Medicare Payment Rule FY 2015: Inpatient Rates to Rise 1.4 Percent

Medicare inpatient rates will increase 1.4 percent in FY 2015.

But the already-shrinking Medicare disproportionate share (Medicare DSH) pool will be $900 million smaller than proposed in April.

These and other payment policies were included in the recently unveiled Medicare inpatient prospective payment system regulation for FY 2015.

law booksThe new regulation, to be published shortly in the Federal Register, also addresses changes in Medicare’s value-based purchasing program, hospital readmissions reduction program, and outlier threshold and introduces Medicare’s new hospital-acquired conditions program and changes in hospitals’ Medicare area wage indexes.

The National Association of Urban Hospitals (NAUH) has prepared a summary of the new regulation tailored to the interests of private safety-net hospitals and can provide projections detailing the anticipated impact of all of these changes on individual private safety-net hospitals.  To receive a copy of this memo, hit the “contact us” link in the upper right-hand portion of this screen.  To see the regulation itself go here and for a Reuters report on the regulation go here.

Foundation to Track Effect of ACA on Hospitals

The Robert Wood Johnson Foundation has launched a project to measure the impact of the Affordable Care Act on hospitals.

Working with 24 state hospital associations, the foundation’s Hospital ACA Monitoring Project will collect quarterly hospital data on admissions, emergency room visits, and selected diagnoses and procedures.  The project will collect data from different types of hospitals with different payer mixes.

RWJFAccording to the foundation, the project “is designed to shed light on some of the effects of health reform on hospitals and provide extremely timely data to researchers, policymakers and hospital leaders.”

Learn more about the Robert Wood Johnson Foundation’s Hospital ACA Monitoring Project from this notice on the foundation’s web site.


Study Points to Risk of DSH Cuts

A new study suggests that future cuts in Medicare disproportionate share (Medicare DSH) and Medicaid DSH payments could pose problems for hospitals that serve large numbers of uninsured patients.

According to a new report in the journal Health Affairs,

Such cuts in government funding of uncompensated care could pose challenges to some providers, particularly in states that have not adopted the Medicaid expansion or where implementation of health care reform is proceeding slowly.

Medicare DSH and Medicaid DSH payments help underwrite the uncompensated care hospitals provide to their uninsured patients.  All private safety-net hospitals receive such payments.

health affairsEven after Affordable Care Act reforms take effect, 25 to 30 million Americans are expected to remain uninsured.  Medicare DSH payments are expected to decline $22.1 billion between now and 2019 and Medicaid DSH payments, temporarily delayed by two separate actions of Congress, are expected to decline $17.1 billion through 2020.

The new study supports The National Association of Urban Hospitals’ long-time position that Medicare DSH and Medicaid DSH cuts would be harmful to private, non-profit urban safety-net hospitals and should be delayed.   NAUH also has endorsed legislation calling for such a delay.

Learn more about the Health Affairs study in this Washington Post article and find the study itself here, on the web site of Health Affairs.

Web Site Flaw Keeps Medicaid, CHIP Applicants in Limbo

More than 400,000 people thought to be eligible for Medicaid and CHIP appear to have their eligibility determinations caught in the web site.

Through a flaw in the federal health care web site, eligibility notifications for these applicants have not been forwarded to state governments and the applicants have not been enrolled in Medicaid or CHIP.

Some states have received only some Medicaid and CHIP verifications from the federal web site while a few have not received any.

Health Care Reform/FlagAware of the problems with the federal site, some newly eligible individuals and families reapplied on the federal site or went directly to their state governments but others have not and still have not been notified of their eligibility for the two programs months after they applied and had their eligibility initially approved.

Because they serve so many low-income and uninsured patients, private safety-net hospitals have a special interest in the resolution of this problem.

Learn more about this situation, the states it affects most, and what it is being done to address it in this CQ HealthBeat report presented by the Commonwealth Fund.