Research Roundup: Medicaid; Infections; And Medicare

Commonwealth Fund: Medicaid And The Role Of The Courts
The courts have shaped virtually all aspects of Medicaid policy, including eligibility, benefits and coverage, access to care, provider participation and payment, and the scope of federal agency demonstration powers under Section 1115. Furthermore, underlying the cases that focus on what federal law requires of participating states is a key threshold question of importance to lawsuits brought against states by beneficiaries and providers: whether, in advance of federal agency review, federal courts can intervene to prevent potentially unlawful state policies from taking effect before they cause immediate and irreparable injury. This question has commanded the attention of a more conservative judiciary, whose rulings increasingly are narrowing access to the courts. (Rosenbaum, 6/12)

The Henry J. Kaiser Family Foundation: Implications Of Work Requirements In Medicaid: What Does The Data Say?
In January 2018, the Centers for Medicare and Medicaid Services (CMS) issued new guidance for state Medicaid waiver proposals that would impose work requirements in Medicaid as a condition of eligibility. As of June 2018, four states have approved waivers to implement Medicaid work requirements, seven states have waiver requests pending with CMS, and other states are considering or developing work requirement programs. These states are all imposing or seeking to impose work requirements on populations already covered (both expansion and non-expansion populations); however, Virginia passed legislation to adopt the Medicaid expansion that included a provision to submit a waiver to impose a work requirement on a new expansion population. This brief builds on previous analyses to provide data on Medicaid enrollees and some of the policy implications of work requirements. (Garfield, Rudowitz, Musumeci and Damico, 6/12)

JAMA Internal Medicine: Identification And Characterization Of Failures In Infectious Agent Transmission Precaution Practices In Hospitals: A Qualitative Study
Preventing the spread of infectious organisms is a priority for hospitals and health care systems. A prominent concern is that cross-transmission can lead to patients becoming colonized and acquiring infections, such as hospital-onset Clostridium difficile infection and methicillin-resistant Staphylococcus aureus bacteremia, as well as infections from other emerging drug-resistant organisms. Minimizing risks for health care personnel is also paramount, as illustrated by the self-contamination and subsequent illness of 2 nurses caring for a patient with Ebola virus disease. (Krein et al, 6/11)

Health Affairs: Comparison Of Hospitals Participating In Medicare’s Voluntary And Mandatory Orthopedic Bundle Programs
We analyzed data from Medicare and the American Hospital Association Annual Survey to compare characteristics and baseline performance among hospitals in Medicare’s voluntary (Bundled Payments for Care Improvement initiative, or BPCI) and mandatory (Comprehensive Care for Joint Replacement Model, or CJR) joint replacement bundled payment programs. BPCI hospitals had higher mean patient volume and were larger and more teaching intensive than were CJR hospitals, but the two groups had similar risk exposure and baseline episode quality and cost. BPCI hospitals also had higher cost attributable to institutional postacute care, largely driven by inpatient rehabilitation facility cost. These findings suggest that while both voluntary and mandatory approaches can play a role in engaging hospitals in bundled payment, mandatory programs can produce more robust, generalizable evidence. Either mandatory or additional targeted voluntary programs may be required to engage more hospitals in bundled payment programs. (Navathe et al, 6/1)