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White House to safeguard Medicaid in budget talks

The Obama administration plans to use the health system reform law’s Medicaid expansion provision as a shield against funding reductions to the rest of the program. At a Jan. 31 health policy conference, a top White House official announced that the administration would reject cuts to the Medicaid program during deficit reduction negotiations because “the world has changed and, because of that, our policies are being affected.” Republican lawmakers have been eyeing significant cuts to entitlement programs as one of several mechanisms to reduce federal deficits, said Gene Sperling, director of the White House National Economic Council, who spoke during a conference hosted by advocacy group Families USA in Washington. Such reductions have included $830 billion in proposed reductions to Medicaid, or a third of its budget, he said. Sen. Orrin Hatch of Utah, the ranking Republican on the Senate Finance Committee, has cautioned that Medicaid and Medicare reforms need to be an ...

Quality demo cuts repeat hospital Medicare trips by nearly 6%

A Medicare test project that emphasized care coordination to keep patients from going back to the hospital scored lower readmission rates compared with similar regions without such a program in place. A study on the Medicare quality improvement organization pilot in the Jan. 23/30 Journal of the American Medical Association reported that 30-day readmission rates in 14 communities were reduced by 5.7% over two years beginning in 2008. In an average locale serving 50,000 Medicare beneficiaries, the care coordination model would cost $1 million a year but also save $4 million by preventing return trips to hospitals, said lead author Jane Brock, MD, MSPH. “When you have a bunch of providers trying to function in concert on behalf of the population they already mutually serve, we think that’s the key intervention that explains our success,” said Dr. Brock, who is chief medical officer for the Colorado Foundation for Medical Care. Following the success during the trial period, ...

Quality of e-visits not yet equal to office visits

Research that compares care given through virtual visits with care given in person at a physician’s office rebuts some of the concerns physicians have about e-visits while supporting other worries, says a Jan. 14 study in JAMA Internal Medicine, formerly Archives of Internal Medicine. Study co-author Ateev Mehrotra, MD, assistant professor at the University of Pittsburgh School of Medicine and policy analyst for the RAND Corp., said patients have sought care from places such as retail clinics and emergency departments because they were able to access them immediately, without the wait they would have faced at a primary care physician’s office. Although tele-health has been considered as an option to get those patients back, “the concern I always hear from my physician colleagues about these electronic visits is, ‘Can you really do this? Can you really accurately diagnose someone using these tele-medicine options?’ ” Dr. Mehrotra said the study provides mixed evidence ...