Medicine and Health Sciences Commons^™

Medicare Part B Premiums And Social Security Benefits, Sally Coberly

National Health Policy Forum

This paper describes the annual determination of beneficiaries' premiums for voluntary Medicare Part B coverage and a provision known as "hold harmless." The hold-harmless provision prevents a beneficiary's Social Security payments from being reduced as a result of an increase in the Part B premium. Because there was no cost-of-living increase for Social Security benefits for 2016, the hold-harmless provision will be in effect. This paper discusses what happens to premiums in 2016 for beneficiaries who are not held harmless—new beneficiaries, beneficiaries who do not participate in Social Security, those who are dually eligible for Medicare and Medicaid, and higher-income …

Meaningful Use Of Health Information Technology: Proving Its Worth?, Lisa Sprague

National Health Policy Forum

Health policymakers in recent years have looked to the implementation of health information technology (IT)—electronic health records and the like—as a means to improve quality, reduce costs, and achieve better health outcomes across populations. But implementing health IT in a meaningful way must go beyond purchasing medical records software. The U.S. Department of Health and Human Services (HHS) devised a set of measures and incentives for hospitals and eligible medical professionals within Medicare or Medicaid to mark successive stages of effective IT implementation. This issue brief discusses the history of meaningful use, the measures used to evaluate effectiveness, and the …

Medicare's Post-Acute Care Payment: An Updated Review Of The Issues And Policy Proposals, Sally Coberly

National Health Policy Forum

Medicare spending on post-acute care provided by home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals accounted for about 10 percent of total program outlays in 2013. The Medicare Payment Advisory Commission and others have noted several long-standing problems with the payment systems for post-acute care and have suggested refinements to Medicare's post-acute care payment systems that are intended to encourage the delivery of appropriate care in the right setting for a patient's condition. The Patient Protection and Affordable Care Act of 2010 contained several provisions that affect the Medicare program's post-acute care payment systems, as …

Challenges Of Forecasting Physician Workforce Needs Amid Delivery System Transformation, Rob Cunningham

National Health Policy Forum

As population growth and the aging of the overall population increase demand for health care, policymakers and analysts grapple with whether sufficient health care providers, particularly physicians, will be available to meet that demand. Some argue there are too few physicians already; others say our current supply-demand problems lie with efficiency. But suppose both are correct? Perhaps the real challenge is to understand how the provision of health care services is changing in response to market forces such as payment changes, patients' expectations, provider distributions, and technology innovations. This issue brief revisits what is known about evolving practice organizations, professional …

How Has The Affordable Care Act Benefitted Medically Underserved Communities? : National Findings From The 2014 Community Health Centers Uniform Data System, Jessica Sharac, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Community health centers represent the single largest comprehensive primary health care system serving medically underserved communities, operating in more than 9,000 urban and rural locations. Newly-released data for 2014 from the Uniform Data System (UDS; the federal health center reporting system) shed important light on the impact of the Affordable Care Act in its first full year of implementation in medically underserved urban and rural communities across the U.S. These communities experience elevated poverty, heightened health risks, lack of access to primary health care, and a significantly greater likelihood that residents will be uninsured.

The UDS data show the ACA’s …

How Will Texas’ Affordable Care Act Implementation Decisions Affect The Population? A Closer Look, Sara J. Rosenbaum, Sara Rothenberg, Sara Ely

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

The Affordable Care Act (ACA) gives states two key choices: Whether to expand Medicaid to cover poor uninsured adults; and whether to establish a state Exchange. No population stands to gain more from these choices than residents of Texas, who experience the nation’s highest uninsured rate. National estimates show that by not expanding Medicaid, the state has foregone coverage for 1.5 million people. County‐level estimates show that in 249 out of 254 counties, the proportion of uninsured adults exceeds 20 percent of the total adult county population. In 31 counties, the proportion of low income uninsured adults exceeds 60 percent …

The Star Rating System And Medicare Advantage Plans, Lisa Sprague

National Health Policy Forum

With nearly 30 percent of Medicare beneficiaries opting to enroll in Medicare Advantage (MA) plans instead of fee-for-service Medicare, it’s safe to say the MA program is quite popular. The Centers for Medicare & Medicaid Services (CMS) administers a Star Ratings program for MA plans, which offers measures of quality and service among the plans that are used not only to help beneficiaries choose plans but also to award additional payments to plans that meet high standards. These additional payments, in turn, are used by plans to provide additional benefits to beneficiaries or to reduce cost sharing—added features that are …

Annual Report 2014, Forum Staff

National Health Policy Forum

This annual report describes the activities of the Forum during the 2014 calendar year, and provides a snapshot of our audience and resources.

