PA Safety Net Admin, Author at Safety-Net Association of Pennsylvania

PHC4 Reports on Hospital Mortality, Admission Rates, and Performance

Mortality rates, admission rates, and other aspects of hospital performance are the subject of a new report by the Pennsylvania Health Care Cost Containment Commission.

The report presents information on hospital volume and outcomes for 17 different medical conditions and surgical procedures from October 2017 through September 2018. It also compares hospital performance over the five-year period from 2013 through 2018 on an aggregate state-wide basis and for individual hospitals.

Overall, the report found decreases in hospital mortality for most of the 17 conditions, with respiratory failure, sepsis, colorectal procedures, and intestinal obstructions experiencing the biggest decreases (by percentage). Hospital admissions for chest pain, chronic obstructive pulmonary disease, and pneumonia experienced the biggest declines while admissions for respiratory failure and sepsis experienced significant increases (in numbers).

For state-wide and hospital-specific data on hospital performance on 17 medical conditions and procedures, see the new PHC4 documents that together constitute its Hospital Performance Report 2018.

PA Safety Net Admin2019-11-12T13:58:38+00:00November 12th, 2019|Uncategorized|Comments Off

MACPAC Looks at Medicaid DSH

At a time when cuts in Medicaid disproportionate share hospital payments (Medicaid DSH) are still scheduled for the current fiscal year and some in Congress are calling for a new approach to allotting DSH funds among the states, the Medicaid and CHIP Payment and Access Commission has released its annual analysis of Medicaid DSH allotments to the states.

The report includes:

data about changes in the uninsured rate
demographic information about the uninsured
information about the cost of hospital uncompensated care
perspectives on hospital Medicaid shortfalls
a comparison of hospital uncompensated care costs when calculated using different methodologies
data about hospitals that provide “essential community services”
information about scheduled Medicaid DSH allotment reductions

All Pennsylvania safety-net hospitals receive Medicaid DSH payments and consider the program an essential tool for serving their communities.

MACPAC will issue a more complete report to Congress in March of 2020.

Learn more about how MACPAC views Medicaid DSH at a time when the program is scheduled to change – and when some want even more change – in the new MACPAC document “Required Analyses of Disproportionate Share Hospital (DSH) Allotments.”

PA Safety Net Admin2019-11-08T06:00:38+00:00November 8th, 2019|DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals|Comments Off

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C.

The following is MACPAC’s own summary of the sessions.

The Commission devoted its Thursday morning discussion to integration of care for beneficiaries who are dually eligible for Medicaid and Medicare. Panelists Amber Christ, directing attorney at Justice in Aging; Griffin Myers, chief medical officer at Oak Street Health; and Michael Monson, senior vice president for Medicaid and complex care at Centene, presented beneficiary, provider, and health plan perspectives and a question and answer session followed.

After lunch, MACPAC staff briefed the Commission on challenges states face as they prepare for mandatory reporting of quality measures for children enrolled in Medicaid and the State Children’s Health Insurance Program (CHIP) and behavioral health measures for adults enrolled in Medicaid. Immediately following that session, the Commission reviewed a new MACPAC-commissioned study on the effects of federal legislation that provided new buprenorphine prescribing authority for nurse practitioners and physician assistants.

After a brief break, MACPAC staff updated the Commission on the status of the Transformed Medicaid Statistical Information System (T-MSIS). The final Thursday session discussed disproportionate share hospital (DSH) allotments as required in MACPAC’s annual March reports to Congress.

MACPAC’s Friday agenda opened with a session on improving Medicaid policies related to third-party liability: specifically, coordination of benefits with TRICARE, the health coverage program for active duty military and their dependents. There are close to 1 million Medicaid beneficiaries with TRICARE coverage but Medicaid’s ability to collect from TRICARE is limited. The final session of the October meeting addressed Medicaid and maternal health.

Supporting the discussion were the following briefing papers:

MACPAC is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide variety of issues affecting Medicaid and the State Children’s Health Insurance Program. MACPAC’s deliberations are especially important to Pennsylvania safety-net hospitals because those hospitals care for especially large numbers of Medicaid patients. Find MACPAC’s web site here.

