A Hospital Prevents Readmissions, but Threatens Revenue
Greenberg and hospitals colleagues have gone to officials with MassHealth, the state's Medicaid program, to demand "they bear some responsibility," and pay for the savings they're getting, he says. Discussions have been initiated with some private health providers as well.
In response, Massachusetts lawmakers recently passed legislation that calls for the state to develop "a global or bundled payment system for high-risk pediatric asthma patients enrolled in the MassHealth program."
That payment "shall reimburse expenses necessary to manage pediatric asthma, including, but not limited to patient education, environmental assessments, mitigation of asthma triggers and purchase of necessary durable medical equipment."
In two years, the project shall "ensure a financial return on investment through the reduction of costs related to hospital and emergency room visits and admissions."
Asked for the status of the effort, MassHealth spokeswoman Jennifer Kritz says the pilot is in the development process, but that "a new payment methodology in a manner that is prudent, both clinically and financially, is a complex undertaking."
The pilot is expected to include multiple providers, and "will be based on the bundle of services that are required to provide high quality care to MassHealth-covered children with asthma," she says.
- Readmissions: No Quick Fix to Costly Hospital Challenge
- How Top-Ranked MA Plans Earn Their Stars
- How Hospitals Can Become 'Upstreamists'
- 4 Ways to Lower the Cost to Collect from Self-Pay Patients
- House Calls Key to Pioneer ACO Success
- How Telehealth Pays Off for Providers, Patients
- 4 Tips for Managing Employed Physicians
- Defensive Medicine Still Prevalent Despite Tort Reform
- 'Overtreatment' Debate Circles Back to Lung Cancer Screening
- WellPoint Dominates Nearly Half of Markets, AMA Says