HHS: Obamacare coverage is reducing hospitals’ unpaid bills

http://www.washingtonpost.com/blogs/wonkblog/wp/2014/09/24/hhs-coverage-expansion-is-reducing-hospitals-unpaid-bills/

The Obama administration is projecting that hospitals will face $5.7 billion less in uncompensated care costs than they otherwise would have in the first full year of the Affordable Care Act's coverage expansion.

Millions more people with health insurance means fewer uninsured patients are coming through hospitals' doors. That means fewer costs from bad debt or charity care from people unable to pay their bills, which amounted to about $50 billion for the nation's hospitals in 2012.

Five years ago, when advocates were still trying to build support for the bill that became the ACA, they saw the potential for reducing the costs of uncompensated care as a big selling point. That's because those costs were already getting passed along to the tabs of people who could pay. This "hidden tax" amounted to about $1,000 for family coverage, according to a 2009 analysis from Families USA.

"When there's uncompensated care, it gets fed back into premiums," Council of Economic Advisers chairman Jason Furman said Wednesday in a briefing with reporters. However, officials said they didn't specifically calculate how the lower costs from uncompensated care would show up in the premiums people pay for coverage.

The reduction in uncompensated care is much greater in states that expanded their Medicaid programs under the Affordable Care Act, according to the new report. About three-quarters of the reduction in uncompensated care, or $4.2 billion, will be seen in about half the states that expanded their Medicaid programs under the federal health care law.

The new uncompensated care figure is based on a previous Department of Health and Human Services projection that an additional 10.3 million people gained insurance in 2014 — though, as previously explained, it could be another year before we have the most reliable numbers. For the new report, HHS also reviewed publicly reported data from the five largest for-profit hospital groups and surveys from major hospital associations.

As the following chart shows, the major hospital systems and associations reported major reductions in uninsured admissions when comparing the first quarters of 2013 and 2014. The drop was more pronounced in states with expanded Medicaid programs.



Meanwhile, the administration said the Medicaid expansion seems to be driving an increase in hospital volume. Hospitals in expansion states saw the volume of Medicaid patients increase between 4 percent and 31 percent between the first quarters of 2013 and 2014, but HHS said it didn't find evidence of an increase in non-expansion states.



The administration also cites some evidence that these trends are playing out in rural hospitals, which have especially struggled to keep their doors open in recent years. Financial pressures, including some introduced by reimbursement reforms under the ACA, have forced two dozen rural hospitals to close since January 2013, according to a Reuters report earlier this month.

HHS Secretary Sylvia Mathews Burwell said the survival of rural hospitals is an issue she is "acutely focused on."

"I'm from rural America, so it's a question that I will consistently ask," she said.

Uncompensated care levels are especially important as the administration looks to ratchet down special payments to hospitals that serve a high proportion of uninsured patients. The cuts are required by the ACA, but the administration says it needs more detailed data about how the reduction in uninsured is playing out at local hospitals around the country.

PROJECTED.............

fuzzy wishful thinking. No actual data.

fuzzy thinking just like the fuzzy wishful thinking they had when they rolled out obamacare so perfectly LOL

fuzzy wishful thinking. No actual data.


No.....fuzzy wishful criticism. Please point out where the projections are incorrect.....be precise and do not be fuzzy.

some rural hospitals may see a increase because thier competiter probaly went out of bussiness.

and medicaid doesnt pay cost

theres so much more to this than you understand.

all this data sent out as propaganda is not what is going on in the system

there is no real way to know the true in your face results that YOU will be able to notice till after 2017. because the ins co bailouts, the other mandates etc etc etc.

i mean they just dumped 100s of thousands of people from the rolls

its effecting jobs, salaries and CARE

you dont know it yet, and you wont until you get on the wrong side of a over worked, under paid or under trained healthcare employee.

but i know, you fucked millions of people for a few. your happy

You win.

You fucked the country and our healthcare system over.

More people have been signed up for Medicaid. Medicaid reimbursement is extremely low and extremely slow in paying. That hurts health care .

More people have been signed up for Medicaid. Medicaid reimbursement is extremely low and extremely slow in paying. That hurts health care .


I disagree. I would rather get a slow low payment, than no payment at all. I am friends with the CEO of a regional hospital group, and he would be the first to agree on the slow paying part and low pay, but he is getting more payments with more people being covered. This is not rocket science as Chrissy is attempting to make this more complicated than it is.......people with insurance coverage is better than trying to collect from judgment proof folks......simple common sense. A fool's errand is trying to argue that folks without health insurance is good for hospitals.....not even close to true in the real world where folks deal with bottom lines.

