The Payment Data Advisory Group of the Pennsylvania Health Care Cost Containment Council (PHC4) will meet on Wednesday, August 8 in Harrisburg.
The meeting will be held at the PHC4 office at 225 Market Street, Suite 400. It begins at 10:30 a.m.
The public is welcome to attend.
Hospitals across the country are worried about what will happen come 2014, when the Affordable Care Act’s individual insurance mandate and Medicaid expansion take effect and they lose funds they currently receive from the federal government to help with the cost of caring for their low-income and uninsured patients.
Hospitals that care for large numbers of such patients receive what are known as disproportionate share hospital payments, commonly referred to as “DSH,” from both Medicare and Medicaid. Under the 2009 health care reform law, however, those payments will be reduced drastically in anticipation of a significant decline in the number of uninsured Americans.
The leaders of these hospitals, however, believe that even the individual insurance mandate and Medicaid expansion will still leave them with many uninsured patients to treat, including illegal residents and those who decline to buy insurance despite the insurance mandate.
Historically, DSH funds have been vital to the financial health of Pennsylvania’s safety-net hospitals.
Read more about this situation, and the challenges hospitals believe they will face as a result, in this New York Times article
.
Roughly one in four Pennsylvania Medical Assistance recipients visited providers last year that used electronic health record (EHR) technology to help manage their health care information.
According to the Department of Public Welfare (DPW), the state has now distributed $130 million in federal EHR incentive payments to 90 hospitals and more than 3000 health care professionals.
Read more about the growing use of EHR technology and the availability of federal funds to support the use of that technology in this Central Penn Business Journal article
.
As the federal government prepares to penalize hospitals with high readmission rates, new research suggests that appropriate readmissions may actually result in better care for the nation’s seniors.
According to new research, some hospitals that have high readmissions rates for the medical conditions that Medicare tracks – heart attacks, heart failure, and pneumonia – also have higher survival rates among patients with those conditions.
Such findings, while preliminary, call into question the manner in which Medicare intends to adjust future payments to hospitals based on their readmission rates in the value-based purchasing program it will introduce in October of this year.
This issue is of particular concern to Pennsylvania’s safety-net hospitals, which care for many low-income and dually eligible seniors who have had sporadic contact with the health care system throughout their lives and often present multiple medical challenges that require more than one hospitalization to address.
Read more about these new findings and their implications in this Kaiser Health News report
.
A decision by Pennsylvania state officials not to expand the state’s Medicaid program as envisioned in the Affordable Care Act would be harmful to the state’s private hospitals – and especially to its safety-net hospitals, according to a Pittsburgh Post-Gazette report.
The law previously required all states to expand their Medicaid programs, but that mandate was struck down last month by the Supreme Court.
The court’s decision has serious implications, Safety-Net Association of Pennsylvania (SNAP) president Michael Chirieleison explained in the article.
“When you remove a critical part of the act like this, it leads to a lot of questions and concerns about the viability and credibility of the remaining initiatives.”
State officials have not yet indicated whether Pennsylvania will expand its Medicaid program.
Read the Post-Gazette article here.
A new federal initiative will use patient satisfaction to help determine Medicare payments to hospitals.
Under the new value-based purchasing program it will launch in October, Medicare will use the results of patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems survey (HCAHPS) as a factor in determining its payments to hospitals.
As reported in the Pittsburgh Post-Gazette, not everyone believes there is a tangible link between patient satisfaction and the quality of care a hospital provides – and not everyone believes the HCAHPS survey accurately measures either.
In addition, a recent article in the Archives of Internal Medicine reported that safety-net hospitals generally receive lower scores on the HCAHPS survey than other providers – a potentially major concern for Pennsylvania’s safety-net hospitals.
Read more about this controversial program in this Pittsburgh Post-Gazette report
.
The National Health Law Program has prepared a useful Q&A about how the Affordable Care Act and its Medicaid expansion will affect Medicare disproportionate share (Medicare DSH) and Medicaid disproportionate share (Medicaid DSH) payments, both of which are so important to Pennsylvania’s safety-net hospitals.
Download that summary here.
The value-based purchasing program that Medicare plans to unroll in October could result in reduced payments to the nation’s safety-net hospitals.
A report published in the Archives of Internal Medicine found that safety-net hospitals receive lower scores in measures that Medicare will use as part of its new value-based purchasing program. Those scores are based on data from the Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) survey.
As a result of those lower scores, the article “Patient Experience in Safety-Net Hospitals: Implications for Improving Care and Value-Based Purchasing” concluded that safety-net hospitals could receive lower Medicare payments that could affect their financial health.
Read a Kaiser Health News on the new study here and the Archives of Internal Medicine report itself here
.
Pennsylvania has reduced its Medicaid dental benefits to basic services – mostly, cleanings, fillings, and extractions.
It has eliminated root canal and periodontal procedures and limits dentures. The changes are expected to save $42 million this year.
Most states do not pay for any dental care.
Read more about the changes in Pennsylvania’s Medicaid dental benefits and their impact on beneficiaries here.
The Pennsylvania Health Law Project has just published its June/July “Health Law PA News” newsletter. The latest edition includes articles about the recently passed state Medical Assistance budget, the implications of the Supreme Court’s Affordable Care Act decision for Pennsylvania, changes in state human resources funding, a delay in HealthChoices expansion in western Pennsylvania, and the lawsuit to compel the state to reinstitute the AdultBasic program.
Read the newsletter here.