HHS Official: Providers Warn Patients Away From Dual-Eligible Pilots
Melanie Bella, who oversees programs for Americans covered by both Medicare and Medicaid, complains that providers are warning patients they will lose benefits if they participate in a managed-care initiative designed to test ways to reduce costs and improve quality. Meanwhile, a Center for Public Integrity probe finds that nursing home patients may not be receiving the advertised level of care.
CMS Official Says Some Providers Obstructing Dual-Eligible Demo
The CMS official in charge of coordinating care for Americans covered by both Medicare and Medicaid says some healthcare providers are illegitimately trying to dissuade dual-eligible beneficiaries from participating in a managed-care initiative designed to test ways to reduce costs and improve quality. She said her agency has increased its surveillance of these providers, though she did not identify any by name. “We are unfortunately seeing lots of bad behavior in most of the states,” said Melanie Bella, director of the Medicare-Medicaid Coordination Office at the CMS, during the National Association of Medicaid Directors (NAMD) on November 4. (Dickson, 11/11)
Nursing Home Care Levels May Be Much Lower Than Families Think
Many U.S. nursing home patients may not be receiving the level of care their loved ones believe they're getting, a Center for Public Integrity probe has found. Staffing levels reported by thousands of nursing homes on a widely-used government website were higher than the staff levels calculated by the Center for Public Integrity through an analysis of annual financial reports submitted by the homes, suggesting that consumers in those facilities may not be getting as many hours of skilled care as they expect. Experts have shown that the amount of care provided by nursing homes is linked to the quality of care. (Lowenstein, 11/12)
Kidney Groups Disappointed By CMS' Five-Star Rating System
Kidney care providers in the United States say they are disappointed and seriously concerned about the CMS' decision to move forward with its five-star rating program for dialysis facilities. The federal agency announced late Friday that it would go ahead in January with the rollout of the rating system, using methodology that has drawn harsh criticism from kidney-care groups since they first viewed it this summer. Kidney Care Partners said Monday that it is deeply troubling that the CMS would “summarily dismiss” recommendations provided by dialysis providers during a review period. (Rice, 11/11)