled in Medicaid managed care organizations (MCOs) are receiving quality care, given the public investment these programs receive.
The report, from the nonpartisan Georgetown University Center for Children and Families (CCF), said that state Medicaid agencies and CMS do not use 1 common measurement for measuring quality of care.
Data and transparency about the quality of care for children are scant, the report said. There is no publicly accessible national database with information on how well individual MCOs are serving enrolled children.
For instance, there is no national database regarding the performance of individual MCOs with respect to Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, which are a guaranteed benefit providing care to children with special needs.
…
Article 2:
Clay’s summary: Good overview for those just beginning to learn about quality rating systems in the space.
Key Passage from the Article
Quality performance metrics such as HEDIS, CMS Star Ratings, and standardized core quality measures (CQMs) can give consumers an objective indication of healthcare payer quality.
Standardized quality measures aggregate how well a payer has performed based on the regularity of services performed, improvements in patient health, and consumer satisfaction.
Commercial, Medicaid, and Medicare payers can leverage quality metrics in order to position and market their health plans as ideal insurance options for beneficiaries.
HEDIS, CMS ratings, and CQMs measure similar healthcare services and consumer-facing operations, but some quality datasets are more specialized, including metrics such as consumer satisfaction rates or chronic disease screening activities.
…
Article 3:
Clay’s summary: So what’s your alternative? That the available data doesn’t support a meaningful dashboard is sort of the point, class…
Key Passage from the Article
CMS Monday released a scorecard that reports quality metrics voluntarily reported by states for Medicaid and the Children’s Health Insurance Program (CHIP), as well as federally reported measures, but the association that represents state Medicaid directors expressed some concerns with the scorecard’s data and what sorts of conclusions may be drawn from them, given the huge variability of state programs, essentially giving it a score of “needs improvement.”
CMS said that it is the “first time” it is publishing state and federal administrative performance metrics; the first 3 areas to be included are state health system performance, state administrative accountability, and federal administrative accountability. Health metrics include things like well-child visits, mental health conditions, children’s preventive dental services, and other chronic health conditions.
…
Helping you consider differing viewpoints. Before it’s illegal.
Article 1:
Clay’s summary: Big Nursing Home lobby cries Uncle; asks for less regulation, please.
Key Passage from the Article
Ahead of a congressional hearing to scrutinize federal oversight of skilled nursing care, the American Health Care Association (AHCA) on Sept. 5 urged lawmakers to recognize the steady and significant improvement in the quality of care for skilled nursing care center residents instead of considering more regulation of an “already overburdened sector.”
The statement by Mark Parkinson, president and chief executive officer of AHCA, came before a House Energy and Commerce Subcommittee on Oversight and Investigations hearing titled “Examining Federal Efforts to Ensure Quality of Care and Resident Safety in Nursing Homes.”
He said while the discussion agenda is focused on whether the Centers for Medicare & Medicaid Services (CMS) and Office of Inspector General exercise enough oversight to ensure residents are free from abuse and receive proper care, such a debate is missing the point and continues a pattern of disrespecting the nursing care profession.
“At a time when Congress faces public criticism for its failure to work together and accomplish shared goals, this hearing seems like a misguided effort to find more ways to regulate an already overburdened sector,” Parkinson said. Long term care is one of the most regulated industries in the country, “yet we’ve shown some of the most dramatic improvement on both self-reported and government quality measures.”
…
Article 2:
Clay’s summary: Better management of asthma in pediatric populations can pay off. So can avoiding medical errors.
Key Passage from the Article
With their drive to deliver high-value care in mind, Nationwide Children’s Hospital in Ohio and Yale New Haven Children’s Hospital in Connecticut embarked on quality improvements efforts to address specific issues within their organizations that were impacting patient outcomes and cost.
Their quality improvement projects paid off in more ways than one. Nationwide has reported significant improvements in asthma control, resulting in $5.2 million in savings, while Yale New Haven Children’s Hospital has seen patient safety and error reporting increase, catching $3 million in savings for the hospital.
…
Article 3:
Clay’s summary: Efforts to bring palliative care into value-based care are in the early stages.
Key Passage from the Article
The American Academy of Hospice and Palliative Medicine (AAHPM), in partnership with the National Coalition for Hospice and Palliative Care and the RAND Corporation, has been awarded a three-year $5.5 million grant from Centers for Medicare & Medicaid Services (CMS) to develop patient-reported quality measures for community-based palliative care.
Filling the gaps in quality measurement of palliative care is one of the main sticking points for the three-year grant, according to AAHPM.
One of the many reasons to develop measures is because major gaps were observed in quality measurement for people with serious illness, according to a 2015 report measuring quality indictors for hospice and palliative carefrom AAHPM and the Hospice and Palliative Nurses Association.
