Category: MMMMRs

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Monday Morning Medicaid Must Reads: Feb 11, 2019

Helping you consider differing viewpoints. Before it’s illegal.
In this issue…

Article 1:     State wrestles with sizable backlog of Medicaid applications

 
Clay’s summary:     Expansion nearly doubled the AK Medicaid rolls. Doubled. 
Key Excerpts from the Article:
As of Jan. 29, Alaska had a backlog of 15,639 cases of new applicants or renewals on the books. About two-thirds of those, or 10,200 cases, were filed in 2018. The average wait time to be approved is currently 55 days, according to Clinton Bennett, the media relations manager for the Alaska Department of Health and Social Services… That’s the average, but not everyone is waiting that long, he wrote in an email…“Cases that are tagged as emergent, involve a pregnant woman or adding a newborn to any case are being processed on average within 2 days,” he wrote.
Alaska has a fairly large Medicaid population with about 210,276 people enrolled in the Medicaid and CHIP programs as of October 2018, according to the Centers for Medicare and Medicaid Services.
That’s about 24 percent of the state’s total population, and up from 123,335 people enrolled at the end of July 2015, just before the Medicaid expansion took effect in the state.
Though it’s still a sizable backlog, it’s significantly down from the total in May 2018, when the Alaska Ombudsman’s Office published a report highlighting the difficulties in the Division of Public Assistance. At the time, the ombudsman noted a backlog of more than 20,000 cases, itself down from 30,000 in July 2017.
 
Read full article in packet or at links provided

Article 2:     Medicare, Medicaid Enrollment Growing Faster Than Private Coverage

 
Clay’s summary:     New analysis says Care/Caid spending growth is nothing to be concerned about. What do they think we are, idiots? Of course they do. Shut up and pay your taxes. Don’t have opinions about how they are spent.
Key Excerpts from the Article:
 Over the course of 11 years, annual spending growth averaged 5.2% for Medicare and 6% for Medicaid. This eclipsed the 4.4% spending growth among private insurers.
However, spending per enrollee from 2006 to 2017 was markedly lower for public programs compared to their private counterparts. Medicare spending per enrollee amounted to 2.4% per year, Medicaid registered at even lower 1.6%, while private insurance posted 4.4% annually.
Medicaid and Medicare also achieved positive annual enrollment growth rates over the same period of time, 4.3% and 2.8% respectively, while private insurers finished with a flat enrollment growth rate.
The study’s findings conclude that while CMS projects Medicaid and Medicare spending per enrollee to grow sizably over the next decade, both programs have “successfully moderated growth.”
The Urban Institute states that the results indicate that neither program require “major restructuring” to reduce national health spending and that the more concerning spending figures lie in the private insurance market.
The study’s authors support “modest policy proposals,” such as limiting state use of provider taxes in Medicaid or modifications to Medicare cost-sharing.
 
Read full article in packet or at links provided

Article 3:     Medicaid cost concerns are valid

 
Clay’s summary:     An op-ed considers a litany of examples when the state was left to deal with federal funding changes that made programs cost a lot more than originally promised- AND they connect the dots to Medicaid expansion and the “free federal money.” How dare they use logic and past experience???!!? Evil Republicans!
Key Excerpts from the Article:
 Even if the state’s portion of Medicaid expansion costs doesn’t rise, the $150 million price tag is still significant. That $150 million is more than twice the amount required to provide a proposed $1,200 pay raise for every teacher this year. It’s more money than what would be saved if roughly 12,400 inmates were released from state prisons, according to one estimate. It’s more than four times the amount required to eliminate a backlog of local government reimbursements for emergency responses.
Every dollar spent on Medicaid expansion is a dollar that doesn’t go to other needs like schools, roads or public safety. And voter rejection of a 2016 sales tax increase shows limited public appetite for the kind of broad-based tax increases required to avoid such tradeoffs.
The real debate is not simply whether one supports Medicaid expansion, but whether one believes Medicaid expansion should be a higher priority than school funding increases or other causes. And, beyond fiscal considerations, debate should also focus on this question: Does Medicaid expansion improve health outcomes? Much research has found little real improvement.
 
