Center For Studying Health System Change

Study: Reimbursement delays and low fees result in doctors turning Medicaid patients away

Anne Zieger — Wed, 19 Nov 2008 12:30:39 -0500

A new study shows that low fees are not the only thing discouraging physicians from accepting Medicaid patients. The study, performed by the Center for Studying Health System Change (HSC), showed that many times reimbursement delays turn doctors away from Medicaid as much as low fees. Article

Study: Some safety-net hospitals putting income over mission

Anne Zieger — Tue, 12 Aug 2008 21:36:14 -0400

In today's brutally-competitive hospital marketplace, every hospital has to focus on finding profitable services to deliver and minimizing bad debt. Unfortunately, being profit-driven can sometimes conflict with a hospital's mission. This is especially the case for safety-net hospitals, according to a new study by the Center for Studying Health System Change. The study, which appears in Health Affairs, concludes that efforts like specialty-service marketing and new construction could compromise the hospitals' other efforts. Overall, safety-net hospitals aren't as financially healthy as an average hospital (which, given the state of the industry, is a sad commentary). About one-third of all safety-net hospitals lost money in 2005, according to the study's authors, who tracked 12 regions for over a decade.

Many safety-net hospitals have gone the route of Seattle's Harborview Medical Center, which has built out its campus and aggressively advertised "centers of emphasis" like neurosciences, orthopedic reconstructive procedures and spinal surgery. Execs there say they need 40 percent of their patients to be commercially-insured to stay financially viable, and that pushing higher-end services like these helps them to stay afloat where others have failed. Meanwhile, Harborview has taken some steps to limit transfers of uninsured patients, something the study's authors say subjects patients to a "wallet biopsy."

To learn more about this study:
- read this piece from The Seattle Times

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Study: Chronic disease payment needs changes

Anne Zieger — Wed, 02 Jul 2008 00:56:49 -0400

While most providers agree that most compensation arrangements don't work well for treating chronically-ill patients, payers have done little to change how they reimburse doctors and hospitals for chronic care, according to a new study by the Center for Studying Health System Change. Existing payment systems encourage disconnected forms of delivery, rather than coordinated care, according to Center President Paul Ginsburg, PhD.

The study describes several pilot programs offering financial incentives for providers caring for chronically ill patients. These include a 2005 diabetes management program by BCBS of North Dakota that uses a nurse case manager to better coordinate care planning and patient self-management. Also included is Rhode Island Medicaid's primary care case management program for adults with multiple chronic conditions enrolled in its fee-for-service program. It also describes the new risk-adjusted annual global payment now being offered by BCBS of Massachusetts.

Barriers to developing more-effective chronic care payment systems include a fragmented care delivery system, lack of payment for nonphysician providers and lack of champions for payment reform, according to the Center's recent report.

To learn more about the study:
- read this HFMA News piece
- read the Center for Studying Health System Change report

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