The Public Health Service, Jennifer Jenson

National Health Policy Forum

This document provides an overview of the Public Health Service (PHS) within the U.S. Department of Health and Human Services, including a brief history and discussion of the agencies and offices that constitute the PHS today. Information on the mission, key programs, and budgets of PHS agencies and offices is also included.

Health Policy Essentials: Common Health Care Acronyms, National Health Policy Forum

National Health Policy Forum

No abstract provided.

Relative Value Units (Rvus), Sally Coberly

National Health Policy Forum

This publication reviews Medicare's relative value units (RVUs), which are assigned to each physician service to represent the resources required to provide the service relative to all other physician services. Three types of resources are included: physician work, that is, the physician time and effort; practice expenses, such as clinical staff and equipment; and professional liability insurance. Each service's RVUs are multiplied by a common dollar conversion factor to determine the Medicare payment.

Clash Of The Titans: Medicaid Meets Private Health Insurance, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Throughout its first forty-eight years of life, the federal Medicaid statute lacked a viable insurance pathway for most low-income adults' ineligible for employer-sponsored coverage. In what is arguably the most important public health achievement since the enactment of Medicare and Medicaid fifty years ago, the Patient Protection and Affordable Care Act (ACA) fundamentally alters this picture. Building on earlier breakthroughs for children, the ACA restructures Medicaid to cover poor adults and juxtaposes its new architecture against an affordable and accessible private insurance market for people ineligible for employer-sponsored or government insurance.

Bundled Payments For Care Improvement Initiative – Insights From The Test Pilots Of Payment Reform, Jason M. Sutherland, William B. Borden

Medicine Faculty Publications

Background: The Medicare Bundled Payments for Care Improvement (BPCI) pilot program aims to reward high-value providers by setting a global payment target for particular episodes of care. The representativeness of BPCI participants will influence the ability of this pilot to inform policy decisions. Methods: We linked the Medicare lists of participants in the risk-bearing portion of BPCI Model 2, encompassing acute and post-acute care, to the American Hospital Association resource file and the 2013 Hospital Value-Based Purchasing quality performance data. We classified episode-initiating hospitals by the number of bundles in which they were participating into “narrow”, “medium” and “comprehensive”. The …

Consumer Assessment Of Healthcare Providers And Systems (Cahps) Surveys: Assessing Patient Experience, Lisa Sprague

National Health Policy Forum

This publication provides an overview of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) family of surveys, which are widely used by both public and private health plans and providers to assess the patient's experience of health care. Included is information on survey contents, how surveys are tailored to different users, and how the resulting information is collected, reported, and used to help consumers make choices and providers carry out quality improvement, as well as its role in pay-for-performance reimbursement.

Many Paths To Primary Care: Flexible Staffing And Productivity In Community Health Centers, Leighton C. Ku, Bianca K. Frogner, Erika Steinmetz, Patricia Pittman

Health Policy and Management Issue Briefs

No abstract provided.

Health Insurance Benefits Advisors: Understanding Responsibilities, Regulations, Restrictions And The Relevance To Implementing The Affordable Care Act, Alexandra M. Stewart, Marisa A. Cox, Leighton Ku

Health Policy and Management Issue Briefs

This brief describes the operational differences among six different types of benefits advisors including: 1) Commercial agents and brokers, 2) Medicaid enrollment brokers, 3) navigators, 4) non-navigator assistance personnel (or in-person assisters), 5) certified applications assisters, and 6) health center outreach and enrollment assistance workers. We will address: 1) the role of each benefits advisor 2) the health plans with which benefits advisors are authorized to work 3) training requirements, 4) compensation 5) conflict of interest requirements, and 6) the impact benefits advisors have on consumer enrollment decisions.