PA Safety Net Admin2019-11-07T06:00:58+00:00November 7th, 2019|DSH hospitals, Federal Medicaid issues, Pennsylvania safety-net hospitals|Comments Off

Medicaid Expansion Brings Improvements to Expansion States

States that expanded their Medicaid programs under the Affordable Care Act have experienced fewer hospital admissions, shorter lengths of stays in the hospital, and lower hospital costs, according to a new Health Affairs study.

Specifically, they experienced:

a 3.1 percent decline in inpatient days
a 3.5 percent decrease in discharges for conditions considered “ambulatory care-sensitive,” such as diabetes, chronic respiratory problems, and pneumonia
a reduction of nearly three percent in hospital costs.

Pennsylvania is one of those expansion states, and Medicaid expansion has greatly enhanced the ability of Pennsylvania safety-net hospitals to serve their communities.

Learn more about how Medicaid expansion has improved the health of the population in states that expanded their Medicaid programs in the Health Affairs study “Medicaid Expansion Associated With Reductions in Preventable Hospitalizations.”

PA Safety Net Admin2019-11-06T06:00:14+00:00November 6th, 2019|Affordable Care Act, Federal Medicaid issues, Pennsylvania safety-net hospitals|Comments Off

Safety-Net Hospitals Gird for Loss of Medicaid DSH Money

Safety-net hospitals and others will lose a significant portion of their Medicaid disproportionate share (Medicaid DSH) payments on November 22 unless Congress delays implementation of the cut in those payments that was mandated by the Affordable Care Act.

And hospitals that receive these payments are now preparing for the worst.

The Medicaid DSH cut was included in the 2010 health care reform law in anticipation of a great reduction in the number of uninsured people leaving hospitals providing much less uncompensated care and therefore not in need of as much DSH money. The law’s reach has not proven to be as great as anticipated, however, and two developments since the law’s passage have put a damper on the expected rise in the number of insured Americans: a court decision that made it optional for states to expand their Medicaid program and the repeal of the requirement that everyone purchase health insurance.

Four times Congress has voted to delay the Medicaid DSH cut because so many people remained uninsured. Now, however, the most recent delay in implementation of the cut, via a provision in the continuing resolution currently funding the federal government, expires on November 21, and hospitals – many of them already with razor-thin margins – are preparing for the worst: a major reduction of their federal Medicaid DSH money.

Pennsylvania’s safety-net hospitals would face potentially major harm if this cut were to be implemented, so last month SNAP asked members of Pennsylvania’s congressional delegation to support a bipartisan movement in Congress to delay the Medicaid DSH cut for two years.

Learn more about the prospect of a major Medicaid DSH cut later this month, how it might affect safety-net hospitals – including the kinds of private safety-net hospitals represented by NASH – and what some hospitals are doing to prepare for the possibility in the Stateline article “Rural and Safety Net Hospitals Prepare for Cut in Federal Support.”

PA Safety Net Admin2019-11-04T06:00:59+00:00November 4th, 2019|Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals|Comments Off

PA to Help Medicaid Beneficiaries Who Want to Work

While Pennsylvania does not have a mandatory work requirement for its Medicaid population, the state is taking a new approach to encouraging Medicaid beneficiaries to pursue work.

It is asking them if they want to work and then, if they say they do, directing them to help finding training an jobs.

As reported by Kaiser Health News,

Starting early next year, the Pennsylvania Medicaid agency under Democratic Gov. Tom Wolf will ask people when they enroll if they want job training assistance. It will then require its private Medicaid managed-care organizations to connect those who want help to local employment specialists and follow up to make sure they got it.

The Wolf administration has resisted legislative efforts to impose a work requirement on the state’s Medicaid population, with the governor twice vetoing legislation that would establish such a mandate. The legislature is expected to take up a similar bill next year because, as one of the bill’s co-sponsors explained, “What they are suggesting is a tiny step in the right direction, but we need to do so much more.”

Learn more in the Kaiser Health News story “States Try A Gentler Approach To Getting Medicaid Enrollees To Work.”

