INDUSTRY NOTES:
Hospital Wage Index May Not Accurately Reflect Occupational Mix
Published on Fri Jan 06, 2006
Reporting discrepancies could bias wages upward and distort adjustments.
Proposed changes to the occupational mix survey show major idiosyncrasies, according to the Medicare Payment Advisory Commission.
The Centers for Medicare & Medicaid Services recently proposed changes to the occupational mix survey, which it will use to adjust hospital wage index computations. The adjustment reflects geographic differences in wage levels by taking into account variations in worker mixes in various labor markets.
In MedPAC's review, it pointed out a mismatch between the hours and wages hospitals submit on their Medicare cost reports and those they'll report on the occupational mix survey. Current CMS policy allows hospitals to omit non-patient-care contract labor from cost reports, which could bias its average wage upward, especially for hospitals contracting many low-wage service workers. The occupational mix survey doesn't account for this variation; instead, it requires hospitals to include contract labor in its reporting. As a result, the occupational mix may not reflect reported hours and wages accurately, MedPAC says.
MedPAC's recommendation is twofold: 1) Adjust the survey to exclude non-patient-care contract worker hours; and 2) Add a new category for reporting employee hours for frequently contracted labor. MedPAC also suggested adding categories to increase accuracy and reporting detail by reducing the number of workers that fall into the nebulous "other" bucket. Florida Passes Managed-Medicaid Bill Florida legislators last week approved a plan Gov. Jeb Bush proposed to offer Medicaid beneficiaries more choices in health care coverage. If other states follow this model--and sources suggest that they're watching closely--private plans could play a more prominent role in delivering coverage to this population.
The plan, which will launch in July 2006 on a pilot basis in Fort Lauderdale and Jacksonville, entails that benes choose from a variety of managed-care plans, which must meet basic coverage mandates. The state will choose plans for those benes who don't choose a plan themselves. Medicaid recipients can opt out of the program altogether and enroll in employer-sponsored health plans instead, using their vouchers to cover expenses.
Opponents of the bill--which both the Senate and House passed handily--worry about the possibility that ailing or disabled members will be subject to higher costs and denial of care. "The Florida waiver represents a very dangerous precedent that is likely to cause significant harm for people who need health care the most," argues Ron Pollack, Executive Director of Families USA. And others question whether the measure will ultimately lower the state's Medicaid costs. "We're concerned that the plan shifts too many risks to seniors without benefiting the state," says Bentley Lipscomb, AARP Florida state director.
But bill advocates contend that such a measure becomes essential in the face of rapidly rising health care costs--Bush cites estimates that the Medicaid system, if [...]
