Morning Briefing
Summaries of health policy coverage from major news organizations
Probe: Medicare Overpays Hospitals Due To Markups
The Wall Street Journal: Medicare Overpays As Hospital Prices Rise
New Jersey’s Christ Hospital collected $2.93 million in special payments for treating the sickest Medicare patients in 2013, more than quadruple what it had the prior year. Much of the increase didn’t come from treating more patients or providing more care. It came from higher list prices charged by the Jersey City hospital—markups of at least 60% from the prior year for many patients with common diagnoses, billing records show. List prices charged by hospitals aren’t supposed to matter to Medicare because the government doesn’t pay them. The federal program almost always pays fixed amounts based mostly on patients’ conditions. That is supposed to prevent hospitals from sticking the government with big price hikes. Nevertheless, jumps in list prices hit the government every year in one corner of the roughly $600 billion Medicare system: treating complicated cases known as “cost outliers.” (Weaver, Wilde Mathews and McGinty, 4/15)
The Associated Press: Study: Needless Tests Given To Medicare Cataract Patients
Millions of older people are getting tests they don’t need to prove they are healthy enough to have cataracts removed, a new study finds. The excess testing before this quick, ultrasafe eye procedure is costing them and Medicare a bundle, and many patients don’t know they can question it, doctors say. (Marchione, 4/15)
Meanwhile, an accountable care program shows modest savings after its first year -
Bloomberg: Obamacare Savings Experiment Yields Modest Results In Study
An ambitious Obamacare experiment in cutting health-care costs led to a reduction of about 1.2 percent in spending on Medicare patients in its first year, researchers said, calling the savings a promising start. Still, the government may need to make changes to keep hospitals and doctors in the program, known as Pioneer, Harvard University researchers said in a paper published by the New England Journal of Medicine. Since Pioneer started in 2012, 13 of 32 organizations that initially joined have exited. (Wayne, 4/15)
And the administration proposes a 1.4 percent increase in Medicare rates for skilled nursing homes -
CQ Healthbeat: Skilled Nursing Homes Would See Medicare Payments Rise 1.4%
Medicare payments to skilled nursing homes in fiscal 2016 would increase by $500 million, or 1.4 percent, under a proposed rule that the Centers for Medicare and Medicaid Services released late Wednesday. The increase is derived from a complex formula. Payment calculations are affected by a 2.6 percent increase, which is then reduced by a 0.6 percentage point error adjustment and another cut of 0.6 percentage point due to a productivity adjustment. (Adams, 4/15)
