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E-Cigarettes and Federal Regulation (Updated)

August 7, 2014 Comments off

E-Cigarettes and Federal Regulation (Updated)
Source: Health Affairs

Policy makers have begun developing rules for how popular alternatives to traditional cigarettes can be marketed and sold.

What’s the issue?
E-cigarettes, virtually nonexistent 10 years ago, have skyrocketed in popularity. Though often shaped like a traditional cigarette, they are fundamentally different in both design and ingredients and are widely believed by supporters and critics to be a safer alternative and a potentially valuable tool in weaning people off tobacco cigarettes. How much safer, however, and how well they function as a smoking cessation device are key questions subject to a fierce debate.

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Translating Research For Health Policy: Researchers’ Perceptions And Use Of Social Media

June 13, 2014 Comments off

Translating Research For Health Policy: Researchers’ Perceptions And Use Of Social Media
Source: Health Affairs

As the United States moves forward with health reform, the communication gap between researchers and policy makers will need to be narrowed to promote policies informed by evidence. Social media represent an expanding channel for communication. Academic journals, public health agencies, and health care organizations are increasingly using social media to communicate health information. For example, the Centers for Disease Control and Prevention now regularly tweets to 290,000 followers. We conducted a survey of health policy researchers about using social media and two traditional channels (traditional media and direct outreach) to disseminate research findings to policy makers. Researchers rated the efficacy of the three dissemination methods similarly but rated social media lower than the other two in three domains: researchers’ confidence in their ability to use the method, peers’ respect for its use, and how it is perceived in academic promotion. Just 14 percent of our participants reported tweeting, and 21 percent reported blogging about their research or related health policy in the past year. Researchers described social media as being incompatible with research, of high risk professionally, of uncertain efficacy, and an unfamiliar technology that they did not know how to use. Researchers will need evidence-based strategies, training, and institutional resources to use social media to communicate evidence.

Understanding Differences Between High- And Low-Price Hospitals: Implications For Efforts To Rein In Costs

February 4, 2014 Comments off

Understanding Differences Between High- And Low-Price Hospitals: Implications For Efforts To Rein In Costs
Source: Health Affairs

Private insurers pay widely varying prices for inpatient care across hospitals. Previous research indicates that certain hospitals use market clout to obtain higher payment rates, but there have been few in-depth examinations of the relationship between hospital characteristics and pricing power. This study used private insurance claims data to identify hospitals receiving inpatient prices significantly higher or lower than the median in their market. High-price hospitals, compared to other hospitals, tend to be larger; be major teaching hospitals; belong to systems with large market shares; and provide specialized services, such as heart transplants and Level I trauma care. High-price hospitals also receive significant revenues from nonpatient sources, such as state Medicaid disproportionate-share hospital funds, and they enjoy healthy total financial margins. Quality indicators for high-price hospitals were mixed: High-price hospitals fared much better than low-price hospitals did in U.S. News & World Report rankings, which are largely based on reputation, while generally scoring worse on objective measures of quality, such as postsurgical mortality rates. Thus, insurers may face resistance if they attempt to steer patients away from high-price hospitals because these facilities have good reputations and offer specialized services that may be unique in their markets.

How Will Federal Medicaid Payments To States In 2015 Be Affected By New Personal Income Data?

October 10, 2013 Comments off

How Will Federal Medicaid Payments To States In 2015 Be Affected By New Personal Income Data?
Source: Health Affairs

The release of per capita state personal income data by the Bureau of Economic Analysis (BEA) on September 30, 2013, permits the calculation of Federal Medical Assistance Percentages (FMAPs) for federal fiscal year (FY) 2015. These income data are the first state-level data from BEA reflecting its recent comprehensive revisions (“benchmarking”)—adjusting concepts, statistical techniques and presentations—in the National Income and Product Accounts (NIPAs). Such revisions serve BEA’s mandate to track gross domestic product (GDP) and income (GDI). Though the income data revisions have little direct relevance for Medicaid and state government finance, they will drive changes in FMAPs and therefore Medicaid grants to states, both in FY 2015 and beyond.

Twenty-one states will see their FMAPs increase in FY 2015 and seventeen will see them decline. The biggest increases will be for Missouri (+1.42), Nevada (+1.26), Arizona (+1.23), and Colorado and Georgia (each +1.01). The biggest declines will be experienced by Iowa (-2.39), South Dakota (-1.90), Oklahoma (-1.72), Pennsylvania (-1.70) and Delaware (-1.68). These changes reflect the combined impacts of actual economic shifts, annual data adjustments and the comprehensive revisions.