…
Helping you consider differing viewpoints. Before it’s illegal.
Article 1:
Clay’s summary: Pretty blatant press-release dressed up as “news,” but interesting read nonetheless.
Key Passage from the Article
“The growth of value-based care is driving the need for deeper healthcare insights, for key activities such as risk adjustment, quality reporting, care and utilization management,” Apixio CEO Darren Schulte, M.D., told Healthcare Analytics News™.
The company’s pitch looks something like this: The Centers for Medicare & Medicaid Services is increasing audits of health plans offering Medicaid Advantage (MA), to ensure correct payments. That means health plans have to keep careful tabs on coding and payments. But unless the health plan owns the clinic, providers don’t share the same financial risks as insurers.
Apixio says about 85-95 percent of MA risk-adjustment payments are based on diagnosis codes from clinics and hospitals. The remaining payments are from chart coding. Diagnosis codes are backed up by patient notes and physician codes, but those records aren’t often reviewed prior to payment by the health plans. Thus, any errors may go undiscovered, which could cause regulatory headaches for health plans — but usually not clinics.
…
Article 2:
Clay’s summary: Care management only works if you are treating the right patient.. kind of makes me think about how they write “not this one” on the leg that is not to be cut off going into surgery..
Key Passage from the Article
This report focuses on the last problem—patient matching—while also recognizing that many other challenges remain for effective and robust interoperability.
Patient matching helps address interoperability by determining whether records—both those held within a single facility and those in different health care organizations—correctly refer to a specific individual. Unfortunately, patient matching rates vary widely, with health care facilities failing to link records for the same patient as often as half the time. Deficiencies in matching patients to their records can lead to safety problems: For example, if an allergy listed in one record is not documented in another, or if records for two different individuals are incorrectly merged, patient harm can occur. In a 2012 survey conducted by the College of Healthcare Information Management Executives (CHIME), 1 in 5 hospital chief information officers indicated that patients had been harmed in the previous year due to mismatches.
Failures to effectively match patients can also be costly, leading to repeat tests and delays in care. In an extreme example, the care for an 11-month-old twin was documented in her sister’s record, resulting in the failure of the health system to recoup $43,000 in costs from the insurer.
…
Article 3:
Clay’s summary: Still losing money in year 7 of your health home? Don’t give up just yet- Health Affairs says they work, so they must work!
Key Passage from the Article
There are clear differences between studies that do and do not find benefits. Positive evaluations assess PCMHs on advanced standards, after up to five years of transformation and with financial incentives to improve quality and efficiency, or—like the HIV study above, the impact with high-cost, high-needs patients. Studies showing little benefit assessed practices with no financial incentives to reward improvement. They also looked at PCMHs using our initial 2008 standards that we updated in 2011, 2014, and 2017. The 2011 updates further emphasize pediatrics, health information technology, and clinician-patient collaboration. We made 2014 updates to emphasize more behavioral health care integration, team-based care, focus on high-need populations care management, and patient and family involvement. We made 2017 updates to streamline our recognition process and better support practices. And we will continue making updates in the future as we continuously listen to stakeholder feedback on how to improve this powerful program.
PCMHs do, in fact, work. That is why the Medicare Access and CHIP Reauthorization Act (MACRA), which rewards clinicians for value instead of volume, gives PCMHs automatic credit. That is why 27 public-sector initiatives across 23 states and many private insurers use the NCQA PCMH model. That is why key medical boards provide PCMH credit for Maintenance of Certification. And that is why approximately 20 percent of all primary care physicians in the US are in the NCQA-recognized PCMH practices.
…
Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2RI7RCi
For optimist readers- http://bit.ly/2RKh1hW
BUCKEYES TO GET MORE OPTIONS ON OPIOID RECOVERY MEDS- Based on what I am hearing, looks like Ohio may be removing prior auth for more drugs besides just suboxone and generics for buprenorphine and naloxone. If you know more, please dial into the show on Monday and weigh in.
NEW PROJECT TO UP CAID IMMUN RATES- If you’ve been around this Medicaid world a while, chances are you have bumped into the immunization “registries” (glorified excel files in a Medicaid official’s computer, usually). The CDC is funding a new consulting project (Nat’l Academy for State Health Policy got $800k) to figure out how to better integrate this data, encourage providers to submit more of it and close gaps for certain vaccines (i.e. Medicaid rotavirus rates for kids are 12 points lower than commercial).
MORE RUH-ROHS IN THE OH PBM SCANDAL- We will cover this in Monday’s show, so tune in. The gist: turns out one of the reasons Centene’s rx costs were more than other MCOs (all of them got caught up in the spread pricing scandal), is because they used their subsidiary (Envolve) as a sort of middle-middle man to the PBMs.
