Florida lawmakers this year directed the state Agency for Health Care Administration to develop the plan, which is designed to more accurately tailor Medicaid payments to the treatment each patient receives. It will replace a complex system that involves calculating per-diem rates for inpatient care—a system that Gov. Rick Scott and other critics say has led to wide differences in how much hospitals get paid. The plan is required to be submitted to Scott and legislative leaders by Jan. 1 and is scheduled to take effect July 1, 2013. The changes have high stakes for hospitals, as some likely will wind up getting paid more under the new system and others will get paid less.
Interfaith Medical Center serves a largely Caribbean-American and poor population in Bedford-Stuyvesant and north-central Brooklyn. Interfaith's chief executive, Luis Hernandez, said this week that while the hospital was making payroll and paying vendors, it had only 18 days to 20 days of cash on hand and it had not been able to pay interest on its state-backed mortgage since November. The chairman of Interfaith's board of trustees, Nathan M. Barotz, blamed Wyckoff Heights Medical Center, in Bushwick, for Interfaith's plight; he accused Wyckoff's administration of dragging its heels on a plan to shore up operations by combining the operations of Interfaith, Wyckoff and Brooklyn Hospital Center, in Fort Greene.
Hospitals, already adjusting to $1.6 billion in cost-cutting changes to Illinois' Medicaid system, are fighting what they call an extreme new emergency rule. Under the new rule, if a Medicaid patient incurs an infection or other hospital-acquired condition during the course of a hospital stay, say, for appendicitis, the state will not pay for treating the infection or the appendicitis. The new rule goes far beyond federal regulations, industry standards, and legislators' intent when they passed Illinois' Medicaid reform laws in May, hospital officials say.
Four years ago, a group called the Ohio Perinatal Quality Collaborative brought together 20 hospitals across the state to try and address the issue of scheduling deliveries early when there is no medical need. All the hospitals were asked to collect information on scheduled births and to submit it to a common database, so the hospitals could compare their performance to the others. During the first four months of the study, for instance, there were 145 more unnecessary deliveries scheduled than during the last four months of the study. This translated to a steady drop in these births from about seven percent of all deliveries at the beginning of the study to about three percent at the end.
Nearly 2 million Californians will receive $73.9 million in rebates from health insurers as part of the federal healthcare law, according to state officials. Insurers notified government regulators in June of how much they owed customers in rebates or premium credits because they didn't spend at least 80% or more of 2011 premiums on medical care. The minimum threshold is 85% for employers with more than 51 workers. Figures released Tuesday mark the final tally for California; insurers must issue refunds by Wednesday. Many employers and consumers have already received letters informing them of their rebate amount. The average rebate is $65 per family, according to the state insurance department.
Spending on a disease like cancer tends to follow a particular pattern. There are high initial costs as the cancer is treated, and then, if all goes well, these costs taper off. For a patient with a fatal version of the disease, though, the cost curve is U-shaped, rising again toward the end—to an average of sixty-three thousand dollars during the last six months of life with an incurable breast cancer. Our medical system is excellent at trying to stave off death with eight-thousand-dollar-a-month chemotherapy, three-thousand-dollar-a-day intensive care, five-thousand-dollar-an-hour surgery. But, ultimately, death comes, and no one is good at knowing when to stop.