Paying For Prescribed Drugs In Medicaid: Current Policy And Upcoming Changes, Brian K. Bruen, Katherine Young

Health Policy and Management Issue Briefs

Since the early 2000s, state Medicaid programs have made concerted efforts to control the cost of prescription drug spending. One crucial aspect in doing so is using a pharmacy reimbursement methodology that best reflects actual drug costs. Currently, states set pharmacy reimbursement policy within broad federal guidelines, resulting in a complex mix of reimbursement rules. Many states use list prices to set reimbursement levels, and these list prices increasingly have been criticized as not accurately reflecting the cost of the drug. Specifically, there are concerns that some benchmarks lead to inflated reimbursement levels. As a result, the federal government has …

Health Care In The Motor City: Thriving Or Surviving?, Sally Coberly, William J. Scanlon

National Health Policy Forum

This site visit explored the forces shaping the delivery of health care in Detroit. Health care providers in Detroit face the twin challenges of controlling costs and serving a bifurcated metropolitan area that includes large numbers of uninsured, low-income, and vulnerable residents as well as more prosperous residents of a reviving inner core and the surrounding suburbs and counties. The program looked at the underlying economic, social, and physical conditions that make improving the health of the city's residents extremely challenging. Efforts to contain costs through payment innovations such as the Blue Cross Blue Shield of Michigan's Physician Group Incentive …

Annual Report 2013, Forum Staff

National Health Policy Forum

This annual report describes the activities of the Forum during the 2013 calendar year, and provides a snapshot of our participants and resources.

National Spending For Long-Term Services And Supports (Ltss), 2012, Carol O'Shaughnessy

National Health Policy Forum

Long-term services and supports (LTSS) for the elderly and younger populations with disabilities are a significant component of national health care spending. In 2012, spending for these services was $219.9 billion (9.3 percent of all U.S. personal health care spending), almost two-thirds of which was paid by the federal-state Medicaid program. This publication presents data on LTSS spending by major public and private sources.

Telehealth: Into The Mainstream?, Lisa Sprague

National Health Policy Forum

Teleheath, and its subset telemedicine, extend across a range of technologies allowing patients to seek diagnosis, treatment, and other services from clinicians by electronic means. Telephone, videoconferencing, iPads, and apps are all employed. In its most established form, hospitals and medical centers use telehealth to reach patients in underserved rural areas. Proponents of telehealth suggest it can relieve medical workforce shortages; save patients time, money, and travel; reduce unnecessary hospital visits; improve the management of chronic conditions; and improve continuing medical education. But telehealth also faces ongoing challenges. States require physicians to be licensed in each state where they treat …

Money Follows The Person (Mfp) Rebalancing Demonstration: A Work In Progress, Carol O'Shaughnessy

National Health Policy Forum

In recent years, federal and state policy efforts have expanded opportunities for people to live in home- and community-based settings rather than in nursing homes and other institutions. As part of the Deficit Reduction Act of 2005, Congress enacted the Money Follows the Person Rebalancing (MFP) program, a Medicaid demonstration to help people who need long-term services and supports (LTSS) transition from nursing homes and other institutions to their own homes or other community settings. The Patient Protection and Affordable Care Act of 2010 extended the program through September 30, 2016. Now in its eighth year of operation, MFP grants …

Medicaid Home- And Community-Based Services Programs Enacted By The Aca: Expanding Opportunities One Step At A Time, Carol O'Shaughnessy

National Health Policy Forum

The Patient Protection and Affordable Care Act of 2010 (ACA) enacted the most significant opportunities for optional state expansion of Medicaid-financed home- and community-based services (HCBS) since 1981, when Congress enacted the section 1915(c) waiver program. Three of the ACA provisions, the Balancing Incentive Program (BIP), the Community First Choice (CFC) state plan option, and the health home state plan option, offer states enhanced federal Medicaid matching funds as long as they meet federal requirements. The ACA also expanded two HCBS programs established under the Deficit Reduction Act of 2005 (DRA) by extending the Money Follows the Person (MFP) Rebalancing …