Read full article in packet or at links provided
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Monday Morning Medicaid Must Reads: Jan 21st, 2019

Helping you consider differing viewpoints. Before it’s illegal.
In this issue…

Article 1:    Feds OK Medicaid Work Requirements in Arizona, Health Leaders Media

Clay’s summary:    This is only the 8th one approved. Must be a fluke.

Key Excerpts from the Article:

Arizona has permission from the federal government to begin imposing work requirements next year on certain Medicaid beneficiaries in the state, but most Native Americans will be exempt, the Centers for Medicare & Medicaid Services announced Friday. Arizona’s waiver is the eighth of its kind, signaling that the Trump administration intends to continue pushing forward with Medicaid work requirements despite pending legal challenges in other states. This is the first waiver to exempt members of federally recognized tribes, resolving a major sticking point with Arizona’s application. State officials had asked CMS to exempt all Native Americans from the new requirement, but Trump administration lawyers said doing so would constitute illegal preferential treatment on the basis of race. The tribes contended, however, that the administration’s position contradicted longstanding legal principles and Supreme Court precedent, as Politico reported.
“There were a lot of complex legal issues here,” CMS Administrator Seema Verma told Politico’s Rachana Pradhan. “I think that we were able to find a middle ground.”…

Read full article in packet or at links provided

Article 2:    Strategies for an Affordable Medicaid Buy-In Option in Colorado, Manatt

Clay’s summary:    We will sell Medicaid on the exchange, and offer subsidized premiums (so nobody really pays for it, except taxpayers). And oh yeah – we’ll pay providers at Medicare rates. What could possibly go wrong?

Full study
Key Excerpts from the Article:

In Colorado, where average Affordable Care Act (ACA) benchmark premiums have increased 71% since 2014, advocates and stakeholders initiated an analysis to evaluate the feasibility and potential impact of a Medicaid buy-in offered outside the individual ACA market, with access to Advanced Premium Tax Credit funding under an ACA Section 1332 State Innovation Waiver. The product would be offered statewide, leverage the current Medicaid infrastructure, provide the same benefits and range of cost sharing as coverage on the state Marketplace (Connect for Health Colorado), and reimburse providers at Medicare rates. The analysis evaluates expected premiums for the buy-in product, the impact of its introduction on existing individual market premiums and the potential for state savings under this program design. The effort was led by a coalition of Colorado health policy advocates, represented by the Colorado Center on Law and Policy, the Colorado Consumer Health Initiative, and the Bell Policy Center. Manatt Health provided the policy and technical support, and Wakely Consulting Group, LLC, conducted the analytical modeling of the proposed program design and scenario alternatives….
 
Read full article in packet or at links provided

Article 3:    Ohio mental health agency closes, blames changes in Medicaid claims, Columbus Dispatch

Clay’s summary:   I’ve seen this movie before.

Key Excerpts from the Article:

Tener said her problems began in July, when the Ohio Department of Medicaid, which had been reimbursing providers for mental-health services provided to Medicaid clients, transferred that responsibility to managed-care insurance plans. Tener said she’s owed $40,000 from the plans, which have been criticized for failing to pay claims in a timely manner or rejecting them for unclear reasons..The Ohio Department of Medicaid has been reviewing the plans continuously and the providers since July 1, said Thomas Betti, the department’s press secretary.
“We understand the significant learning curve with the new system; however, data suggests that month over month, significant improvement is being made in the area of claims payment,” Betti said. “Issues have been minimal and quickly resolved.”Betti said the state sought to assist providers through the transition by disbursing about $146 million, via the managed-care plans, in advance payments from July through October. Those payments are similar to loans; providers are required to repay the money, and the state has instructed managed-care plans to delay repayment schedules, which had been set to begin in November….

