Medicare readmission penalties hit some states harder than others

Kaiser Health News reports that Medicare readmissions penalties are falling hardest on hospitals in New Jersey, New York, Arkansas, Mississippi and the District of Columbia.

Find the article here.

According to KHN, a total of 2,217 hospitals, or 71 percent of those eligible, are receiving penalties for having too many patients with heart attacks, heart failure or pneumonia return within 30 days. Only hospitals with at least 25 heart failure, heart attack or pneumonia cases for Medicare to evaluate were eligible

A total of 307 hospitals received the maximum penalty: a reduction of 1 percent in all of Medicare’s reimbursements for the fiscal year that began Oct. 1.

These new numbers come after CMS found errors in its initial calculations in August. Learn about the recalculations here. 

But the new numbers do not represent significant geographic or demographic shifts.

The revised penalties, like their earlier versions, fall hardest on safety-net hospitals.

KHN divides hospitals into four quartiles, based on how many poor patients they tended to treat. In the quartile of hospitals with the most poor patients, 12 percent received the maximum penalty, and only 20 percent avoided any penalty. By contrast, in the quartile of hospitals with the fewest poor patients, only 7 percent received the maximum penalty, and 33 percent were not penalized at all.

What Drives up Health Care Costs?

There is no one driver and everyone contributes – this according to Kaiser Health News. KHN, in collaboration with the PBS NewsHour reports on a study from the Bipartisan Policy Center, a think tank in Washington, DC which identifies 7 factors associated with health care costs.

The US currently spends more on health care than any other country - $2.6 trillion or about 18% gross domestic product. In 2000 the percentage of GDP was below 15% and by 2020 it is projected to be about 20%.

Here are the 7 factors –

1. We pay our doctors, hospitals and other medical providers in ways that reward doing more, rather than being efficient.

2. We're growing older, sicker and fatter.

3. We want new drugs, technologies, services and procedures.

4. We get tax breaks on buying health insurance -- and the cost to patients of seeking care is often low.

5. We don't have enough information to make decisions on which medical care is best for us.

6. Our hospitals and other providers are increasingly gaining market share and are better able to demand higher prices.

7. We have supply and demand problems, and legal issues that complicate efforts to slow spending.

Find the article here. 

Find the BPC’s Health Care Cost Drivers Report here. 

The drivers are labeled a bit differently than the 7 drivers presented by the KHN/NPR report, but the drivers are the same and the report has more detail for each.

Find the more detailed BPC study “What Is Driving U.S. Health Care Spending? America’s Unsustainable Health Care Cost Growth” here.

“At a basic level, health spending is a product of the price of health care services and the utilization of those services. The underlying drivers of price and utilization, which in turn are the key drivers of overall health care spending growth in the U.S., are described in this paper.”

2013 National Patient Safety Goals for Hospitals

The Joint Commission has issued its 2013 National Patient Safety Goals for Hospitals.

Find them here.
The purpose of the National Patient Safety Goals is to improve patient safety. As stated by the Commission, the goals focus on problems in health care and how to solve them.

For 2013, the goals include –

Identify patients correctly. NPSG.01.01.01: “Use at least two ways to identify patients. For example, use the patient’s name and date of birth. This is done to make sure that each patient gets the correct medicine and treatment.”

Prevent infection. NPSG.07.01.01: “Use the hand cleaning guidelines from the Centers for Disease Control and Prevention or the World Health Organization. Set goals for improving hand cleaning. Use the goals to improve hand cleaning.”

Second presidential debate focuses little on healthcare

A prominent feature of the first presidential debate, healthcare was barely mentioned in the second of three presidential debates – and the last scheduled to focus on both domestic and foreign policy.  The two candidates focused heavily on other domestic issues such as jobs, taxes, energy, and immigration policy. 

Instead, of discussing it directly, the candidates wove healthcare—albeit slightly—into answers to questions on other topics. For instance, the president mentioned contraceptive coverage under the Patient Protection and Affordable Care Act as well as funding for Planned Parenthood during a discussion of income inequalities between men and women in the workplace.

President Obama argued that Romney “feels comfortable having politicians in Washington decide the healthcare choices that women are making.” 

Obama said that his healthcare bill requires insurance companies to provide contraceptive coverage to everyone who is insured because the issue is not just a health issue, but also an economic one.

"When Gov. Romney says that we should eliminate funding for Planned Parenthood: There are millions of women all across the country who rely on Planned Parenthood for not just contraceptive care, they rely on it for mammograms, for cervical cancer screenings…that's a pocketbook issue for women and families all across the country, and it makes a difference in terms of how well and effectively women are able to work."

Romney said Obamacare has hurt the middle class and deterred small businesses from hiring new employees.  Romney said of Obama and Obamacare that “[Obama] said he'd reform Medicare and Social Security—he hasn't even made a proposal for either one…he said middle-income families would have a reduction in their health insurance premiums, it's gone up by $2,500 a year.”

“If Obamacare is implemented fully, it will be another $2,500 on top. The middle class is getting crushed under the policies of a president who has not understood what it takes to get the economy working again.”

The candidates will meet for the final debate Oct. 22 at Lynn University in Boca Raton, Fla., to discuss foreign policy.

Read the original article from ModernHealthcare.com here. The article requires readers create a free profile for the site.

Safety-Net Hospitals Brace for Cut to Federal Subsidies

Hospitals that treat a disproportionately large number of patients who cannot pay for some or all of their care, known as safety-net hospitals, have relied on subsidies provided by the federal government to help defray costs for more than 20 years. But that funding is set to decline starting in 2014 with the full implementation of the Affordable Care Act, the federal health care reform legislation now known as Obamacare.

