Health Insurance Roundup—Medicaid work requirements prove costly; Physician-led ACOs show promise

Health insurance, pen and stethoscope
Work requirements and other changes to Kentucky’s Medicaid program could cost nearly $187 million in the first six months. (Image: Getty/Minerva Studio)
Robert Tennant
Robert Tennant (MGMA)

Guidance on electronic payment fees removed from CMS site

Last fall, it looked like the issuance of new government guidance settled the ongoing controversy over health plans that charge physician practices fees to receive their payments electronically. But now the Centers for Medicare & Medicaid Services has unexpectedly removed that guidance, which gave providers the right to refuse virtual credit card payments and stopped payers from charging all but minimum transaction fees being charged to receive electronic payments.

Robert Tennant, director of health information technology policy at the Medical Group Management Association (MGMA), told FierceHealthcare the fees are “grossly unfair.” (FiercePracticeManagement)

Launching Medicaid work requirements prove costly

The federal government will foot much of the multimillion-dollar bill for state efforts to implement Medicaid work requirements. Work requirements and other changes to Kentucky’s Medicaid program, for example, could cost nearly $187 million in the first six months, mainly to cover administrative costs and technology to track work hours and payments. More than $167 million of that would be covered by the federal government.

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Kentucky’s Republican Gov. Matt Bevin says the program will ultimately save the state money, however.

In Tennessee, a work requirement proposal would cost the state an estimated $18.7 million each year and the federal government more than $15 million annually. And in Virginia, a recent government analysis showed launching a work mandate could cost the state tens of millions of dollars. (Roll Call)

Wellmark plan would bypass ACA pre-existing condition requirements

In Iowa, proposed legislation would allow the Iowa Farm Bureau Federation to offer health insurance plans that don't comply with the federal Affordable Care Act. The new coverage could offer relatively low premiums for young and healthy consumers, but people with pre-existing health problems could be charged more.

The plan would be offered by Wellmark Blue Cross & Blue Shield.

Farm Bureau spokeswoman Laurie Johns said about 28,000 of its current members could take part in such a plan, many of whom are farmers who buy their own health insurance. But anyone can join the Iowa Farm Bureau if they pay annual dues of $55 or less, making the option available to almost anyone in the state. (Des Moines Register)

Physician-led ACOs show promise—and results

Participating in a physician-led accountable care organization can be an alternative for independent physicians who don’t want to consolidate with a hospital or health system. And the model shows promising results, outperforming ACOs led by hospitals and other large medical organizations in some studies.

They also can provide a way for practices to handle increasing government regulation and help with the administrative burden that comes with quality data reporting under the Medicare Access and CHIP Reauthorization Act. (FiercePracticeManagement)

Expert advice on shoring up value-based care models

Value-based care is an essential approach for hospitals to become more cost efficient, but the model must also relieve the burdens on patients by providing them with better care, according to two articles examining value-based care in the Journal of the American Medical Association.

In one, former CMS Administrator Mark McClellan, M.D., and his co-authors laid out a framework for alternative payment models, noting that such models “must help make patients better healthcare consumers and mitigate perverse incentives that reward low-quality patient care.”

The second viewpoint article, co-authored by Harvard Medical School faculty members Ishani Ganguli, M.D., and Timothy G. Ferris, M.D., said that the accountable care organization model may be the way to correct some of the flaws in care delivery created by the still dominant fee-for-service model. But they also insisted the model must incorporate more teamwork. (FierceHealthFinance)

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