The New York Times’ “Doctor and Patient” blog has taken a brief look at safety-net hospitals.
In the article “The Fraying Hospital Safety Net,” Dr. Pauline Chen examines the challenges safety-net hospitals face and the ability of many of them, even in the face of those challenges, to deliver quality care.
Read this New York Times article on safety-net hospitals here.
If Pennsylvania moves ahead and expands Medicaid eligibility as envisioned in the Affordable Care Act, the ability of newly enrolled recipients to obtain medical care may be jeopardized by the reluctance of some physicians to take on more Medicaid patients.
According to a recent article in the journal Health Affairs, 68 percent of the state’s doctors are currently accepting new Medicaid patients. Those who are not cite low reimbursement rates and already-high patient loads among the reasons they are not accepting new Medicaid patients.
Pennsylvania Governor Tom Corbett has not revealed whether he intends to expand Medicaid eligibility in the state and is not expected to do so until after the November election. The mandatory Medicaid expansion, part of the 2010 health care reform law, was ruled unconstitutional by the U.S. Supreme Court, leaving expansion decisions to the individual states.
The Pennsylvania Department of Health says that 94 percent of rural doctors and 84 percent of the state’s urban doctors currently care for Medicaid patients.
Read more about the situation in Pennsylvania today and its implications for Medicaid expansion in this Pittsburgh Post-Gazette article
.
The Pennsylvania Department of Public Welfare has released changes in the state’s Medical Assistance fee-for-service fee schedule.
The changes, which took effect September 1, can be found in this Medical Assistance Bulletin notice
.
Come fall, the Pennsylvania Department of Welfare (DPW) will introduce a new system that performs an automated review of Medical Assistance claims before the state pays those claims.
The new system employs a computer program called InvestiClaim that will review claims for procedure or diagnosis codes with inadequate medical documentation, duplicate claims, provider types, license numbers, and other considerations.
The state projects that this new system will save $5 million a year.
The future use of a system to review claims prior to payment was included in Governor Corbett’s original Medical Assistance budget proposal for FY 2013.
Read more about InvestiClaim and how it will work in this PA Independent article.
Medicaid improves access to care and saves lives and deserves to be expanded in the manner envisioned in the Affordable Care Act, according to a new blog entry on the web site of the health care-focused Commonwealth Fund.
According to the blog commentary, Medicaid “fulfills the two main purposes of health insurance – ensuring access to needed care and providing adequate financial protection from burdensome medical expenses.” It also cites research that “confirms that expanding Medicaid not only improves access to care and financial protection of vulnerable individuals and families, but actually saves lives.”
In addition, the blog suggests that Medicaid recipients have only slightly greater cost-related access-to-care problems than individuals with private insurance.
The Safety-Net Association of Pennsylvania (SNAP) and the state’s private safety-net hospitals have eagerly anticipated the expansion of Medicaid eligibility mandated by the Affordable Care Act. In the wake of the Supreme Court decision ruling the expansion mandate unconstitutional, these safety-net hospitals now await for Governor Corbett’s decision on whether Pennsylvania will move ahead with that Medicaid expansion.
The title of this commentary is “Medicaid Works: Public Program Continues to Provide Access to Care and Financial Protection for Society’s Most Vulnerable,” and it can be found here, on the Commonwealth Fund’s web site.
The Department of Public Welfare (DPW) has issued a number of new bulletins governing Pennsylvania’s Medical Assistance program.
These new regulations include an amendment to the state’s Medicaid plan for children with disabilities; the process for prior authorization of pituitary suppressive drugs; the process for prior authorization of erythropoiesis stimulating protein; the process for prior authorization of benign prostatic hyperplasia treatments; the process for prior authorization of antibiotics (GI); and the process for the prior authorization of platelet aggregation inhibitors.
In addition, DPW formally announced the expansion of HealthChoices
to 13 counties in western Pennsylvania and the termination of ACCESS Plus in those counties effective October 1 and its intention to publish in the near future a new bulletin adding growth factors to the Medical Assistance program’s list of items requiring prior authorization.
A new Medicare reimbursement policy that will penalize hospitals financially for readmitting patients within 30 days of discharge will have a disproportionate impact on hospitals that care for large numbers of low-income patients.
According to an analysis by Kaiser Health News, hospitals that treat significant numbers of low-income patients – those eligible for Medicare disproportionate share (DSH) payments – are more likely to be penalized by Medicare than other hospitals. Those that serve the most poor patients are twice as likely to suffer the maximum Medicare penalty as those that care for the fewest low-income patients.
The penalties apply to patients readmitted after suffering pneumonia, heart attacks, and heart failure.
The new Medicare readmissions reduction program poses a particular challenge for Pennsylvania’s safety-net hospitals, such as those that belong to the Safety-Net Association of Pennsylvania (SNAP), because so many of their patients have additional medical problems and often have difficulties following post-discharge instructions and getting and paying for follow-up care.
Read more about the new Medicare reimbursement program and the Kaiser analysis in this Kaiser Health News report
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The Pennsylvania Department of Public Welfare (DPW) has released its annual list of inpatient hospitals that qualify for Medical Assistance disproportionate share (DSH) payments, including the DSH percentages for acute-care general hospitals, psychiatric units of inpatient hospitals, drug and alcohol units of inpatient hospitals, medical rehab units of inpatient hospitals, freestanding rehab hospitals, private psychiatric hospitals, and private drug and alcohol hospitals.
Find the list and the corresponding DSH percentages in this Pennsylvania Bulletin notice.
A study published in the journal Health Affairs found that 32 percent of office-based physicians in Pennsylvania do not accept new Medicaid patients.
This is slightly higher than the nation-wide rate of 30.9 percent of physicians who will not accept new Medicaid patients.
Read more about the study in this Central Penn Business Journal article or find the study itself here, on the Health Affairs web site.
In an extensive interview with the Central Penn Business Journal, Pennsylvania Department of Public Welfare Secretary Gary Alexander shared his views on the state’s Medicaid program, the changes he would like to see, and the challenges the state faces in the immediate future.
Among the issues Alexander addressed are his desire to have greater flexibility to operate the state’s Medical Assistance program; the state’s prospects for expanding Medicaid eligibility as called for in the Affordable Care Act; his concern that greater access will increase rather than decrease uncompensated care and emergency room use; his interest in greater transparency for health care costs and quality; and his fight against fraud, waste, and abuse.
Read the complete Central Penn Business Journal interview with Secretary Alexander here
.