The assistance is known as DSH payments, for disproportionate share hospital, and the program is critical to keeping the hospital's finances in the black, said Michael Harristhal, vice president of public policy and strategy at Hannepin County Medical Center in Minneapolis. "That's been a very important part of our total revenue stream," he said.

Harristhal said that the annual revenue for his medical center, Minnesota’s largest safety-net hospital, approaches $700 million, and about $30 million of that comes from the DSH program. Even though those payments amount to less than 5 percent of the hospital's revenue, he said they help Hennepin break even.

The $11 billion DSH program provided $75 million to Minnesota hospitals last year, including children's hospitals in Minneapolis and St. Paul, the University of Minnesota Medical Center and Regions Hospital in St. Paul.

The federal healthcare law won't eliminate DSH payments altogether, but it cuts them by half over five years. The reductions begin in 2014, the same year the law requires most Americans to obtain health insurance or pay a penalty. The theory is that hospitals will need fewer DSH subsidies because they'll be treating a reduced number of patients who lack insurance.

University of Minnesota health economist Lynn Blewett said the state's own history may provide some reassurance to safety net hospitals.

"We did some work a number of years ago with the MinnesotaCare program and saw as MinnesotaCare expanded, levels of uncompensated care were reduced," Blewett said. "So there is some evidence that as you get more people covered, that there should be less need for free care provided by hospitals."

Still, Blewett said, there is great uncertainty about how large a cut Minnesota's safety net hospitals will face.

The law calls for cutting half a billion dollars from the DSH program starting in about a year, but the Obama administration has yet to decide which states will see the largest cuts.

Scott Leitz, the assistant commissioner of Minnesota’s Department of Human Services, said state hospitals will still need help. The department estimates there will be 200,000 people in Minnesota who lack health insurance in 2016, either by choice or through exemptions in the health law. The state may need to reallocate the DSH payments, he said.

"We'll have to make an analysis around who is seeing the uninsured, and are we allocating the dollars today properly or do we need to make any changes," Leitz said.

For now, safety net hospitals can only wait to find out how much of their own safety net will survive.

How does healthcare reform benefit women?

A NAHAM member has asked us to share a recent article, written by Susan Blumenthal, M.D., public health editor at the Huffington Post and former U.S. Assistant Surgeon General. A summary of the article can be found below, but you may also view the full article and Dr. Blumenthal’s profile here.

Dr. Blumenthal writes that women have historically experienced discrimination in terms of their health – despite making 80 percent of health care decisions for their families, using more medical services than men, and suffering greater disability from chronic disease.  

Here is what has changed – “Just 20 years ago, women's health was neglected in the halls of public policy, at the research bench, and in clinical settings in America.”

Pointing to the Patient Protection and Affordable Care Act of 2010 (most commonly referred to as Obamacare), Dr. Blumenthal says the new law has given women “access to comprehensive, quality health care”. 

She writes – “In fact, 19 million women in America do not have health insurance. Women are more likely to lose their insurance if divorced or widowed, and often paid more for premiums than did men. Thanks to the recent passage of the Patient Protection and Affordable Care Act of 2010 (recently upheld by the Supreme Court), all of this will change.”

Dr. Blumenthal also cites several significant improvements “to ensure an efficient, effective, and equitable health care system for women -- and men -- over the life cycle.”

Currently, only 50 percent of women have employer-sponsored insurance compared to 57 percent of men.  Obamacare eliminates gender rating on premiums.

Obamacare also allows children up to age 26 to be included on their parents.  (“As a result of this provision in the new law, 1 million young women now have health insurance.”)

Women can no longer be denied coverage for pre-existing conditions like cancer, asthma, or depression.

Under its "Patient's Bill of Rights,"Obamacare prevents insurance companies from instituting lifetime benefit caps, dropping patients who file reimbursement claims, and spending more than 20 percent of premium payments on administrative costs.

The expansion of Medicaid under Obamacare will bring more women into the healthcare system through coverage.  Dr. Blumenthal writes that currently “two-thirds of Medicaid beneficiaries are women, and the majority of the 55 percent of uninsured women who have incomes below 138 percent of poverty will now qualify for Medicaid coverage in 2014.”

Furthermore, women with incomes between 139 percent and 399 percent of the poverty level will be eligible for tax-credits towards the purchase of insurance plans.

Meningitis Outbreak: 75 facilities affected

NPR has reported that 75 medical facilities received a potentially contaminated drug suspected of infecting 47 patients with meningitis nationwide. A list of those facilities can be found here.

The hospitals and clinics that have used the possibly tainted steroid are located in 23 states, from New Hampshire to California and Idaho to Florida. The Centers for Disease Control and Prevention has released the facility names and phone numbers so that patients who have had spinal injections at these facilities will know if they're at risk for a rare and dangerous kind of meningitis.

The number of meningitis cases went up by 12 last Friday, October 5^th, but the number of deaths remained stable at five. The CDC says all 42 known survivors are still hospitalized, and officials expect more cases to emerge over the coming weeks.

The CDC urges patients who have received steroid injections in the past month to seek immediate care if they have headaches, fever, nausea, dizziness, slurred speech or confusion. Many who have received the potentially contaminated drug have escaped harm, however, and others have had only mild symptoms.

Close to 18,000 doses of the drug, methylprednisolone acetate, have been recalled by the Massachusetts pharmacy that made it. The drug is used to treat back pain.

NPR’s article can be found here.