States project higher Medicaid enrollment, spending in FY 2014   10/07/2013
States expect Medicaid enrollment and spending to increase an average 8.8% and 10.3%, respectively, in fiscal year 2014, according to a survey released today by the Kaiser Commission on Medicaid and the Uninsured. That compares with 2.5% and 3.8% growth, respectively, in FY 2013. Enrollment is projected to grow about 12% on average in the 25 states planning to cover low-income parents and childless adults under the Patient Protection and Affordable Care Act in 2014, and 5.3% in other states. Among other findings, a total of 38 states froze or reduced Medicaid inpatient hospital rates in FY 2013, and 31 states planned to do so in FY 2014. About 40 Medicaid programs reported adding or expanding care coordination initiatives in FYs 2013 and 2014, while 39 reported expanding managed care or managed care quality initiatives.
Quality measure may penalize hospitals for detecting blood clots   10/07/2013
The rate of postoperative blood clots, or venous thromboembolism (VTE), may not be a valid hospital quality outcome measure, according to a study published online today by the Journal of the American Medical Association. “Our study calls into question the merit of the PSI-12 VTE outcome measure as a quality measure and its use in public reporting and performance-based payments,” the authors write. “Hospitals reported to have the highest risk-adjusted VTE rates may in fact be providing vigilant care by ordering imaging studies to ensure that VTE events are not missed.” The study by researchers at Northwestern University and Northwestern Memorial Hospital in Chicago found a positive correlation between VTE imaging and event rates for Medicare patients undergoing major surgical procedures at 2,786 hospitals in 2009 and 2010.
Managed care exec joins AHAs policy team   10/07/2013
AHA today named Jeffrey Goldman vice president for coverage policy at the organization. Goldman has held various progressive leadership roles at Kaiser Permanente since 1989, most recently serving as vice president of strategic planning and performance for the Mid-Atlantic States Region, where he directed strategy and business development activities for one of the largest commercial and Medicare health plans in the Maryland, Virginia and Washington, D.C., areas. In this new AHA position, Goldman will provide leadership and strategic direction on matters related to the new insurance marketplaces, Medicaid expansion and redesign, and other health care coverage and private insurance issues affecting hospitals and health systems. “Jeff’s deep understanding of both health plans and providers will be a tremendous asset,” said AHA Senior Vice President for Public Policy Analysis and Development Linda Fishman. “His years of experience at Kaiser Permanente will enhance our service to hospitals and health systems in the post-ACA health reform era.”