Policymakers who hope to see hospitals respond to financial incentives for better quality care will be disappointed by a newly published report on costly, potentially deadly, hospital-acquired infections.
My colleague Maureen McKinney reported on the results, published in the New England Journal of Medicine: The 2008 Medicare policy to stop payment for catheter-associated bloodstream and urinary tract infections contracted by patients during a hospital stay did not produce a hoped-for drop in infection rates.
The rate of bloodstream infections, on the decline before the policy change, continued to drop at about the same pace as before the pay cut, the researcher said.
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Pay doctors to churn through patients, procedures and tests, and they will. As a business model, “do more, earn more” has been singled out by policymakers and the industry as deeply flawed and one reason the U.S. spends so much on healthcare.
But, as two health policy experts point out in the Aug. 8 Journal of the American Medical Association, efforts to find another way—including accountable care—have so far produced little change.
Payment for each procedure or visit continues to underpin many emerging accountable-care organizations, including Medicare's popular shared savings program, wrote Drs. Allan Goroll of Harvard University Medical School and Stephen Schoenbaum of the Josiah Macy Jr. Foundation.
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Here's one consequence of the Supreme Court's healthcare-reform decision: States with low Medicaid eligibility thresholds that choose not to expand Medicaid would leave poor adults to churn between subsidized commercial insurance and no insurance whatsoever.
Yesterday's decision created a potential gap in coverage for poor adults. Here's how: The Supreme Court said that the federal government cannot enforce an expansion of Medicaid eligibility by threatening to cut off all Medicaid funding to states that fail to expand. That leaves states free to ignore Medicaid expansion under the law.
Poor adults were expected to benefit most from Medicaid expansion, which opens the safety-net insurer to everyone with incomes below 133% of the federal poverty guidelines starting in 2014.
As of January, eligibility for poor, working parents in 33 states is capped below 100% of the federal poverty guideline ($23,050 for a family of four), a survey by the Henry J. Kaiser Family Foundation shows. Adults without children are completely ineligible for Medicaid in all but eight states, but can receive limited health benefits or premium support in 17 states, the Kaiser Family Foundation said.
Meanwhile, subsidies for commercial insurance are available for those with incomes between 100% and 400% of the federal poverty guidelines.
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