2seaoat wrote:More people have been signed up for Medicaid. Medicaid reimbursement is extremely low and extremely slow in paying. That hurts health care .


I disagree.  I would rather get a slow low payment, than no payment at all.  I am friends with the CEO of a regional hospital group, and he would be the first to agree on the slow paying part and low pay, but he is getting more payments with more people being covered.   This is not rocket science as Chrissy is attempting to make this more complicated than it is.......people with insurance coverage is better than trying to collect from judgment proof folks......simple common sense.   A fool's errand is trying to argue that folks without health insurance is good for hospitals.....not even close to true in the real world where folks deal with bottom lines.

BS

You cant even begin to understand the new restraints on trying to collect a payment in this environment. And even if they collect a payment, Medicaid is not sustainable income for a hospital at any reasonable level. This is why Medicaid usually attracts the very few poor quality doctors.

I am in the real world. I deal with bottom line every day.

You are in unicorn wealthy man world. That is not the real world.

I am in the real world. I deal with bottom line every day.

Now you are not telling the truth. You are arguing that a person coming into your system without insurance is better than one coming into your system with insurance. That is either a lie, or a fool pretending they know what they are talking about. How do you collect 200k from a person who is forced to file bankruptcy versus a person who has the insurance company pay the 200k six months late.......again.....a fools errand.

Joanimaroni wrote:More people have been  signed up for Medicaid. Medicaid reimbursement  is extremely low and extremely slow in paying. That hurts health care .

I don't know what sort of math they taught back in the day when you were studying, though things may have changed since then. In today's math, "extremely low" is larger than "zero", and "extremely slow" is faster than "never".

Make sense?

2seaoat wrote:I am in the real world. I deal with bottom line every day.

Now you are not telling the truth.  You are arguing that a person coming into your system without insurance is better than one coming into your system with insurance.   That is either a lie, or a fool pretending they know what they are talking about.  How do you collect 200k from a person who is forced to file bankruptcy versus a person who has the insurance company pay the 200k six months late.......again.....a fools errand.

You should know by now she doesn't know what the hell she is talking about. Never has.

boards of FL wrote:

Joanimaroni wrote:More people have been  signed up for Medicaid. Medicaid reimbursement  is extremely low and extremely slow in paying. That hurts health care .

I don't know what sort of math they taught back in the day when you were studying, though things may have changed since then.  In today's math, "extremely low" is larger than "zero", and "extremely slow" is faster than "never".  

Make sense?

Dammit,.you learned me something. Who'd a thunk it.

Medicaid reimbursement, many times does not even cover expenses. Physicians that have a large medicaid practice....eventually stop taking medicaid patients.

Joanimaroni wrote:

boards of FL wrote:

Joanimaroni wrote:More people have been  signed up for Medicaid. Medicaid reimbursement  is extremely low and extremely slow in paying. That hurts health care .

I don't know what sort of math they taught back in the day when you were studying, though things may have changed since then.  In today's math, "extremely low" is larger than "zero", and "extremely slow" is faster than "never".  

Make sense?

Dammit,.you learned me something. Who'd a thunk it.

Medicaid reimbursement, many times does not even cover expenses.  Physicians that have a large medicaid practice....eventually stop taking medicaid patients.

Here again, a reimbursement that does not cover expenses is greater than a reimbursement of zero.

Medicaid reimbursement > No reimbursement

boards of FL wrote:

Joanimaroni wrote:

boards of FL wrote:

Joanimaroni wrote:More people have been  signed up for Medicaid. Medicaid reimbursement  is extremely low and extremely slow in paying. That hurts health care .

I don't know what sort of math they taught back in the day when you were studying, though things may have changed since then.  In today's math, "extremely low" is larger than "zero", and "extremely slow" is faster than "never".  

Make sense?

Dammit,.you learned me something. Who'd a thunk it.

Medicaid reimbursement, many times does not even cover expenses.  Physicians that have a large medicaid practice....eventually stop taking medicaid patients.

Here again, a reimbursement that does not cover expenses is greater than a reimbursement of zero.  

Medicaid reimbursement >  No reimbursement

I take it you have never been self employeed and you never ran a successful buisness either.

