Unbiased Analysis of Today's Healthcare Issues

Financial Outlook for Non-Profit Healthcare Firms…

…is poor according to Moody’s. “By limiting the expansion of insurance coverage, the ruling blunts the impact of one of the law’s few credit positive features. Uncertainty regarding which states will and will not participate in the Medicaid expansion adds to the political gridlock regarding healthcare reform, making it increasingly difficult for hospitals to perform […]

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How Massachusetts hospitals increased Medicare reimbursement rates by 20 percent

The answer is by using exceptions/loopholes to payment rules.  The Medicare Wage Index adjusts payments to hospitals based on hospital worker wages wages in the hospital’s labor market.  Payment exceptions, in this case the rural floor, causes payments to hospitals in Massachusetts to increase by 16.4 percent simply by having one hospital reclassify.  Here is […]

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Why is end-of-life spending so high?

The answer is because using more intensive services does reduce mortality. This is the finding of a recent JAMA paper. After controlling for patient case mix, the authors examine variation in hospital spending in the last year of a patient’s life. The authors note that “Higher-spending hospitals differed in many ways, such as greater use […]

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Do safety net hospitals provide care strategically?

It is widely known that safety net hospitals provide less intensive care than hospitals whose patient base is mostly commercially-insured.  One question is whether safety net hospitals discriminate the care provided based on their patients insurance status.  In other words, do commerically insured individuals who visit safety net hospitals receive more care than patients treated […]

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Medicare Payments for Hospitals in Under-served Areas

One of the goals of Medicare is to provide its beneficiaries access to quality care regardless of where they live.  Thus, the Medicare program provides financial incentives to providers located in these remote areas. Whereas most Medicare pays most hospitals through the inpatient prospective payment system (IPPS), it pays certain rural hospitals based on their […]

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How Health Reform will affect Hospital’s Business Strategy

For many years, fee for service payment was the status quo. FFS model encourages hospitals to adopt the following strategies to maximize market share and profits: Centered on short-term acute care Focused on specialist alignment Driven by a volume-based service-line strategy Using expensive medical equipment purchases to encourage physician referrals Attracting patients with new construction […]

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Medicare’s Agenda for Hospital Accountability

CSC provies a nice overview of some of Medicare’s hospital quality initiatives. These initiatives include a value-based purchasing (VBP) program, reduced reimbursement for excessive hospital readmissions, and reduced reimbursement for hospital-acquired conditions (HAC).  Each of these three broad quality initiatives is described in more detail after the jump. It is important to note that these […]

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Medicare to Hospitals: The Patient is Always Right

Starting in fiscal year 2014, Medicare will start rewarding hospitals with high quality care and penalizing hospitals with low quality care.  The rewards and penalties will be financial in nature. High-quality hospitals will receive a bonus and low-quality hospitals will receive a financial penalty.  There is a lot of existing documentation on this hospital value-based […]

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New Legislation affecting Medicare Hospital Payments

Recent Legislation CMS completed its implementation of Medicare severity–diagnosis related groups (MS–DRGs) and cost-based relative weights in FY 2009. TMA, Abstinence Education, and QI Programs Extension Act of 2007 (TMA), the Congress mandated payment reductions of 0.6 percent in 2008 and an additional 0.9 percent in 2009 to offset the effects of documentation and coding […]

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Negotiating Power

On Monday I attended a talk at AcademyHealth on the impact of market consolidation on the cost of health care.  Particularly interesting was Robert (Bob) Berenson’s analysis of the effect of provider consolidation on negotiating power and health care prices.  Particularly, provider have been gaining market power of late, according to recent CTS site visits. […]

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