Why Red State Govs May Embrace Medicaid Expansion
Keckley thinks that DSH payments may not disappear quite as quickly as was originally forecasted, "but there will be offsetting that much more pressure through the back door."
"The front door is reimbursement and the feds will probably get a few of those dollars back, especially for safety net hospitals in light of the fact that not as many people are going to be insured through Medicaid," he says.
"But on the back end I suspect CMS will be more aggressive on fraud and necessary care and accelerate these pilots so they can get the money back in terms of penalties or that they simply don't have to payout as much because of under performers."
"The mood at CMS is that fraud is under-captured and they haven't figured out how to deal with it," he says. "They aren't going to do pay and chase anymore and they think this necessary care issue is big. That there is so much being done that the evidence says is unnecessary that they will have reason to go to the providers and the plans that have allowed it and say 'we need a give back. You can't get away with this anymore."
John Commins is a senior editor with HealthLeaders Media.
- How Top-Ranked MA Plans Earn Their Stars
- Readmissions: No Quick Fix to Costly Hospital Challenge
- How Hospitals Can Become 'Upstreamists'
- 4 Ways to Lower the Cost to Collect from Self-Pay Patients
- WellPoint Dominates Nearly Half of Markets, AMA Says
- CMS Offers Some ACOs $114M for 'Upfront' Costs
- 4 Tips for Managing Employed Physicians
- House Calls Key to Pioneer ACO Success
- Ebola: Second TX Nurse Diagnosed After Improper Protective Gear Application
- Providers Ask HHS to Address EHR Interoperability Barriers