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MEDICARE: CMS fast facts provides US national statistics

This is a nice two-page summary of current statistics related to the Medicare and Medicaid programs. It provides official federal government counts of people and money – the number of beneficiaries and persons served and a recap of national health expenditures.  But WAIT!  There’s more!  I am excited to let you know of a count of the total number of providers by type in the U.S.  How many total hospitals?  How many hospitals of different types?  How many skilled nursing facilities?  Ambulatory surgery centers?  Labs?  And other types of providers.  These are useful totals for business planners who are sizing the market for a new product, for example.


U.S. Centers for Medicare & Medicaid Services. (2016, July 7). Fast Facts.  Click here for free full text: https://www.cms.gov/fastfacts/

For more indepth information: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/CMS-Fast-Facts/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org


HIP REPLACEMENT: You might have to go to school first

Total joint replacement procedures – hips and knees – are commonly performed on Medicare patients, costing an estimated $7 billion annually for the hospital care alone.  The Centers for Medicare & Medicaid Services (CMS) has developed a bundled payment pilot initiative with mandatory participation for 67 selected health care markets nationwide.  One cost-reduction approach that is being tried by several providers is the idea of having elective hip and knee patients go to an “academy,” or otherwise receive patient education, before surgery to remove or lessen risk factors that might complicate their recovery.  Among the hospitals and health systems trying this out are: DCH Regional Health System (Tuscaloosa, Ala.), Catholic Health Initiatives (Englewood, Colo.), and BayCare Health (Clearwater, Fla.).

For more information about the CMS initiative, click here: https://innovation.cms.gov/initiatives/cjr

Source: Evans, M. (2016, Mar. 28). Ready or not, the bundled-payment challenge is about to start. Modern Healthcare, 46(13), 8-9.  Click here for publisher’s website: http://www.modernhealthcare.com/article/20160326/MAGAZINE/303269996  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

FORECASTING: Hospital payer mix 2014 and 2024, U.S.

What are the projections for U.S. hospitals’ Medicare margins over the next 10 years?  This brief article by a staff specialist at the Healthcare Financial Management Association takes a look at data from the Congressional Budget Office and the Medicare Payment Advisory Commission to address this issue.  I especially like the inclusion of payer mix statistics for the two endpoint years.  Here they are:


  • 37.8 percent  Commercial
  • 35.1 percent Medicare
  • 18.2 percent Medicaid
  •   5.8 percent Other governmental
  •   3.1 percent Self-pay


  • 40.0 percent Medicare
  • 33.0 percent Commercial
  • 18.4 percent Medicaid
  •   5.7 percent Other governmental
  •   2.9 percent Self-pay

Source: Mulvany, C. (2016, Apr.). Margins under pressure. HFM. Healthcare Financial Management, 70(4), 30-33. Click here: https://www.hfma.org/Content.aspx?id=47230 Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Payment and Delivery System Reform in Medicare: a Primer on Medical Homes, Accountable Care Organizations, and Bundled Payments

In response to the Affordable Care Act, Medicare has been testing new payment models to improve patient care and control costs. A recent Kaiser Health Foundation report is a primer on three of these models — medical homes, accountable care organizations, and bundled payments:

  • Medical homes are team-based care models focused on primary care practices for delivery and coordination of patient care. The payment model typically provides a monthly management fee or other payment in addition to fee-for-service reimbursement.
  • ACOs are groups of physicians, hospitals, and other providers that collectively share accountability for the quality and cost of care delivered to patients in an ACO. Financial incentives involve shared savings or losses for ACO performance based on meeting quality and cost benchmarks.
  • Bundled payments focus on setting an episode of care budget for a particular clinical condition over a defined time period rather than paying separately for each delivered service. By better managing and coordinating care, providers can come in ‘under budget’.

Each payment model is discussed, including its goals, financial incentives, number of participants, potential implications for beneficiaries, and early results on quality and savings. Preliminary results from these models have been mixed and are summarized in the report.

Source: Basement S. and others. Payment and delivery system reform in Medicare: a primer on medical homes, accountable care organizations, and bundled payments. Kaiser Family Foundation, Feb. 2016. https://kaiserfamilyfoundation.files.wordpress.com/2016/02/8837-payment-and-delivery-system-reform-in-medicare1.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Role of Post-Acute Care in New Care Delivery Models

With new models for the delivery of health care, post-acute care provides — long-term care hospitals, skilled nursing  and rehabilitation facilities, and home health agencies — have an important role to play. They can help reduce hospital readmissions, improve care coordination and care setting transitions, and participate in the development of bundled payment approaches.

A new Trendwatch report from the American Hospital Association looks at the factors driving changes in post-acute care and highlights innovative examples of how leading post-acute care providers and health systems are adjusting and creating new business models to improve patient care.

A separate addendum report provides more background on Medicare spending by sectors within post-acute care and their patient characteristics. Medicare’s current fee-for-service system by post-acute care venue is also summarized.