Read full article in packet or at links provided

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Monday Morning Medicaid Must Reads: Jan 14th, 2019

Helping you consider differing viewpoints. Before it’s illegal.
In this issue…

Article 1:    Why 700,000 Ohioans were removed from Medicaid coverage, Columbus Dispatch, Jan 12

Clay’s summary:    Could be: a) improving economy, b) glitch in enrollment system, c) evil Republicans working with Putin to hack Ohio’s democracy. You decide.
Key Excerpts from the Article:   
More than 700,000 Ohioans were removed from the state’s Medicaid program in just the first 10 months of 2018. Franklin County had the most disenrollments, with nearly 90,000 losing the health-care coverage from January through October, the most recent data available show.
But no one quite knows why such a huge shift took place in the state-federal program for low-income Ohioans.
Read full article in packet or at links provided

Article 2:    Trump admin’s Medicaid block grant waiver idea invites legal and political firestorm, Axios, Jan 14

Clay’s summary:    They’re baaack (read in Poltergeist voice).
Key Excerpts from the Article:   
The Trump administration is considering giving states the ability to receive Medicaid block grants, Politico reported on Friday, a move that has experts unsure of its legality and the political world bracing for its volatility.
Read full article in packet or at links provided

Article 3:    Public Option And Medicaid Buy-Ins Emerge From 2020 Democratic Presidential Hopefuls, Forbes, Jan 13

Clay’s summary:    Dems see writing on wall re unravelling ACA, start to work on workarounds at state level.
Key Excerpts from the Article:   
Several Democratic governors – including one likely to run for President – are working on legislation to expand coverage to the poor in their states with legislation that would allow residents to “buy into” government subsidized Medicaid or other state coverage.
In all, “at least 10 states” are looking at Medicaid “buy ins,” Stateline reported last week. These proposals are akin to earlier proposals by some Democratic Senators mentioned as Presidential candidates to expand Medicare to Americans as young as 50 years old.
Such public options are seen by some as an alternative to more progressive single-payer “Medicare for All” proposals that would have the government control health insurance and require more taxpayer dollars. Most public option proposals emerging would continue the role of private insurers in helping administer the health benefit expansions.
Read full article in packet or at links provided
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Monday Morning Medicaid Must Reads: Jan 7th, 2019

Helping you consider differing viewpoints. Before it’s illegal.
In this issue…

Article 1:   Healthy and Working: Benefits of Work Requirements for Medicaid Recipients, Buckeye Institute, December 2018

Clay’s summary:   Beware the red pill.
Key Excerpts from the Article:
Extending Medicaid benefits to individuals who are able to work may reduce their lifetime earnings over the  long-term and adversely affect their consumption patterns in the short-term. Although households may benefit in  the short-term from Medicaid coverage through little- or no-cost health care, the ACA’s Medicaid expansion does  not promote individual long-term earnings growth or wealth accumulation. Workers have less incentive to invest in  their human capital than if they were required to work in order to receive benefits.
 
To address this concern, states that have participated in the ACA’s Medicaid expansion are now considering—or  have already begun to impose—work requirements for some new Medicaid enrollees. Work and “community  engagement” requirements, such as education and job training, tend to keep benefits recipients participating in the  work force, helping them to gain valuable work experience and generate higher earnings and income over the  long-term.
Using publicly available economic data, this report reveals the potential impact of imposing work requirements on  healthy, single individuals with no children. We study how eligibility work requirements may affect the lifetime  earnings of some Medicaid enrollees and find that Medicaid work requirements could:
 
* • Increase lifetime earnings by $212,694 for women and $323,539 for men—even assuming that the  individual remains on Medicaid for their entire working life; and
* • Raise the hours worked per week by 22 hours for women (from 12 hours to 34 hours per week), and by  25 hours for men (from 13 hours to 38 hours per week), bringing Medicaid recipients well above the typical 20  hours per week requirement.
 
We also find that the financial prospects look even brighter for individuals who transition off of Medicaid; they  may earn close to $1 million more over the course of their working years.
 