PA Safety Net Admin2019-10-29T06:00:57+00:00October 29th, 2019|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

PA Safety-Net Hospitals Step Up When One of Their Own Closes

A core group of safety-net hospitals, led by SNAP members, has filled the gap left by the closure of Hahnemann University Hospital, another safety-net hospital, in Philadelphia.

Safety-Net Association of Pennsylvania logo The Philadelphia Business Journal reports that since Hahnemann’s closing was announced during the summer, ER volume has risen 15 percent, admissions have risen 12 percent, and births have risen more than 50 percent at Thomas Jefferson University Hospital, a SNAP member. Meanwhile, SNAP member Pennsylvania Hospital has seen its ER visits rise nine percent, SNAP member Penn Presbyterian Medical Center has seen its ER volume increase five percent, and SNAP member the Hospital of the University of Pennsylvania has seen its ER volume rise five percent.

Patient volume also has risen significantly at Temple University Hospital.

Learn more about how Pennsylvania safety-net hospitals, including SNAP members, have filled the void left by the closing of another safety-net hospital in the Philadelphia Business Journal article “Hahnemann fallout: Nearby hospitals see uptick in ER visits, admissions.”

PA Safety Net Admin2019-10-25T06:00:53+00:00October 25th, 2019|Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off

PA to Invest in Philadelphia Community Served by Safety-Net Hospitals

Pennsylvania will spend more than $4 million on health-related services in the North Philadelphia Enterprise Zone, an area in which nearly 13 percent of the state’s Medicaid population resides.

Hospital building This area is served almost exclusively by Pennsylvania safety-net hospitals and recently suffered a major loss when one of those providers, Hahnemann University Hospital, closed its doors. According to a SNAP analysis, more than 50 percent of the patients previously served by Hahnemann will now turn for care to SNAP members Thomas Jefferson University Hospital (18.3 percent), Pennsylvania Hospital (11.3 percent), the Hospital of the University of Pennsylvania (nine percent), Penn Presbyterian Medical Center (4.7 percent), Jefferson Health Northeast (4.1 percent), and Mercy Hospital Philadelphia (3.2 percent).

The $4 million will be spent on expanded home visiting services for families with children, eviction prevention assistance for low-income families, and programs that help residents move from public assistance to jobs.

Learn more in the Philadelphia Business Journal article “State Invests in North Philadelphia’s Health Enterprise Zone.”

PA Safety Net Admin2019-10-22T06:00:28+00:00October 22nd, 2019|Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off

PA Insurance Exchange Rates to Rise in 2020

Insurance premiums will rise on Pennsylvania’s new health insurance exchange in 2020, the Wolf administration has announced.

2020 will mark the first year Pennsylvania operates its own health insurance exchange under the Affordable Care Act. Previously, Pennsylvanians shopped for health insurance on the federal health insurance exchange.

Pennsylvania State Map Pennsylvania rates will rise an average of four percent for individual plans and 9.7 percent for small groups, the state Insurance Department has announced. All insurers that offered plans in 2019 will do so again in 2020 and the exchange will include a new insurer and increased choice in some of the state’s 67 counties. Beginning in 2020, residents of only six counties will have only a single insurer offering individual plans.

Learn more from this Wolf administration news release.

PA Safety Net Admin2019-10-18T06:00:04+00:00October 18th, 2019|Uncategorized|Comments Off

MA Bulletin Presents New PDL

Pennsylvania’s new Medicaid preferred drug list is presented in an October 10, 2019 state Medical Assistance Bulletin.

Bookshelf with law books The Department of Human Services bulletin outlines the purpose of the new PDL, provides background information, and describes how the PDL was developed and will work. In addition, it lists the past Medical Assistance Bulletins rendered obsolete by the new bulletin and describes the prior authorization procedures that will be employed when the new program takes effect on January 1, 2020.

Finally, the bulletin includes a comprehensive list of the prescription drugs on the new PDL.

See the October 10 PDL Medical Assistance Bulletin here.

PA Safety Net Admin2019-10-15T09:59:07+00:00October 15th, 2019|Medical Assistance Bulletin, Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

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