MHA Today | June 13, 2017

June 13, 2017


MHA Today: News for Healthcare Leaders

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In This Issue
Nearly 502,000 Clinicians Incur Payment Reductions
Individuals Drop Out Of Health Care Marketplace


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Nearly 502,000 Clinicians Incur Payment Reductions

Staff Contact: Andrew Wheeler

Clinicians who failed to report quality measures through the physician quality reporting system in 2015 will receive payment penalties in 2017. According to the Centers for Medicare & Medicaid Services, 501,933 clinicians failed to report quality measures that would satisfy the PQRS requirements in 2015. These clinicians will receive a 2 percent reduction off the Medicare physician fee schedule.

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Individuals Drop Out Of Health Care Marketplace

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services published data on the effectuated enrollment for 2017 and projects the number of insurers expected to offer products on the health insurance exchange in 2018. The first report includes details about the number of individuals who signed up for coverage and have been paying their premiums in 2017. CMS states that nearly two million people have not paid their insurance premium to begin and maintain their coverage. The report points to premium increases as being the primary reason for individuals not beginning or maintaining coverage. During 2016, 290,201 individuals in Missouri enrolled and 252,044 effectuated coverage; a rate of 86.9 percent. In 2017, 244,382 enrolled and 223,759 effectuated coverage; a rate of 91.6 percent.

CMS also released a report that projects the number of insurers expected to offer marketplace plans in 2018 by county. Because of the lack of insurer participation, CMS estimates that individuals in 47 counties will have no options for coverage in 2018. Twenty-five of the 47 counties nationwide, or 53 percent, are located in Missouri. In 2017, 18,549 individuals in those 25 Missouri counties enrolled in the marketplace and will have no plans to choose from in 2018. Today, Centene announced that they may be offering marketplace plans in 2018 to fill in the marketplace desert created in Missouri. If Centene meets the initial rate requests for 2018, which are due next month, it may provide an option for some of Missouri’s counties.

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Consider This ...

In the U.S., 14.8 million adults have been diagnosed with ulcers.

Source: Centers for Disease Control and Prevention