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  • Tom Boyd

Patients postpone care…

Today’s Datapoint

AIS’s Health Business Daily, February 15, 2011

More than $300 million…was paid to whistleblowers involved in 2010’s federal health care fraud enforcement efforts, which yielded more than $4 billion in recoveries, according to an annual report released by HHS and DOJ.


CDC reports on nation’s health

AHA News Now, February 16, 2011

The percentage of non-elderly adults who reported delaying or forgoing medical care due to cost increased from 9% in 1999 to 15% in 2009, according to the latest annual report from the Centers for Disease Control and Prevention on the state of the nation’s health.  The rate was highest among the uninsured and lowest among those with private coverage.  In 2009, 37% of uninsured adults reported delaying or forgoing care due to cost, compared with 14% of those with Medicaid and 9% of privately insured adults.  The report compiles health data from state and federal health agencies and includes a feature section on “death and dying.”  According to the report, one-quarter of U.S. deaths in 2007 occurred at home, up from 16% in 1989.  To view the report, “Health, United States, 2010,” visit


New Analysis Examines Which Types of Medicare Advantage Plans Will Receive Quality-Based Payments in 2010 (excerpt)

Kaiser Family Foundation, February 17, 2011

Beginning next year, Medicare Advantage plans will be awarded additional payments based on their quality ratings as a result of the 2010 health reform law.  The Centers for Medicare and Medicaid Services has proposed a demonstration that would modify the quality-based payments for plans, providing additional payments for 2012 to 2014.

Quality Ratings of Medicare Advantage Plans, 2011 is now available online.


Homecare Insider Q

February 17, 2011

Q:  Is there a requirement that states that hospital discharge planners must offer a choice of home health agencies to patients who opt for those services?

A:  There is a requirement that addresses this and all patients have the right to choose their healthcare providers.  Federal regulations require hospitals to develop a list of home health agencies that:  ask to be on the list, are Medicare certified, and provide services in the area where the patient lives.  They are then required to present the list to patients who are to receive services.  If a hospital has a financial interest in a homecare agency and that agency is included on the list, the financial interest must be disclosed.  The Centers for Medicare and Medicaid Services offers guidance regarding non-discrimination in post-hospital referral to home health agencies by requiring that hospital discharge planning may not limit qualified providers of home health services, must include the availability of home health services in the area, must disclose financial relationships with home health service entities, and has advised agencies to contact their regional office to report suspected violations of these requirements.  It is important to remember that your agency must request to be on the list of home health agencies.  View article on the web.


Healthcare Finance News, January 11, 2011

The Camden Group names top 10 healthcare trends in 2011 (excerpt)

  1. Insurance membership will take a hit from slow recovery.  Few unemployed will take advantage of COBRA while employees, faced with paying more of their health plan premium, will select high-deductible, low premium…

  2. No easing on payment pressure. …

  3. Patients will postpone care, hurting providers.  With high unemployment and underemployment and increased out-of-pocket costs, people will continue to put off treatment…

  4. Cost is king.  Soft volume, downward pressure on revenues and a deteriorating payer mix with increased bad debt will drive providers to seek more cost savings.  However, unions, staffing ratios and regulations will make those cuts difficult. …

  5. Capital remains elusive. … Lenders are requiring an increase in days cash-on-hand, coverage ratio, stronger EBITDA and smaller borrowings. …

  6. Physicians will make or break new care models.  To improve outcomes and lower costs, hospitals and medical groups will focus on accountable care, bundled payments, patient-centered medical homes and/or clinical integration.  Reducing variations in care – primarily by physicians – will be central to any successful strategy. …

  7. Construction focus is on fast returns. …

  8. IT becomes more pervasive – or else.  Information technology underpins providers’ ability to shift to new care models, so IT moves to center stage with efforts to implement electronic medical records, computerized physician order entry and health information exchanges…

  9. Let’s make a deal.  Mergers and acquisitions will be brisk…

  10. Market share, market share, market share.  … more volume will generate incremental revenue and decrease per unit cost. …

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