One of the high-profile programs within the Affordable Care Act is the drive to reduce preventable hospital readmissions among the Medicare population. The program focuses on fee-for-service patients who came back to the hospital within 30 days. Hospitals in the third year of the program face a fine of up to 3 percent of their Medicare payments. Kaiser Health News analyzed the most recent CMS hospital data, and found more than 2,600 hospitals faced penalties in the last round and could lose $400 million.
Reducing unnecessary hospitalizations is a good idea, pretty much a slam-dunk quality move.
But is the readmissions program using the right metrics? Are hospitals that are doing all the right things cutting both readmissions and admissions – and therefore facing penalties because the proportion isn’t dropping, the readmission rate is the same share of the total admissions? Some new research suggests that may be the case. As Joanne Lynn, M.D., a geriatrician and prominent health policy researcher put it (and I’m paraphrasing), it’s the denominator, stupid. Continue reading
A recent Health Affairs blog post by Heather Howard (a familiar name to AHCJ members who have attended the panels or webcasts she’s done for us) and her colleague Galen Benshoof at the State Health Reform Assistance Network (housed at Princeton) outlined an aspect of the coming King case on exchange subsidies. The information was new to me, and may be unfamiliar to other reporters too. I’ve summarized the key points below and included story ideas at the bottom. You can read the original (more detailed) post here.
The Affordable Care Act (ACA) encourages state innovation in many ways, but one of the most significant is the “Wyden waivers” or the State Innovation Waivers program in section 1332 of the law. They become available in 2017, although planning can start earlier.
Some states are thinking about taking these waivers, which include “exchanges, benefit packages, and the individual and employer mandates.” States can get all the federal money that would have gone into those provisions – hundreds of millions or even billions of dollars – but they have to provide comparable coverage and it must be affordable. HHS and Treasury have released some guidance but not a whole lot of detailed rules and instructions.
The Atlanta chapter of AHCJ and the Alliance for Health Reform sponsored a Dec. 2 event focused on the second open enrollment period for the Affordable Care Act.
The panel discussed the state of navigator assistance, narrow networks and slower-than-expected enrollment since the insurance exchanges opened Nov. 15. About 25 AHCJ members and invited guests gathered for the event.
Joining me on the panel were Trey Sivley, a division director in the office of Georgia’s Insurance Commissioner; Lisa Stein of Seedco, which runs a navigator program in Georgia and three other states; and Dorian Martindale of Whitefoord, a federally qualified health center in Atlanta.
We post new resources on the Health Reform section of the website every month, and encourage you to visit and explore. But we wanted to draw your attention to some that are particularly timely.
Image by Sean via flickr.
- The Kaiser Family Foundation has a new tool, Mapping Marketplace Enrollment. You plug in a ZIP code and then you can see how many people are eligible for a federal exchange plan, and what proportion signed up in 2014 “within a 100,000-resident statistical-geographical area associated with the ZIP code.” It also provides demographic information, and can be used to make comparisons, including statewide.
- Louise Norris, a licensed broker who writes and blogs about insurance and the Affordable Care Act has done a 38-page e-book guide to Open Enrollment (Note: I’ve skimmed half of it, not read every word, but I have seen some of Norris’s work in the past.)
- We recently posted about closures of rural hospitals, and a reader pointed us to this recent issue brief from the Centers for Disease Control and Prevention. It looks at rural residents who are hospitalized – who goes to rural hospitals and who “bypasses” them to go to urban ones.
- ProPublica just launched a web app that allows consumers – and journalists – to look up their current plan to see how premiums, deductibles and out-of-pocket costs will change next year, or compare all 2015 plans offered in an area.
Most of us have heard about “super-users” – patients who are constantly in and out of the hospital, running up large bills. Most have multiple chronic diseases, are poor, and often have mental illness or substance abuse problems. Most live alone, and some are homeless.
Four communities – Lehigh Valley, Pa.; Kansas City, Mo.; San Diego and Aurora, Colo. – have received grants under the Affordable Care Act to tackle the super-user problem. (Other non-ACA-funded initiatives are also underway). Investigative reporter Tim Darragh, formerly of The Morning Call in Allentown, Pa., spent a year tracking the grant in the Lehigh Valley. The super-user innovation grants, which were issued in 2012, provide $14.3 million and (at least for Lehigh) expire in mid-2015.
Darragh, now a reporter at The Star-Ledger in New Jersey, looked at a broad range of issues in the project. He also was able to weave narrative into the policy reporting. The Morning Call recently published five pieces:
Sarah Gantz has been fascinated with Maryland’s Medicare waiver since the Baltimore Business Journal hired her to write about health care more than two and a half years ago. She describes the policy as “the lifeblood of Maryland’s $15 billion hospital industry.”
Maryland is the only state with an “all-payer” hospital system – a system in which every health plan and every payer pays about the same rate to a given hospital for a given procedure or treatment. That includes Medicare, under a waiver from the federal government. A commission sets the costs and there’s a lot less cost-shifting in the system if everyone is playing by the same rules.
Despite its importance, Gantz says that most people write it off as a wonky hospital rule that doesn’t affect them. With help from the AHCJ Reporting Fellowship on Health Care Performance, Gantz set out to explain why the policy is worth taking the time to understand. In this piece for AHCJ, she tells our readers what she learned and how she turned wonky policy into stories about real people.
By now you have heard of “Dentalgate.” The administration, twice, released ACA enrollment numbers this fall that included nearly 400,000 dental plans, alongside the regular health insurance plans. That made it sound like more than 7 million people were covered in the state and federal exchanges.
That’s wrong. Depending on which date you used, there were either about 6.9 million (as of mid-August) or 6.7 million (October).
You know the politics too: The GOP said it was “deception;” the Department of Health and Human Services said, “Oops.” There will be a hearing on the Hill on Dec. 9 when CMS chief Marilyn Tavenner will testify before the House Oversight committee.
But what do we know about where the numbers come from, or what they say about attrition from the 8 million who signed up for coverage by the middle of April? Continue reading
Jayne O’Donnell and Laura Ungar had an interesting story recently in USA Today about rural hospital closures.
The pace of closures has picked up in the past few years; the hospitals blame readmission penalties under the ACA, inadequate federal reimbursement policies, and the mandate to switch to costly electronic health records.
It’s also clear that the problem is more widespread in the states that have not expanded Medicaid, such as Georgia and Alabama.
Come January, the Republicans will have big majorities in the House and the Senate – majorities they have not had since President Obama took office or since the Affordable Care Act was passed along party lines in 2010.
Now what? Even the Republicans are figuring that out – but here’s some of what we know.
The Senate and the House will both have ACA repeal votes. Such a vote will win overwhelmingly in the House and, in the Senate, the Republican majority is also expected to vote against the ACA (or for a procedural motion related to a straight out repeal vote) but it will still fall short of the 60 needed to clear a filibuster.
The New York Times recently pulled their reportorial and graphics know-how together to do a one-year assessment of the ACA. It concludes: “After a year fully in place, the Affordable Care Act has largely succeeded in delivering on President Obama’s main promises, an analysis by a team of reporters and data researchers shows. But it has also fallen short in some ways and given rise to a powerful conservative backlash.”
The package consists of seven sections that run the gamut, with some key numbers and charts. Overall it’s a positive but not uncritical look. The cost section is particularly nuanced, noting the challenges of narrow networks and high deductibles.
Most of these topics we’ve considered on this blog over the last few years. But the series provides a nice, compact overview and handy reference going into the second year.
Here are the seven sections covered, and the nutshell conclusion the Times provided for each.