What Types Of Hospitals Have High Charge-To-Reimbursement Ratios?

July 17, 2013 Comments off

What Types Of Hospitals Have High Charge-To-Reimbursement Ratios?
Source: Health Affairs

Recently, the Centers for Medicare & Medicaid Services (CMS) released the average value of hospital billed charges and their corresponding Medicare reimbursed rates for the 100 most common diagnosis related groups (DRGs). The release included data for each Medicare-eligible hospital with eleven or more discharges for the specific DRG in the year 2011. This represents information on 3,337 different hospitals with an average of 48.9 different DRGs (SD=31.3) per institution. On average, hospitals billed Medicare 3.77 times (standard deviation = 1.83) what they were actually reimbursed, with a range of 0.42 to 16.23.

While the difference between charges and reimbursement rates is well known, little has been written about the characteristics of hospitals associated with these factors. This post evaluates hospital characteristics as they relate to higher charged rates compared to actual reimbursed rates for the Medicare population. Hospitals that charge more tend to be affiliated with a hospital system, located in urban areas, and investor-owned, while hospitals that charge less tend to be small, unaffiliated, government-owned entities located in rural areas.

Premium Assistance in Medicaid

June 8, 2013 Comments off

Premium Assistance in Medicaid
Source: Health Affairs

States have proposed using expansion funds to buy private coverage for Medicaid beneficiaries through the new health insurance exchanges.

What’s The Issue?

Nearly a year after the US Supreme Court’s June 2012 decision declaring the Affordable Care Act’s (ACA’s) Medicaid expansion optional, states continue to grapple with whether or not to pursue the option for newly eligible populations. Although the Medicaid expansion accounted for about half the total number of people projected to gain coverage under the ACA, many states to date have declined to expand Medicaid or are leaning toward rejecting the option because of cost and political concerns. But the long-term consequences of denying the Medicaid expansion, especially large coverage gaps for millions of low-income people, are also prompting some states to consider novel alternatives for extending Medicaid under the ACA.

One approach that has piqued states’ interest is using the additional federal funds as “premium assistance” for eligible Medicaid beneficiaries to purchase private coverage through the law’s new health insurance exchanges.

This middle ground or “private option” appears more politically tenable for states led by conservative lawmakers intent on moving more people into the private market. Proponents of the Medicaid premium assistance option also tout it as a potential path to lowering Medicaid spending, perhaps driving down private exchange costs over time and reducing the cyclical movement of beneficiaries between Medicaid and the exchanges based on their fluctuating incomes.

Skeptics of premium assistance contend the option is less attractive than first thought. States must show that the novel model is cost-effective compared to enrolling people in Medicaid. They must also ensure that the coverage provided through exchange plans is consistent with federal Medicaid requirements, including the scope of benefits provided and cost sharing. Another hurdle is that both states’ legislatures and the federal government have to approve states’ premium assistance plans.

This policy brief examines a range of policy issues surrounding premium assistance using Medicaid expansion funds and next steps for states.

The Aligning Forces For Quality Experience: Lessons On Getting Consumers Involved In Health Care Improvements

June 6, 2013 Comments off

The Aligning Forces For Quality Experience: Lessons On Getting Consumers Involved In Health Care Improvements

Source: Health Affairs

Aligning Forces for Quality is the Robert Wood Johnson Foundation’s signature effort to improve the overall quality of health care in targeted communities, reduce racial and ethnic disparities in care, and provide models for national reform. Activities in each of the sixteen Aligning Forces for Quality alliance communities are guided by a multistakeholder alliance of consumers, providers, and payers. To achieve goals established at the national and local levels, the alliances integrate local consumers into governance and decision making, program design and implementation, and information dissemination efforts. This article describes how the Aligning Forces for Quality investments have evolved since the initiative’s launch in 2006 and offers some early lessons learned. Individual alliances have engaged consumers in numerous capacities, from serving on dedicated consumer advisory boards to representing the consumer’s perspective in the design of public reports of providers’ quality. The alliances’ ongoing and mindful inclusion of consumers provides insights into eliciting and applying their perspectives in the pursuit of improved health care quality, value, and transparency.

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