MEDICARE AND MEDICAID FEATURED TOPICS IN INQUIRY'S 2012 FALL ISSUE

ROCHESTER, NY (11/15/2012)(readMedia)-- Hospital readmission for Medicare patients, the low-income subsidy for Medicare Part D, Medicaid eligibility, Medicaid disproportionate share hospital payment, and wellness program incentives are all explored in Inquiry's fall issue:

"Likelihood of Hospital Readmission after First Discharge: Medicare Advantage vs. Fee-for-Service Patients," by Bernard Friedman, H. Joanna Jiang, Claudia A. Steiner, and John Bott – Analysis of descriptive data shows a lower likelihood of hospital readmission within 30 days of discharge for patients in Medicare Advantage plans compared to those in fee-for-service plans. However, after applying risk adjustment and controlling for self-selection into managed care plans, findings point to a noticeably higher likelihood of hospital readmission among Medicare Advantage enrollees. The authors encourage informing Medicare beneficiaries about the risk-adjusted readmission rates of health plans in their area, which would give some indication of the quality of health care under each plan.

"Eligibility and Take-up of the Medicare Part D Low-Income Subsidy," by J. Samantha Shoemaker, Amy J. Davidoff, Bruce Stuart, Ilene Zuckerman, Eberechukwu Onukwugha, and Christopher Powers – Concern exists that many people eligible for the Medicare Part D low-income subsidy (LIS) are not enrolled in the assistance program, which can reduce prescription drug plan premiums and cost-sharing. This study found that published literature tends to over represent the LIS-eligible population and thus the portion not receiving the subsidy, while a third of potentially eligible people remain unenrolled. Incorporating supplementary data on income and assets into information from the Medicare Current Beneficiary Survey (MCBS) enhances "the ability to draw appropriate conclusions about eligibility and take-up of the LIS," the authors write.

"Variation in Medicaid Eligibility and Participation among Adults: Implications for the Affordable Care Act," by Genevieve M. Kenney, Victoria Lynch, Jennifer Haley, and Michael Huntress – Using the 2009 American Community Survey, this study found that 4.5 million adults are eligible for Medicaid, but are uninsured. The Medicaid participation rate among eligible adults is 67 percent, and it varies substantially across states and across socioeconomic and demographic subgroups. The authors note that dealing with the dual challenge of reaching previously eligible adults as well as those newly eligible under the Affordable Care Act (ACA) may require that states and the federal government implement other policy changes, in addition to the mandated coverage and other features included in the ACA.

"Medicaid Disproportionate Share Hospital Payment: How Does It Impact Hospitals' Provision of Uncompensated Care?" by Hui-Min Hsieh and Gloria J. Bazzoli – This paper looked at the association between uncompensated care and cuts in Medicaid disproportionate share hospital (DSH) payments, which go to safety-net hospitals to support free and discounted care for uninsured and Medicaid patients. Results showed that nonprofit hospitals in California did reduce the provision of uncompensated care in response to cutbacks in DSH payments, but the response was not especially sensitive to the cutback in DSH funding. Sources of support for indigent care will change under the ACA, but reform will not eliminate all uninsured people and the authors advise continued monitoring of uncompensated care.

"Can We Legally Pay People for Being Good? A Review of Current Federal and State Law on Wellness Program Incentives," by Lisa Klautzer, Soeren Mattke, and Michael Greenberg – This paper examines the legal risk that employers and insurers might face in using financial incentives to encourage participation in wellness programs or attaining health-related targets. Findings suggest that the trend seems to be moving toward creation of exceptions for wellness incentives from potentially challenging legislation, and thus the litigation risk under bona fide wellness programs appears limited.

Also featured in INQUIRY's fall issue:

"The McNerney Forum-Hospital Tax Exemption: How Did We Get Here?" by Bruce McPherson – In this column, McPherson, the president and CEO of the Alliance for Advancing Nonprofit Health Care, traces the history and changes of tax exemption for nonprofit hospitals up to the Affordable Care Act.

"Dialogue–Hospital Tax Exemption: Where Do We Go From Here?" – Picking up where McPherson's column ends, this dialogue features a lively exchange among three hospital industry experts as they discuss the future of nonprofit hospitals' tax-exempt status.

"The View from Here: The Lost Decade and Our Moral Compass," by Alan C. Monheit – In this column, INQUIRY's editor discusses the past 10 years – what he calls the "lost decade" – and their detrimental economic consequences for the middle class and other less affluent groups. He calls for reorienting priorities and using a "moral compass" to implement policies that value the common good, restore a vibrant middle class and support the most vulnerable in society.

INQUIRY, the journal of health care organization, provision, and financing, is in its 49th year. The nonprofit Excellus Health Plan, Inc., publishes INQUIRY; the journal maintains a freelance editorial staff and is run as an independent, peer-reviewed, quarterly academic journal. Press releases and article abstracts are available on the INQUIRY website at www.inquiryjournal.org under "Current Issue Table of Contents."