The full extent of U.S. spending on Medicaid, the $459 billion state-federal health insurance program for the poor, is unclear because of mismatches between government databases, auditors reported. A $43 billion gap showed up in a comparison of 2009 spending data from the states, which run Medicaid, and the U.S. Centers for Medicare and Medicaid Services, which pays for more than half the program, according to a report released today by the Government Accountability Office. In a separate report, the inspector general for the U.S. Health and Human Services department said the agency hadn't audited about $4 billion in payments to doctors and hospitals for installations of electronic record systems.
In the wake of President Obama's reelection and a favorable Supreme Court ruling, a growing sense of certainty about healthcare reform is helping to drive the health information exchange market, according to a new report from Frost & Sullivan. In addition, the report notes, the stage 2 Meaningful Use requirements and market changes are increasing demand for HIEs. Entitled "U.S. Health Information Exchange Market: A Comprehensive Guide to Market Dynamics, Technology Vendors and Future Trends," the research and consulting firm's report predicts that healthcare providers "will significantly ratchet up their participation in HIE over the next 18 to 24 months."
A project at seven big hospitals reduced infections after colorectal surgeries by nearly one-third. It prevented an estimated 135 infections, saving almost $4 million, the Joint Commission hospital regulating group and the American College of Surgeons announced Wednesday. The two groups directed the 2 1/2-year project. The average rate of infections linked with colorectal operations at the seven hospitals dropped from about 16% of patients during a 10-month phase when hospitals started adopting changes to almost 11% once all the changes had been made. Hospital stays for patients who got infections dropped from an average of 15 days to 13 days, which helped cut costs.
Governors will eventually succumb to pressure to expand their Medicaid programs, a pair of healthcare experts predicted Thursday, arguing that the prospect of medical practices going out of business will force their hands. "The governor gets to decide whether these providers are going to go out of business," Dan Mendelson, president of Avalere Health, said. Gail Wilensky, who headed Medicaid for President George H.W. Bush, predicted that states resisting Medicaid expansion would reverse themselves within a few years—if only because the federal government plans to cover 100 percent of the costs for the first few years and 90 percent thereafter.
The Centers for Medicare and Medicaid Services will have to manage and analyze double the volume of Medicare data and triple the terabytes of Medicaid data after health reform is fully in place. By 2015, the waves of Medicare claims data will explode from 370 terabytes to 700 terabytes. For Medicaid, 30 terabytes of data will multiply to 100 terabytes, according to a CMS official. CMS has been upended by health reform just as providers have, and the agency is transforming how it operates and communicates with physicians and hospitals to be ready for the roll out of the health reform law in 2014.
The Centers for Medicare and Medicaid Services (CMS) has provided a list of questions for providers to ask clearinghouses and billing services about their preparedness for the Oct. 1, 2014 ICD-10 compliance date. CMS suggests that providers investigate using a clearinghouse or billing service to aid the the ICD-10 transition if one is not already in use.