Making the Case for Addressing Health Disparities: What Drives Providers and Payers?

Abstract Purpose: The creation of the Centers for Medicare & Medicaid Services Office of Minority Health placed increased emphasis on federal efforts to address health disparities. Although the literature establishes a social justice case for addressing health disparities, there is limited evidence of this case being sufficient for businesses to invest in such initiatives. The purpose of this study was to better understand the “business case” behind an organization's investment in health disparity reduction work. Methods: We conducted six case studies (44 on-site interviews) with diverse private-sector provider and payer organizations. Results: While providers and payers cited business rationales for initiating disparity-focused efforts, their motivations differed. Conclusion: As federal entities address health disparities, and payment models shift from volume to value, engaging private stakeholders with the leverage to move the health disparities needle is of principal importance. Published in Health EquityVol. 2, No....

Do Live Discharge Rates Increase as Hospices Approach Their Medicare Aggregate Payment Caps?

Abstract Context The rate of live discharge from hospice and the proportion of hospices exceeding their aggregate caps have both increased for the last 15 years, becoming a source of federal scrutiny. The cap restricts aggregate payments hospices receive from Medicare during a 12-month period. The risk of repayment and the manner in which the cap is calculated may incentivize hospices coming close to their cap ceilings to discharge existing patients before the end of the cap year. Objective The objective of this work was to explore annual cap-risk trends and live discharge patterns. We hypothesized that as a hospice comes closer to exceeding its cap, a patient's likelihood of being discharged alive increases. Methods We analyzed monthly hospice outcomes using 2012–2013 Medicare claims. Results Adjusted analyses showed a positive and statistically significant relationship between cap risk and live discharges. Conclusion Policymakers ought to consider the unintended consequences the aggregate cap may be having on patient outcomes of care. Do Live Discharge Rates Increase as Hospices Approach Their Medicare Aggregate Payment Caps? Dolin, Rachel et al. Journal of Pain and Symptom Management , Volume 55 , Issue 3 , 775 -...
Puerto Rico’s children need recovery funds

Puerto Rico’s children need recovery funds

BY ANDREW ROSZAK, OPINION CONTRIBUTOR — 01/13/18 01:00 PM EST Hurricane Maria made landfall and caused horrific damage in Puerto Rico and the U.S. Virgin Islands on Sept. 20, 2017. The historic storm caused widespread destruction to critical infrastructure throughout these islands. Now, 18 weeks after landfall, many people, including children, still lack access electricity and clean water, among other necessities. The damage has been so great that people are leaving Puerto Rico in record numbers. From Oct. 3, 2017 to Jan. 3, 2018, more than 297,000 individuals have arrived in Florida, according to the Florida Division of Emergency Management. As is the case in most disasters, even once the immediate threat goes away, the public health and environmental health issues persist. This is certainly the case in Puerto Rico. Numerous challenges, such as a lack of clean, reliable, drinking water to the widespread occurrence of mold compound recovery efforts. Adding to these challenges is the significant loss of the health workforce. Of the 15,000 doctors who were on the island when Maria made landfall, only 9,000 remain. As documented by Child Care Aware of America during a recent visit, the children of Puerto Rico and the U.S. Virgin Islands continue to feel the after effects of Hurricane Maria. On the islands, many are unable to return to child care or school due to a lack of power. While some schools are open, many are only operating for a few hours — they dismiss children in the early afternoon as the buildings become too hot to house them. For those who have left the islands they are struggling to adapt to a new...

Small Change, Big Consequences — Partial Medicaid Expansions under the ACA

Adrianna McIntyre, M.P.P., M.P.H., Allan M. Joseph, M.P.H., and Nicholas Bagley, J.D. Though congressional efforts to repeal and replace the Affordable Care Act (ACA) seem to have stalled, the Trump administration retains broad executive authority to reshape the health care landscape. Perhaps the most consequential choices that the administration will make pertain to Medicaid, which today covers more than 1 in 5 Americans.1 Much has been made of proposals to introduce work requirements or cost sharing to the program. But another decision of arguably greater long-term significance has been overlooked: whether to allow “partial expansions” pursuant to a state Medicaid waiver. Arkansas has already submitted a waiver request for a partial expansion, and other states may well follow its lead.2 To understand Arkansas’s request, and why it matters so much, some background is in order. Medicaid waivers have long allowed states to experiment with delivery reform and coverage expansions, but waivers became more consequential in 2012, when the U.S. Supreme Court gave states a choice about whether to expand their Medicaid programs to cover everyone with an income of up to 138% of the federal poverty level. Some states sought greater flexibility to expand Medicaid on their own terms, which made participation in the expansion more palatable in Republican-controlled states. After intense negotiations, the Obama administration granted expansion waivers to seven states... Full article published in The New England Journal of Medicine...

Nearly 1 In 5 Hospice Patients Discharged While Still Alive

Heard on Morning Edition Hospice care is for the dying. It helps patients manage pain so they can focus on spending their remaining time with loved ones. But in recent years, nearly 1 in 5 patients has been discharged from hospice before he or she dies, according to government reports. A study published last month in the journal Health Affairs finds that hospices with the highest rate of so-called live discharges also have the highest profits. The lead author is Rachel Dolin, a David A. Winston fellow researching health policy. Her paper found an association between high live discharge rates and high profit margins, but it didn't determine the cause.... Full article at...

A Positive Association Between Hospice Profit Margin And The Rate At Which Patients Are Discharged Before Death

By Rachel Dolin1, G. Mark Holmes2, Sally C. Stearns3, Denise A. Kirk4, Laura C. Hanson5, Donald H. Taylor6, and Pam Silberman7  Abstract Hospice care is designed to support patients and families through the final phase of illness and death. Yet for more than a decade, hospices have steadily increased the rate at which they discharge patients before death—a practice known as “live discharge.” Although certain live discharges are consistent with high-quality care, regulators have expressed concern that some hospices’ desire to maximize profits drives them to inappropriately discharge patients. We used Medicare claims data for 2012–13 and cost reports for 2011–13 to explore relationships between hospice-level financial margins and live discharge rates among freestanding hospices. Adjusted analyses showed positive and significant associations between both operating and total margins and hospice-level rates of live discharge: One-unit increases in operating and total margin were associated with increases of 3 percent and 4 percent in expected hospice-level live discharge rates, respectively. These findings suggest that additional research is needed to explore links between profitability and patient-centeredness in the Medicare hospice program. Published in Health Affairs, Vol.  36, No....