State News

Massachusetts | Sep 12, 2019 | Report

Price Hikes, Upcoding Drive Massachusetts Inpatient Spending

Commercial inpatient healthcare spending has increased in Massachusetts despite declining volumes, according to Modern Healthcare. Commercial inpatient spending across the state grew 10.7 percent from 2013 to 2018, while service use decreased by 12.8 percent, according to a report from the Massachusetts Health Policy Commission. In addition, the average commercially insured patient risk score increased 11.3 percent from 2013 to 2017, which theoretically should have increased intensive care unit and cardiac care unit volumes and lengths of stay. Instead, the data suggest that hospitals are maximizing coding rather than treating sicker patients.

Florida | Sep 12, 2019 | News Story

Half of Floridians Delayed or Skipped Medical Care Because of High Costs, Survey Shows

More than half of Floridians delay or skip medical care, struggle to pay their medical bills or are uninsured because health care is too expensive for them, according to a new survey from the Healthcare Value Hub. These results were especially pronounced in Central Florida, where four out of five respondents said they were worried about not being able to afford healthcare. The majority, regardless of political affiliation, said the government had to solve the problem, particularly the high cost of care and prescription drugs, the Orlando Sentinel revealed. 

New Jersey | Sep 12, 2019 | News Story

Raising the Minimum Wage in New Jersey: Implications for Earnings and Medicaid Eligibility and Enrollment

Due to a recently-legislated incremental minimum-wage increase from $8.85 in 2019 to $15 by 2024, some New Jersey workers could lose Medicaid eligibility, according to a report by the Urban Institute. However, the report notes that the number of those who will lose eligibility and coverage will be small relative to the number who will experience a wage increase. Those at risk of losing Medicaid coverage constitute less than 5 percent of all nondisabled, nonelderly adult Medicaid enrollees in the state, and all of those who would lose Medicaid eligibility would remain in the income range allowing them to qualify for subsidized coverage on the marketplace.

Tennessee | Sep 12, 2019 | News Story

New Rural Research Center Will Focus on Breaking Cycle of Poor Health

A new rural health research center in Tennessee will focus on breaking the cycle of inter-generational behavior that contributes to poor health. The Center for Rural Health Research will be housed at the College of Public Health at East Tennessee State University in Johnson City, TN, according to Daily Yonder. The center will also work to become a source for policymakers – providing the data from which those in government and other policy making organizations can make decisions to help improve the health of those in rural and nonurban communities.

District of Columbia | Sep 11, 2019 | News Story

Department of Health Care Finance Announces Medicaid Program Reforms and Intent to Re-Procure Managed Care Contracts

Washington D.C.’s Department of Health Care Finance (DHCF), the District’s Medicaid agency, announced that it will transition nearly 22,000 individuals currently in the Medicaid fee-for-service program to a Medicaid managed care program in addition to launching two major changes that will improve equity and value for the Medicaid, Alliance and Immigrant Children’s Programs. First, DHCF will expand value-based purchasing requirements in the managed care program to promote an enhanced focus on health outcomes for Medicaid enrollees. Second, DHCF will implement universal contracting for critical providers in the city’s healthcare market to even the playing field and improve access to needed healthcare providers for all Medicaid enrollees. Given DHCF’s role as the payer for 40 percent of the District’s population, these changes are expected to have a broader positive impact for the District’s healthcare delivery system, as well.

Colorado | Sep 10, 2019 | News Story

New Colorado Law Protects Adverse Health Care Incident Resolution Process

A new Colorado law will establish a legally protected process for communication with patients and/or their families and a format for resolution after an adverse healthcare incident, according to the National Law Review. Participation by healthcare facilities and providers is voluntary and the process must be initiatied by the healthcare provider involved in the adverse incident or by another provider jointly with the health facility involved. If the process is initiated by the patient or their family/representative, the discussion will not be protected. If followed correctly, this complicated process can significantly benefit nursing homes and assisted living facilities in investigating, communicating and resolving compensation issues related to adverse resident outcomes. 

Arizona | Sep 10, 2019 | Report

Private Insurers Expected to Pay Record High Rebates to Consumers for Excessive Premiums Relative to Health Care Expenses

Private insurance companies are expecting to pay out a record of at least $1.3 billion in rebates to consumers this year based on their share of premium revenues devoted to healthcare expenses in recent years, according to a Kaiser Family Foundation analysis. In the individual market alone, insurers will pay out the highest rebates in Virginia, followed by Arizona and Texas. Arizona’s individual market rebates are expected to reach $92.3 million.

Montana | Sep 10, 2019 | News Story

Montana Awarded $19M Grant for Statewide Health Information Exchange

Montana has received a $19 million awared from the Centers for Medicare and Medicaid Services (CMS) to support a statewide health information exchange (HIE), according to HIT Consultant. The HIE will give providers access to patient data in real-time with participating providers across the state to improve quality of care and reduce healthcare costs. A coalition of healthcare providers and public and private health plans created a nonprofit organization, Big Sky Care Connect, to develop the HIE, which will begin sharing healthcare data in 2020. 

Virginia | Sep 9, 2019 | News Story

‘UVA has Ruined Us’: Health System Sues Thousands of Patients, Seizing Paychecks and Putting Liens on Homes

Over six years ending in June 2018, the University of Virginia Health System and its doctors sued former patients more than 36,000 times for over $106 million, seizing wages and bank accounts, putting liens on property and homes and forcing families into bankruptcy, a Kaiser Health News and Washington Post analysis has found. Uninsured patients are left to cover bills that are sometimes twice what a commercial insurer would have paid due to insurer discounts and negotiated rates. Under a Virginia program designed to help state and local governments collect debt, the health system also seized $22 million in state tax refunds to patients with outstanding medical bills in the last six fiscal years — most of it without court judgments, in addition to billing them for legal costs and interest on their unpaid bill. This nonprofit hospital system offers charity care and other community benefits to patients, but savings of only $4,000 in a retirement account can disqualify a family from aid, even if its income is barely above poverty level. Health system representatives have defended themselves, stating that suing patients and using collections agencies are last resorts. Contributing to the problem, standards for community benefit requirements are vague—the American Hospital Association merely requires hospitals to have a financial assistance policy and make “reasonable efforts” to determine whether a patient qualifies before initiating collections. 

California | Sep 6, 2019 | News Story

California Enacts Law Requiring Kaiser to Share More Hospital Financial Data

California passed a measure to require Kaiser Permanente to join other insurers in providing more detailed information on expenses and revenue, reports The Sacramento Bee. Moving forward, Kaiser must report expenses and revenue for each of its facilities; break down revenue by type of payer (Medicare, Medi-Cal or private insurance) at each facility; and break down rate increases by type of service (hospital, physician services, pharmacy, radiology and laboratory). Consumer advocates support the increased transparency, citing that Kaiser has had a fairly broad exemption from much of the state’s rate review processes that other insurers have to follow. This bill ensures that Kaiser will provide the same types of information justifying their rates as other health insurers.