Requiring labor force participation for benefits eligibility creates an incentive for individuals to increase human  capital investment through the labor market. We show that there is a significant potential economic benefit for  those able-bodied adults who would change their work effort in response to a work requirement for Medicaid  eligibility.
Read full article in packet or at links provided

Article 2:   State Trends and Analysis, Pew Trusts, November 2018

Clay’s summary:   Turns out you do have to choose between healthcare and education. Until we find where the unicorns are hiding the magic wands, that is.
Key Excerpts from the Article:
Medicaid’s claim on each revenue dollar affects the share of state resources available for other priorities, such as education, transportation, and public safety. Because Medicaid is an entitlement program, states must provide certain federally required benefits for any eligible enrollee, even during times of sluggish revenue growth. So policymakers have less control over growth in states’ Medicaid costs than they do with many other programs.
Read full article in packet or at links provided

Article 3:   Estimated Impacts of the Proposed Public Charge Rule on Immigrants and Medicaid, KFF, October 2018

Clay’s summary:   The potential safety net costs for newly arriving Americans may be getting more attention if the rule is passed.
Key Excerpts from the Article:
On October 10, 2018, the Trump administration released a proposed rule to change “public charge” policies that govern how the use of public benefits may affect individuals’ ability to obtain legal permanent resident (LPR) status. The proposed rule would expand the programs that the federal government would consider in public charge determinations to include previously excluded health, nutrition, and housing programs, including Medicaid. It also identifies characteristics DHS could consider as negative factors that would increase the likelihood of someone becoming a public charge, including having income below 125% of the federal poverty level (FPL) ($25,975 for a family of three as of 2018). This analysis provides new estimates of the rule’s potential impacts. Using 2014 Survey of Income and Program Participation data, it examines the (1) share of noncitizens who originally entered the U.S. without LPR status who have characteristics that DHS could potentially weigh negatively in a public charge determination and (2) number of individuals who would disenroll from Medicaid under different scenarios:
Nearly all (94%) noncitizens who originally entered the U.S. without LPR status have at least one characteristic that DHS could potentially weigh negatively in a public charge determination. Over four in ten (42%) have characteristics that DHS could consider a heavily weighted negative factor and over one-third (34%) have income below the new 125% FPL threshold.
Read full article in packet or at links provided
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Monday Morning Medicaid Must Reads: Dec 10th, 2018

Helping you consider differing viewpoints. Before it’s illegal.
In this issue…

Article 1:  Medicaid Access & Coverage to Care in 2017 (MHPA’s Institute for Medicaid Innovation, Oct 2018)

Clay’s summary:  The industry survey from this leading Medicaid health plan association doesn’t disappoint.
Key Excerpts from the Article:  … Key findings from the data were noted in the high-risk care coordination, value-based payment models, women’s health, and behavioral health sections. For instance, results from the survey demonstrate that the majority of Medicaid MCOs in 2017 performed a number of core functions in providing comprehensive, high-risk care coordination. The most commonly performed core functions included developing a plan of care for members, supporting adherence to the plan of care, engaging a care team of professionals to address the needs of the member, and conducting risk assessments….The findings also indicate that Medicaid MCOs are increasingly using value-based payment (VBP) models when providing care for their members. In 2017, half of Medicaid MCOs indicated that they were piloting population-specific VBP models, while over 15 percent were expanding successful pilots. Finally, approximately 10 percent of MCOs surveyed reported that they had extensive VBP arrangements in place in 2017. As barriers to VBP adoption are removed, we anticipate an increase in the number of Medicaid MCOs transitioning from the pilot phase to fully implemented arrangements….
 
 
Read full article in packet or at links provided

Article 2:  Who can be believed in medical research? Charles Barta, Nov 21 2018

Clay’s summary:  An AZ physician provides an overview of bogus medical and health systems theories throughout the years. Including that old chestnut about how expanding Medicaid would reduce ER in Oregon (that one’s a real knee-slapper!)
Key Excerpts from the Article:  … One interesting fact that has not been reported involves the idea that increasing Medicaid would clearly lower inappropriate emergency room visits and the expense these visits cost the public. We would save money…Oregon decided to prove this in 2009. It vastly increased the number of residents eligible for Medicaid. Unfortunately, the state didn’t have the funds to pay for this, so they put a lottery in place. Half the people eligible were given Medicaid while the other half became a “control group.” This was a scientifically perfect, randomized experiment. …The results? Two years later, the covered group had a 40 percent increase in unnecessary ER use. When a social experiment doesn’t work, the usual excuse of “we didn’t fund it enough — we need more money” wasn’t applicable. The next excuse, “The newly enrolled didn’t have time to get used to the system so they didn’t attempt to make (free) appointments with their doctors.” Two years later, a follow-up study was done. Surprise! The increase in unnecessary ER rose dramatically. The only news organization that reported this was NPR….
 