Medicaid Home- And Community-Based Services Programs Enacted By The Aca: Expanding Opportunities One Step At A Time, Carol O'Shaughnessy

National Health Policy Forum

The Patient Protection and Affordable Care Act of 2010 (ACA) enacted the most significant opportunities for optional state expansion of Medicaid-financed home- and community-based services (HCBS) since 1981, when Congress enacted the section 1915(c) waiver program. Three of the ACA provisions, the Balancing Incentive Program (BIP), the Community First Choice (CFC) state plan option, and the health home state plan option, offer states enhanced federal Medicaid matching funds as long as they meet federal requirements. The ACA also expanded two HCBS programs established under the Deficit Reduction Act of 2005 (DRA) by extending the Money Follows the Person (MFP) Rebalancing …

Seeking Value In Medicare: Performance Measurement For Clinical Professionals, Lisa Sprague

National Health Policy Forum

The Medicare program, despite its reputation of being a bill payer with little regard to the worth of the services it buys, has begun to put in place a range of programs aimed at assessing quality and value, with more to come. Attention to resource use and cost is nascent. The issues are complex, and it is no surprise that there is a level of contention between providers and regulators, even though both profess commitment to improved quality. This paper summarizes the quality and value programs that apply to physicians and other clinical professionals, as well as programs designed to …

Health Workforce Needs: Projections Complicated By Practice And Technology Changes, Rob Cunningham

National Health Policy Forum

As population growth and the aging of the overall population increase demand for health care, policymakers and analysts posit whether sufficient health care providers will be able to meet that demand. Some argue there are too few providers already; others say our current supply-demand problems lie with efficiency. But suppose both are correct? Perhaps the real challenge is to understand how physician practices are changing in response to market forces such as payment changes, provider distributions, and technology innovations. This issue brief reviews what is known about evolving practice organizations, professional mixes, information technology support, and the implications of these …

The Commission On Long-Term Care: Background Behind The Mission, Carol O'Shaughnessy

National Health Policy Forum

The American Taxpayer Relief Act of 2012 (ATRA, P.L. 112-240) created a Commission on Long-Term Care charged with developing a plan for financing of long-term services and supports (LTSS) and issuing a report in September 2013. Significant research and advocacy have been devoted to LTSS financing issues and perceived inadequacies of the delivery system over the past several decades, but the most recent comprehensive review of financing options was in 1990 by the Pepper Commission. This publication presents brief background behind the mission of the Commission, including a time line of selected federal and national activities on LTSS financing and …

Medicare Advantage Update: Benefits, Enrollment, And Payments After The Aca, Kathryn Linehan

National Health Policy Forum

In 2012, the Medicare program paid private health plans $136 billion to cover about 13 million beneficiaries who received Part A and B benefits through the Medicare Advantage (MA) program rather than traditional fee-for-service (FFS) Medicare. Private plans have been a part of the program since the 1970s. Debate about the policy goals—Should they cost less per beneficiary than FFS Medicare? Should they be available to all beneficiaries? Should they be able to offer additional benefits?—has long accompanied Medicare's private plan option. This debate is reflected in the history of Medicare payment policy, and policy decisions over the …

Cms's Proposed Rule Implementing The Aca-Mandated Medicaid Dsh Reductions, Kathryn Linehan

National Health Policy Forum

State Medicaid programs make Medicaid disproportionate share hospital (DSH) payments to hospitals to help offset costs of uncompensated care for Medicaid and uninsured patients. Unlike most Medicaid spending, annual DSH allotments for each state are capped. Under the Patient Protection and Affordable Care Act of 2010 (ACA), DSH payments will decrease starting in fiscal year (FY) 2014 and continuing through FY 2020. This paper describes the proposed rule for reducing these federal allotments, which was released on May 15, 2013, by the Centers for Medicare & Medicaid Services (CMS). Comments on the proposed rule are due July 12, 2013.

2014 …

Annual Report 2012, Forum Staff

National Health Policy Forum

This annual report describes the activities of the Forum during the 2012 calendar year, and provides a snapshot of our resources.