The resistance to the fact that the ACA is helping Americans and our healthcare system is getting desperate.......next thing you know they will blame Ebola on President Obama and the ACA.

Joanimaroni wrote:

boards of FL wrote:

Joanimaroni wrote:

boards of FL wrote:

Joanimaroni wrote:More people have been  signed up for Medicaid. Medicaid reimbursement  is extremely low and extremely slow in paying. That hurts health care .

I don't know what sort of math they taught back in the day when you were studying, though things may have changed since then.  In today's math, "extremely low" is larger than "zero", and "extremely slow" is faster than "never".  

Make sense?

Dammit,.you learned me something. Who'd a thunk it.

Medicaid reimbursement, many times does not even cover expenses.  Physicians that have a large medicaid practice....eventually stop taking medicaid patients.

Here again, a reimbursement that does not cover expenses is greater than a reimbursement of zero.  

Medicaid reimbursement >  No reimbursement

I take it you have never been self employeed and you never ran a successful buisness either.

I take it you have never been employed in any capacity that requires a very basic understanding of math.  If you had, this exchange would have been over after my first post.

The fundamental principles of basic mathematics are not influenced by whether or not I have ever ran a business or have been self employed.

Let's say I currently own and operate my own business:

Medicaid reimbursement > Zero reimbursement

Let's say I have never owned or operated my own business:

Medicaid reimbursement > Zero reimbursement

See how that works?  This may come as an earth shattering revelation, but mathematical principles exist independently of my status of having owned or operated a business.

All that said.  I feel this has been a healthy exchange.  I'm going to include it in my upcoming book "Communicating Painfully Straightforward Analysis to GOP Supporters:  An Exercise in Futility or an Ultimate Test of Patience?"

boards of FL wrote:

Joanimaroni wrote:

boards of FL wrote:

Joanimaroni wrote:

boards of FL wrote:

Joanimaroni wrote:More people have been  signed up for Medicaid. Medicaid reimbursement  is extremely low and extremely slow in paying. That hurts health care .

I don't know what sort of math they taught back in the day when you were studying, though things may have changed since then.  In today's math, "extremely low" is larger than "zero", and "extremely slow" is faster than "never".  

Make sense?

Dammit,.you learned me something. Who'd a thunk it.

Medicaid reimbursement, many times does not even cover expenses.  Physicians that have a large medicaid practice....eventually stop taking medicaid patients.

Here again, a reimbursement that does not cover expenses is greater than a reimbursement of zero.  

Medicaid reimbursement >  No reimbursement

I take it you have never been self employeed and you never ran a successful buisness either.

I take it you have never been employed in any capacity that requires a very basic understanding of math.  If you had, this exchange would have been over after my first post.

The fundamental principles of basic mathematics are not influenced by whether or not I have ever ran a business or have been self employed.

Let's say I currently own and operate my own business:

Medicaid reimbursement > Zero reimbursement

Let's say I have never owned or operated my own business:

Medicaid reimbursement > Zero reimbursement

See how that works?  This may come as an earth shattering revelation, but mathematical principles exist independently of my status of having owned or operated a business.

All that said.  I feel this has been a healthy exchange.  I'm going to include it in my upcoming book "Communicating Painfully Straightforward Analysis to GOP Supporters:  An Exercise in Futility or an Ultimate Test of Patience?"

So, I take it that is a no.

If a service is performed at a loss... it is better not to perform the service. See basic business comprehension.

Th Dude wrote:If a service is performed at a loss... it is better not to perform the service. See basic business comprehension.

Boards does not understand that concept. Accounts receivable has to be significantly higher than accounts payable to make a profit that will afford a living.

It would've been smarter to just socialize the govt programs fully... labs, clinics, hospitals... etc.

The savings in the private market would be substantial... as it is now the private market supports the govt programs.

Results matter.

Th Dude wrote:If a service is performed at a loss... it is better not to perform the service. See basic business comprehension.

Correct. But since we're talking about healthcare, and since anyone can walk into an ER and get treated with or without health insurance (hence, many healthcare providers do not have the choice to not perform service), the above comment is irrelevant. See reality.

It's really amazing that you can't sort all of this out in your mind before waddling to the computer and posting the above comment.

Joanimaroni wrote:So, I take it that is a no.

I take it you've never gone canoeing on a Wednesday while wearing a Cleveland Browns throwback jersey.