Read full article in packet or at links provided

Article 3:  Our opinion: State budget reforms are needed, Houma Today Editorial Board, Nov 19, 2018

Clay’s summary:  A small town newspaper comes out in favor of income verification and work requirements for Medicaid eligibility. They must be evil, GOP-loving, Trump worshiping [Insert current set of slurs media tells you to append to people with opinions non-leftist).
Key Excerpts from the Article:  … But some of these reforms make a lot of sense. For instance, income verification for Medicaid can limit paying out benefits to those who don’t qualify while making sure those who do qualify get the help they need….A recent state audit claimed that as much as $85 million could have been spent over the past several years on people who didn’t qualify for Medicaid. That’s because Health Department officials check income only once, at the time of the enrollee’s initial application for the program. They don’t check again until 12 months later, when the person applies for renewal of coverage. In the meantime, the person could have gotten a new job or increased income, becoming ineligible for Medicaid….
 
Read full article in packet or at links provided
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Monday Morning Medicaid Must Reads: Nov 19th, 2018

Helping you consider differing viewpoints. Before it’s illegal.
In this issue…

Article 1: COUNTERPOINT: Medicaid expansion is unfunded, unsustainable for state of Nebraska

Clay’s summary: Voters didn’t listen to this dude.
Key Excerpts from the Article:  …It is also likely that expansion costs will far exceed projections, just as costs have in nearly every state that has expanded. Iowa spent over $150 million more than expected. Kentucky’s Medicaid program is facing a $296 million budget shortfall due to unpredictable costs (yes, the program itself is that much in debt). Ohio’s Medicaid program costs the state an average of $437 million a month…
Read full article in packet or at links provided

Article 2: Maryland might not have properly vetted some Medicaid enrollees

Clay’s summary: Perhaps there was maybe some payments that could have been somewhat non-compliant with the law but who’s to say, really? It’s a gray area- move along.
Key Excerpts from the Article: Maryland may have allowed residents who did not qualify for Medicaid into the government health program for the poor by failing to consider all of their income, according to a routine audit of the quasi-governmental agency that oversees the Maryland health exchange.
Read full article in packet or at links provided

Article 3: Virginia facing high unexpected Medicaid costs

Clay’s summary: Well at least they decided to expand and spend even more (this is all costs not-related to recent expansion largess).
Key Excerpts from the Article:
State officials said Friday that Virginia has about $460 million in unforeseen Medicaid costs. …The new costs, first reported by the Richmond Times-Dispatch, are unrelated to Virginia’s recent decision to expand Medicaid eligibility to low-income adults under the Affordable Care Act. …Instead, Secretary of Finance Aubrey Layne said much of the new costs stem from faulty forecasts overestimating the benefits of having private health insurers cover a greater number of some of the state’s more costly Medicaid recipients. Another reason for the increase is a higher-than-expected enrollment of children in the state’s Medicaid program, he said…
Read full article in packet or at links provided
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Monday Morning Medicaid Must Reads: Nov 12th, 2018

Helping you consider differing viewpoints. Before it’s illegal.
 
In this issue…
Article 1:

MACPAC urges Azar to pause, re-evaluate Arkansas’ Medicaid work requirements, Eli Richman, FierceHealthcare, Nov 9, 2018

Clay’s summary:
MACPAC feels left out with all the attention on work requirements, needed to go on record as raising yellow flag.
Key Excerpts from the Article:
In a letter to Department of Health and Human Services (HHS) Secretary Alex Azar, the independent commission that advises CMS on policy matters said it was “highly concerned” about the statistics and recommended the state pause the program until adjustments can be made… The disenrolled individuals in Arkansas were unable to report work and community engagement activities as required by the policy, but the commission argued that the state’s approach contributed to the challenges. However, MACPAC cited extremely low rates of successful reporting: A whopping 91.6% of the beneficiaries required to report compliance failed to do so in September 2018…. “The low level of reporting is a strong warning signal that the current process may not be structured in a way that provides individuals an opportunity to succeed, with high stakes for beneficiaries who fail,”
Read full article in packet or at links provided
 