Source: Role of post-acute care in new care delivery models. Trendwatch, American Hospital Association, Dec. 2015. http://www.aha.org/research/reports/tw/15dec-tw-postacute.pdf  Addendum: Background On Post-Acute Care. http://www.aha.org/research/reports/tw/15dec-tw-postacute-adden.pdf

Posted by AHA Resource Center (312) 422-2050 rc@aha.org

What happens in a government shutdown?

September 30 marks the end of the federal government’s fiscal year, which makes early fall one key time when political contention sometimes brings the threat of a government shutdown.  Sometimes it remains merely a threat, but there were, in fact, shutdowns in 1995 (21 days) and in 2013 (16 days).  I am writing this post on September 30, 2015, and the New York Times is reporting today that it looks like a shutdown will be averted this year.

However, agencies prepared contingency plans for a 2015 shutdown – and you can read them on the website of the Office of Management and Budget here:  https://www.whitehouse.gov/omb/contingency-plans

Modern Healthcare reported that a short shutdown would probably not have much impact on health care providers.  Medicare reimbursement comes from a trust fund separate from annual federal appropriations.  Veterans Affairs hospitals were expected to remain open.

A particular challenge for 2015 would be trying to implement the ICD-10 coding system at the time that a government shutdown would hit.


Herszenhorn, D.M. (2015, Sept. 30). Senate passes spending bill to avert government shutdown. The New York Times. http://www.nytimes.com/2015/10/01/us/politics/government-shutdown-congress.html?_r=0

Kessler, G. (2011, Feb. 25). Lessons from the great government shutdown of 1995-1996. The Washington Post. http://voices.washingtonpost.com/fact-checker/2011/02/lessons_from_the_great_governm.html

Kutscher, B. (2015, Sept. 28). Prolonged government shutdown would affect providers. Modern Healthcare, 45(39), 4.  http://www.modernhealthcare.com/article/20150926/MAGAZINE/309269941/prolonged-government-shutdown-would-affect-providers

Conn, J. (2015, Sept. 28). CMS preps for an upload and a shutdown. Modern Healthcare, 45(39), 4.  http://www.modernhealthcare.com/article/20150926/MAGAZINE/309269940

Mercia, D. (2013, Oct. 4). 995 and 2013: three differences between two shutdowns. CNN Politicshttp://www.cnn.com/2013/10/01/politics/different-government-shutdowns/

Percent of Office-Based Primary Care Physicians Not Accepting New Patients

The Centers for Disease Control and Prevention reports that 8.4% of office-based primary care physicians were not accepting new patients in 2013. New patient acceptance differed by insurance type, however. Over a third of the physicians were not accepting new Medicaid patients. Here’s the CDC infographic:


PCPs not accepting new patients - CDC aug15


Source: Hing E and others. Quick stats: Percentage of office-based primary care physicians not accepting new patients by source of payment – United States, 2013. Morbidity and Mortality Weekly Report, Aug. 14, 2015. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6431a10.htm

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

EMERGENCY DEPARTMENTS: Medical homes help slow growth in ED visits

Medical homes were effective in slowing the growth of emergency department visits and ED payments in Medicare patients part of this large-scale study based on data from fiscal year 2008 to 2010.  Fee-for-service Medicare patients in 308 patient-centered medical homes recognized by the National Committee for Quality Assurance were compared with a control group of other Medicare patients.  The study also looked at inpatient hospitalization, but found no significant different between the medical home patients and the other Medicare patients in this regard.

Source: Pines, J.M., Keyes, V., and others. (2015, June). Emergency department and inpatient hospital use by Medicare beneficiaries in patient-centered medical homes. Annals of Emergency Medicine, 65(6), 652-660. Retrieved from http://www.annemergmed.com/article/S0196-0644(15)00003-7/pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org


Basics on Medicare Payment Systems by Provider Type

How Medicare calculates reimbursement rates for hospitals and other health facilities or services provided to Medicare patients can be complex.  The Medicare Payment Advisory Commission — MedPAC — has updated its Payment Basics series. The series provides a short overview for the different Medicare payment systems that will help in better understanding them. Here’s a list of what’s available in the series:

Source: Payment basics. Medicare Payment Advisory Commission, Oct. 17, 2014. http://www.medpac.gov/-documents-/payment-basics

Posted by AHA Resource Center (312) 422-2003, rc@aha.org

Benchmarks: Hospitals’ IRS Schedule H Community Benefit Reporting

Hospitals and systems allocated 12.3% of their total expenses toward community benefit in 2011, according to a new analysis of Schedule H filings. That’s up from 11.3% in 2009. [Tax-exempt hospitals report their community benefits to the IRS in a form called Schedule H.]

Community benefit expenditures covered charity care and financial assistance for patients, bad debt, absorption of underpayments from Medicaid and Medicare programs, community and population health improvement, underwriting of medical research and health professions education, and subsidization of high cost essential health services.

Benchmark community benefit costs are presented for systems and by hospital size, type, and location. Spending percentages are broken out for types of community benefits as well. Also benchmarked are practices on threshold use of federal poverty guidelines for determining free and discounted care for patients.

Source: Ernst & Young LLP. Results from 2011 tax-exempt hospitals’ schedule H community benefit reporting. American Hospital Association, Aug. 2014. http://www.aha.org/content/14/schedhreport.pdf

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org