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States are pursuing a number of reform models for changing the way health care providers are paid, reports Deborah Bachrach, special counsel at Manatt, Phelps & Phillips, a health law and consulting firm in New York City, and former New York Medicaid director
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Many of the payment reform approaches outlined by the Center for Medicare and Medicaid Innovation (CMMI) established by The Centers for Medicare & Medicaid Services are initiatives that states have pursued for some time, such as medical homes, says Neva Kaye, managing director for health system performance at the Washington, DC-based National Academy for State Health Policy (NASHP).
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Not surprisingly, the biggest current fiscal challenge for Delaware Medicaid is the dramatic increase in enrollment over the past two years, according to Rita M. Landgraf, secretary of the state's Department of Health and Social Services.
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For Medicaid programs that have good relationships with managed care contractors already in place, it's a "natural development" to add the population of seniors and people with disabilities, says Alice R. Lind, RN, MPH, senior clinical officer at the Center for Health Care Strategies (CHCS) in Hamilton, NJ. "The timing is right now, because budgets are tight."
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In previous years, there was a widespread perception that the reason managed care was cost-effective was that services were restricted, according to Alice R. Lind, RN, MPH, senior clinical officer at the Center for Health Care Strategies (CHCS) in Hamilton, NJ. This was a largely undeserved reputation, she says, but it worked against managed care expansion.
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States have some good fiscal opportunities to expand home- and community-based services (HCBS) in the Patient Protection and Affordable Care Act (PPACA), according to Charlene Harrington, RN, PhD, FAAN, director of the University of CaliforniaSan Francisco's National Center for Personal Assistance Services.
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The problem of "churning," when individuals cycle on and off Medicaid rolls, is expected to increase after the Medicaid expansion, according to a study published in the February 2011 issue of Health Affairs, "Issues In Health Reform: How Changes In Eligibility May Move Millions Back And Forth Between Medicaid And Insurance Exchanges."
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As a result of two cuts to Medicare reimbursement, the hospice industry will see the overall median Medicare profit margin drop from 2% in 2008 to -14% in 2019, according to a study recently released by the National Hospice and Palliative Care Organization (NHPCO).
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Hospitals might improve their ethics consultation processes if they design and use a brief ethics family assessment tool to determine families' and patients' values, two ethicists say.