Article 2:

Medicaid Expansion Opponent Picked to Lead Medicaid, Steven Porter, Health Leaders Media, Oct 16, 2018

 
Clay’s summary:
The current CMS/Trump administration has repeatedly expressed a clear belief that CMS can leverage Medicaid to alleviate poverty vis a vis work requirements being asked for by states. Lefties keep repeating the same rebuttals (and effectively calling Ms. Verma a liar when she refutes leftist claims that work requirements’ main goal is to reduce Medicaid rolls), and have not offered any other solutions to alleviate poverty. In the lefty mind, CMS really only pays for things and does not have any other function. In a shocking turn of events, the current CMS/Trump administration (duly elected by American voters, despite what tin-foil hat wearing loony left zombies think re RussiaHoax) has appointed someone who has a history of not floating the pay-for-everything Medicaid mainstream. If your head did not explode from this paragraph- quick, go knit another protest hat to deal with the trauma of someone disagreeing with you!
Key Excerpts from the Article:
Mary Mayhew’s rise-out-of-poverty rhetoric around Medicaid policymaking aligns with statements made by Trump administration officials. Mayhew oversaw a shrinking state Medicaid program and opposed Medicaid expansion… One critic, a Democrat, described her as “antagonistic toward Medicaid.” …A former hospital lobbyist who spent most of the past decade as Maine’s health commissioner under Gov. Paul LePage has been tapped to lead Medicaid on the federal level. …Mary Mayhew earned a reputation in Maine as someone who, alongside LePage, championed additional limits on the public benefit programs she oversaw, reducing enrollment in the state’s Medicaid program by 67,000 beneficiaries between 2011 and 2015 then opposing Medicaid expansion under the Affordable Care Act….
Read full article in packet or at links provided
Article 3:

Wisconsin Wins Federal Approval for Medicaid Work Requirements, Steven Porter, Health Leaders Media, Oct 31, 2018

Clay’s summary:
But, but, but- muh lawsuit!!!
Key Excerpts from the Article:
 
The state is the fifth to secure approval for such a program, but a federal judge blocked Kentucky’s waiver last summer, so Wisconsin is the fourth with an active waiver.
The federal government formally approved Wisconsin’s plan Wednesday to impose work requirements on certain Medicaid recipients, signaling that the Trump administration is not backing down from the controversial policy position.
Read full article in packet or at links provided
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Monday Morning Medicaid Must Reads: October 29th, 2018

Helping you consider differing viewpoints. Before it’s illegal. 

 

Article 1:  

Report Asks About Quality Assurance in Medicaid Managed Care for Children, AJMC, Allison Inserro, 2/27/2018

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.

  …

Read it here 

Article 2:   

How HEDIS, CMS Star Ratings, CQMs Impact Healthcare Payers, HealthPayer Intelligence, Thomas Beaton, 12/21/2017

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.

  …

Read it here 

 

 

 

Article 3:   

CMS Scorecard for Medicaid, CHIP Measures Draws Scrutiny From State Directors, AJMC, Allison Inserro

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.

  …

Read it here 

 

 

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Monday Morning Medicaid Must Reads: October 22nd, 2018

Helping you consider differing viewpoints. Before it’s illegal. 

 

Article 1:  

AHCA Points to Gains in Quality as House Panel Weighs SNF Oversight, Patrick Connole, Provider Magazine, 9/5/2018

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.”

  …

Read it here 

Article 2:   

Quality Improvement Projects Save Children’s Hospitals Millions, Jacqueline LaPointe, RevCycle Intelligence, 6/21/2018

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.

  …

Read it here 

 

 

 

Article 3:   

CMS Awards $5.5M to Develop Palliative Care Quality Measures, Kaitlyn Mattson, Home Health Care News, 9/30/2018

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.

  …

Read it here