Yep. Just as I thought.

I know you hate to hear this......but everything can not be summed up in one of your mathmatical equations. I'll kayak in the bay but no canoeing on a river. I am afraid of snakes and the Browns are not my favorite team.


http://healthpolicy.wustl.edu/Content/HealthCareAccess.html?


OpenDocument Overview
Washington University
Organization
Director and Staff
Events
Events






Health Care Access for Medicaid Patients – Physicians and Dentists Interview Study

i. executive summary




When physicians and dentists were asked what the greatest business challenges in accepting and treating Medicaid patients are, they responded:
§ Low/slow reimbursements
§ Excessive paperwork/authorization problems
§ Abuse of system/lawsuits

When physicians and dentists were asked what the greatest medical challenges in accepting and treating Medicaid patients are, they responded:
§ Sicker/needier patients
§ Non-compliant/undependable patients
§ Difficulty in making referrals
§ Treatment not covered
§ Patients’ bad attitudes

According to physicians/dentists interviewed, treating Medicaid patients takes more time and resources. They are sicker/needier than other patients and tend not to comply with instructions/prescriptions due to lack of education and other personal/health issues.

Although Medicaid patients are generally a more difficult, time-consuming and expensive population to work with, according to responding physician/dentists, most doctors indicated they would be willing to take/take more Medicaid patients if reimbursements were on the same par as Medicare or other insurance programs.

Dentists were less likely to accept Medicaid patients than physicians, and spoke of low reimbursements and treatments not covered as reasons why. One dentist noted the difficulty, or impossibility, in finding specialist dentists to perform procedures such as wisdom teeth removal or root canals for Medicaid patients.
Executive Summary

Beyond the solution of increasing reimbursements, physicians/dentists offered several suggestions to “fix” Medicaid:
§ Institute a patient co-pay
§ Provide protection from lawsuits
§ Speed up the payment of reimbursements
§ Penalize no-shows
§ Allow necessary treatments
§ Allow paper claims
§ Change punitive system
§ Institute better screening.


Physicians and dentists from the five Missouri regions who were interviewed for this study gave consistent responses, and no notable differences were found.






Low/Slow Reimbursement
“I can’t stay in business with what they currently pay.” (St. Louis County/family general practice/Takes Medicaid)
“I can’t afford to keep it up. I’m losing money financially.” (Bootheel/ dentist/Takes Medicaid)

“Sometimes they will overwhelm your practice and I can’t make a living accepting many. They don’t show up for appointments or value your services.” (Springfield/dentist/Takes Medicaid)

“The reimbursement is low and the whole program is a big hassle.” (St. Louis County/psychiatrist/Does Not Take Medicaid)

“It’s financial. My office manager has said keep it less than ten percent or I’ll go bankrupt.” (Cape Girardeau/pediatrician/Takes Few Medicaid)

Non-Compliant/Undependable Patients
“Because they are no-shows.” (St. Louis City/neurologist/Takes Few Medicaid)
“The aggravation factor. Compliance is an issue. These patients won’t change their lifestyle. The don’t show up for appointments and some have poor hygiene. You have to air the room when they leave.” (Springfield/family general practice/Takes Few Medicaid)

Sicker/Needier Patients
“It’s harder to deal with Medicaid patients. I am compensated less, and I had to call the police once with a troubled patient.” (Cape Girardeau/allergist/Takes Medicaid)
“Usually they are the most needy, and we work harder because of major medical problems, like a disabled child. Their expectations are too unreal medically, and they object if I prescribe a medication allowed by Medicaid and not one of their choice. They make appointments more often than necessary, and many like to hang around and talk to my staff about their problems.” (Cape Girardeau/pediatrician/Takes Few Medicaid)

Yea, but

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HHS also PROJECTED a great roll out. How did that go?

Are you now reduced to bragging about PROJECTIONS?

You do know what a PROJECTION is don't you?

Its not fact until it happens you see. And it hasn't happened yet. There is no data or proof.

Matter of a fact the white house is so protective over all of the data in relation to obamacare... I wonder why?

And if its such a great damn hing, you would think every dem in the country would be running on how great obamacare has been. BUT THEY ARE NOT.

they are running from Obama and obamacare as far as they can get. EVEN IN CALI LOL

If you all can't find the brainpower to wrap your heads around the idea that uncompensated care generates a lower level of compensation than medicaid...well...I think you know how this sentence ends.