Warm Southern Breeze

"… there is no such thing as nothing."

Posts Tagged ‘CMS’

UPDATED: If #ALpolitics Would #ExpandMedicaidNow, They Could CUT Medicaid Co$t$ More Than 50%

Posted by Warm Southern Breeze on Thursday, August 6, 2015

UPDATE: Tuesday, 11 August 2015

In my first & earlier calculations, I inadvertently overlooked multiplying the Annual Medicaid Spending in Alabama figure (which is a TOTAL of $5,241,269,869) by 70%, which would represent the portion paid for by the Federal government. Alabama’s 30% share of that figure (the share paid for by the state) would be $1,572,380,960.70. It would also be reasonable to expect that Expanding Medicaid in Alabama to 138% of the Federal Poverty Level would increase total economic activity (through Medicaid spending) in the state at least 38%. So to Expand Medicaid, the baseline figure for TOTAL Medicaid spending (combined Federal and State funds) would approximate $7,232,952,419. According to the provisions of the law, Alabama’s sharing portion (if Governor Bentley chose to Expand Medicaid) would still be 2016-100%; 2017-5%; 2018-6%; 2019-7%; 2020 and beyond-10%. The corrections to the figures herein are dollar amounts only (based on the $7,232,952,419 total expanded figure), not the %ages. Data & figures are now also shown in table format.

Folks, it may (or may not) surprise you to know a sampling of the collective thoughts of our wrong-wing friends, and relatives on matters political in Alabama, especially as they pertain to Medicaid.

Here’s a verbatim excerpted sampling of what I came across today.

• No one want increased entitlements. Too much waste and abuse. get a job folks. no to medicaid
• Medicaid is a lifestyle
• scare tactic. nursing homes overcharge. working people of Alabama are tired of taking care of lazy people
• ask any hospital administrator or physician in private practice. Medicaid devalues services. Reject medicaid

I dare say, MOST are clueless about the genuinely tangible economic and public health benefits Medicaid provides to this state, and the revenue and jobs it creates. All they hear are the wails and moans of representatives and/or senators – mostly of whom, if not exclusively, are Republican.

Where does Alabama's Medicaid money come from? Where does it go?

Where does Alabama’s Medicaid money come from?
Where does it go?
Source: Alabama Medicaid Agency Annual Report – FY 2012

Medicaid is a Federal/State matching/sharing program which provides (pays for) healthcare services for the impoverished wherein states pay a minority matching portion, while the Federal Government through CMS (Centers for Medicare and Medicaid Services) pays the majority portion. Within reasonable guidelines, the states have broad discretion and liberty to operate Medicaid according to the way they see fit, and the needs of the residents they serve. There are, however, certain minimums standards to which every state must adhere.

Under the provisions of the OLD law, the states that do NOT Expand Medicaid pay a higher %age rate for their services than they would if they were to Expand Medicaid to provide services to those whom are at 138% of the Federal Poverty guidelines – which is what the PPACA provides. The PPACA is the Patient Protection and Affordable Care Act- though it’s more often called the ACA “Affordable Care Act,” and colloquially referred to as “ObamaCare.”

Under the provisions of the PPACA, states that choose to Expand Medicaid will have 100% of those costs paid-for by the CMS beginning 2014, until 2016. The incentive for expansion is based upon Read the rest of this entry »

Posted in - Did they REALLY say that?, - My Hometown is the sweetest place I know, - Politics... that "dirty" little "game" that first begins in the home. | Tagged: , , , , , , , , , , , , , , , , , , , , | 2 Comments »

Alabama Medicaid Incompetency: State must repay Federal Childrens Health Insurance Program $88,197,498

Posted by Warm Southern Breeze on Friday, December 20, 2013

Did you know? (No, you probably didn’t.)

In a report dated August 2013, the Department of Health and Human Services Office of Inspector General (HHS OIG) conducted a criminal and administrative investigation and found that Alabama claimed, and was paid millions in unallowable performance bonus payments under the Children’s Health Insurance Program Reauthorization Act (CHIRPA).

This FRAUD was because of INCOMPETENCY in Alabama governance.

The HHS OIG found that the Alabama state agency overstated its FYs 2009 and 2010 current enrollment in its requests for bonus payments. The State agency overstated its current enrollments because, rather than Read the rest of this entry »

Posted in - Business... None of yours, - My Hometown is the sweetest place I know, - Read 'em and weep: The Daily News | Tagged: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | 2 Comments »

What happens when physician pay is tied to efficiency & quality?

Posted by Warm Southern Breeze on Monday, April 16, 2012

What would it be like if you were paid for your success?

What would it be like if you were rewarded for high efficiency?

Is it possible that successful patient outcomes could be correlated to compensation?

How would one measure non-compliant patients, or those with poor prognoses?

Medicare moves to tie doctors’ pay to quality and cost of care

By Jordan Rau, jrau@kff.org Published: April 14

CMS plans to base the 2015 bonuses or penalties on what happens to a doctor's patients during 2013.

Twenty-thousand physicians in four Midwest states received a glimpse into their financial future last month. Landing in their e-mail inboxes were links to reports from Medicare showing the amount their patients cost on average as well as the quality of the care they provided. The reports also showed how Medicare spending on each doctor’s patients compared with their peers in Kansas, Iowa, Missouri and Nebraska.

The “resource use” reports, which Medicare plans to eventually provide to doctors nationwide, are one of the most visible phases of the government’s effort to figure out how to enact a complex, delicate and little-noticed provision of the 2010 health-care law: paying more to doctors who provide quality care at lower cost to Medicare, and reducing payments to physicians who run up Medicare’s costs without better results.

Making providers routinely pay attention to cost and quality is widely viewed as crucial if the country is going to rein in its health-care spending, which amounts to more than $2.5 trillion a year. It’s also key to keeping Medicare solvent. Efforts have begun to change the way Medicare pays hospitals, doctors and other providers who agree to work together in new alliances known as “accountable care organizations.” This fall, the federal health program for 47 million seniors and disabled people also is adjusting hospital payments based on quality of care, and it plans to take cost into account as early as next year.

But applying these same precepts to doctors is Read the rest of this entry »

Posted in - Did they REALLY say that?, - Read 'em and weep: The Daily News | Tagged: , , , , , , , , , , , , , , , , , | Leave a Comment »

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