Med­i­caid on the main stage

Stud­ies fail to ad­dress long-term vi­a­bil­ity: NAPH

Modern Healthcare - - Front Page - Jessica Zig­mond

Two new Med­i­caid stud­ies ex­am­ined spend­ing vari­a­tions across states and the ben­e­fits of cov­er­age as state and fed­eral lawmakers eval­u­ate ways to re­duce spend­ing in the pro­gram. But nei­ther study ad­dressed whether Med­i­caid pay­ments to providers are suf­fi­cient to keep them op­er­at­ing and meet­ing the needs of ben­e­fi­cia­ries.

That was the mes­sage last week from the Na­tional As­so­ci­a­tion of Pub­lic Hos­pi­tals and Health Sys­tems, which rep­re­sents the nation’s safety net hos­pi­tals—where half of all care is pro­vided to Med­i­caid and unin­sured pa­tients and for which Med­i­caid ac­counts for 35% of to­tal net rev­enue.

A study pub­lished in the July is­sue of Health Af­fairs found sig­nif­i­cant vari­a­tion in the vol­ume of ser­vices and prices for Med­i­caid spend­ing across states. Un­der­stand­ing those dif­fer­ences, the study au­thors noted, could help im­prove the qual­ity and ef­fi­ciency of care.

An­a­lysts stud­ied Med­i­caid cash as­sis- tance data from 2001 to 2005 for in­pa­tient hos­pi­tal ser­vices, out­pa­tient ser­vices and pre­scrip­tion drugs. They also con­cluded that the sup­ply of pri­mary-care physi­cians in cer­tain ar­eas was associated with re­duced rates of ad­mis­sion for di­a­betes, lung disease and adult asthma—sug­gest­ing that in­creased ac­cess to pri­mary care could im­prove the man­age­ment of chronic disease for Med­i­caid ben­e­fi­cia­ries.

Xiaoyi Huang, as­sis­tant vice pres­i­dent for pol­icy at NAPH, said the as­so­ci­a­tion agrees with the Health Af­fairs study’s con­clu­sion that bet­ter ac­cess to pri­mary-care ser­vices re­sults in less fre­quent hos­pi­tal vis­its.

The study au­thors found that the av­er­age num­ber of out­pa­tient vis­its and the price per visit were associated with re­duced ad­mis­sions, sug­gest­ing that bet­ter ac­cess to pri­mary care may re­sult in re­duced ad­mis­sions. They noted that pro­vi­sions of the Pa­tient Pro­tec­tion and Affordable Care Act that fo­cus on pri­mary care—such as those aimed at in­creas­ing the size of the pri­mary-care work­force, ex­pand­ing cov­er­age for preven­tive ser­vices and tem­po­rar­ily in­creas­ing physi­cian pay­ment rates un­der Med­i­caid—may re­sult in fewer hos­pi­tal­iza­tions.

Pri­mary-care ac­cess was also high­lighted in a sec­ond Med­i­caid-re­lated study last week. The Na­tional Bu­reau of Eco­nomic Re­search re­leased a re­port that showed Med­i­caid en­roll­ment could lead to bet­ter self-re­ported phys­i­cal and men­tal health and lower med­i­cal debt. In 2008, the state of Ore­gon opened a

A doc­tor speaks to a Med­i­caid pa­tient in Atlanta. Ge­or­gia, like many other states, strug­gles to cut spend­ing.

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