HOW MANY YEARS IS IT OK TO NOT HAVE A MEDICAID INSPECTOR GENERAL IN A STATE? 4 years is the answer if you’re Kansas. After the top Medicaid oversight spot (over the $3B program- but hey that’s chump change when its those taxpayer chumps funding it, right?) sat empty since 2014, the seat is now being manned (wo-manned, actually) by Sarah Fertig. Congratulations, Sarah!
CONGRATS TO OUR FRIENDS AT WELLCARE- It’s the time of year where we see which MCOs are doing better per NCQA quality ratings, and Wellcare just got high marks in NJ and NY. Congrats!
FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Let’s start the ticker and see who wins this week’s award. Vicki Chisam of Batesville, AR was charged with her role in a $2M Medicaid fraud (part of the Preferred Family Healthcare mental health scheme we have covered). Chisam was apparently the EHR data manipulation specialist in the crimes. She herself is tied to $589k in pilfery. Lyubov Beylina of Brooklyn (along with 7 other upstanding citizens) was charged with stealing $600k for billing for therapy while on vacation in the Dominican Republic. She also forged signatures of parents of children she was therapy-ing. Joanna Michelle Phillips of Cheyenne, WY was sentenced to 18 months for stealing $58k via false claims. Mercy Ainabe of Houston, TX was sentenced this week for her role in a patient recruitment Medicaid fraud scheme. She and her fellow fraudsters used a home health care front to bill for medically un-necessary services, pay bennies to sign-up and send kickbacks to docs. Total tab – $3.6M (but to Medicare, so she can’t win this week). Epo Onega of Staten Island was popped for using her teaching job to steal $59k with bogus speech therapy claims. Vicki- you win! Hopefully you can re-connect with some of your old workmates once you all get sentenced. Taxpayers – you lost about $7M in this paragraph! Work hard! Somebodies gotta pay for all this fraud (hint- you do, chumps). Are you a Medicaid bennie on a waiting list for a waiver program? Keep waiting! Sorry, we have to make sure we keep paying fraudsters before we open up your slot.
That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (plant mums – they can actually do really well in the ground) and keep running the race (you know who you are).
FULL, FREE newsletter@ mostlymedicaid.com . News that didn’t make it and sources for those that did: twitter @mostlymedicaid .
Trystero: Otac je poslao Sina da spasi svet. Also – chuir an t-Athair am Mac gus an saoghal a shàbhaladh.
Helping you consider differing viewpoints. Before it’s illegal.
Article 1:
Clay’s summary: The specific needs of Rural Americans- finally a focus of pop health?
Key Passage from the Article
The set includes nine measures intended for a hospital setting—such as scores on the Hospital Consumer Assessment of Healthcare Providers (HCAHPS) survey and Cesarean section rates—and 11 for ambulatory care settings, such as medication reconciliation postdischarge and preventive screenings for diabetes, behavioral health issues and tobacco use.
…
Article 2:
Clay’s summary: You mean the government can’t write a reg to improve quality of care? And actually focuses on minutia that can be counted versus outcomes that matter? Egads! #Resist!
Key Passage from the Article
When he’s using microsurgical techniques to treat unbearable facial pain, neurosurgeon Richard Zimmerman, MD, values precision above all. But as the chair of quality outcomes at Mayo Clinic in Arizona, he has come to accept that the government’s system for measuring health care quality is less than precise.
“If you’re a hematologist–oncologist, the survival rate of cancer patients might be a better indication of quality than how often you document that you have screened for depression,” he says.
But screening a patient for depression—or, more accurately, documenting that you have screened for depression, regardless of whether you actually remembered to do so—leads to higher pay from the Medicare program. Nobody’s paying more for high cancer-survival rates.
Welcome to health care’s pay-for-value movement, in which public and private payers want to reward—and penalize—physicians based on the quality of care they provide.
It’s a good idea with a big problem: Physicians don’t believe in it.
…
Article 3:
Clay’s summary: Looking forward to seeing the creativity of haters in coming up with a way this is a bad thing.
Key Passage from the Article
Modernizing the Medicaid program environment will require investments in data analytics and a greater reliance on meaningful quality measures, says CMS Administrator Seema Verma in a new blog post. As spending on healthcare in general – and Medicaid in particular – continues to rise, providers and regulators will need to continue to create more effective partnerships around raising quality and cutting costs, Verma stated. “As program costs have continued to rise, we have failed to deliver a level of transparency and accountability for achieving positive outcomes commiserate with our significant investment,” she wrote. “But this is finally beginning to change. Over the last several years, CMS has collaborated with states to improve how we collect and use data to modernize and measure the Medicaid and CHIP program.”
…
