The uninsured do not use emergency rooms more than the insured.
And the expansion of health insurance coverage increases rather than decreases ER use.
So concludes the new Health Affairs study “The Uninsured Do Not Use the Emergency Department More – They Use Other Care Less.” Find the study here.
A bipartisan group of senators has written to Senate majority leader Mitch McConnell and Senate minority leader Chuck Schumer expressing concern about cuts in Medicare Medicare prescription drug payments to qualified providers as a result of new regulations governing the section 340B prescription drug discount program. Those cuts have been adopted by regulation by the Centers for Medicare & Medicaid Services and will take effect beginning on January 1, 2018.
Under the regulation adopted by CMS, Medicare payments for prescription drugs dispensed on an outpatient basis to low-income patients will be reduced to qualified providers by $1.6 billion in the coming year. While acknowledging problems with how the 340B program has evolved over the years, the senators ask their leaders to partner “…with CMS and other stakeholders to ensure the 340B program continues to support safety-net providers in helping low-income individuals access quality health care services with proper oversight and transparency.”
All Pennsylvania safety-net hospitals participate in the 340B program.
Neither Pennsylvania senator signed the letter.
See the letter here.
Physicians who serve large numbers of low-income patients are more likely to incur penalties under Medicare value-based purchasing programs.
So concludes a new study in Annals of Internal Medicine.
According to the report,
Performance differences between practices serving higher- and those serving lower-risk patients were affected considerably by additional adjustments, suggesting a potential for Medicare’s pay-for-performance programs to exacerbate health care disparities.
This result is based on a study of the Medicare Value-Based Payment Modifier program, which no longer operates, but could have implications for other programs that seek to reward or penalize practitioners based on the outcomes they produce.
Such findings could lead practitioners to avoid serving such patients so they can avoid penalties, which in turn could jeopardize access to care in some communities. That, in turn, could have implications for Pennsylvania safety-net hospitals and the communities they serve.
Learn more about the study, its findings, and its implications by going here to see the Annals of Internal Medicine report “The Value-Based Payment Modifier: Program Outcomes and Implications for Disparities.”
One of the long-time barriers to states and hospitals addressing low-income patients’ social services needs and the social determinants of health has been a lack of resources for such assistance. Medicaid, in particular, has not been a financial participant in such efforts.
But that may be changing.
The new federal Medicaid managed care regulation, updated nearly two years ago, allows for the inclusion of some non-clinical services as covered Medicaid services and for funding for such services to be folded into Medicaid managed care plans’ capitation rates and medical loss ratios. The updated regulation also encourages greater coordination of care for Medicaid patients and coverage for long-term services and supports in the home and community for medically qualified patients.
Because they serve so many low-income patients, Pennsylvania safety-net hospitals are especially interested in policy changes that might enable them to serve such patients more effectively.
The Commonwealth Fund has taken a closer look at how the 2016 Medicaid managed care regulation may facilitate addressing the psycho-social needs of Medicaid beneficiaries. Go here to see its report “Addressing the Social Determinants of Health Through Medicaid Managed Care.”
Hospitals and other health care providers say it is an essential tool in ensuring access to care, and to prescription drugs, for their low-income patients.
Pharmaceutical companies say it has expanded beyond its original purpose and is being used by hospitals to pad their profits.
Members of Congress are divided: some are supportive and some are skeptical.
The section 340B program that requires drug companies to provide discounts to selected hospitals and other providers that serve large numbers of low-income patients has been the subject of controversy in recent years. During that time, the administration has generally sided with hospitals and maintained the program.
That support was tempered recently when the Centers for Medicare & Medicaid Services proposed a 28 percent cut in Medicare payments to hospitals for drugs provided to low-income patients through the 340B program. Hospital industry groups responded by suing the federal government and will have their day in court later this month.
Pennsylvania safety-net hospitals participate in the 340B program and consider it essential to their ability to serve their communities.
What are the issues? Why do hospitals and other providers consider 340B so essential to their well-being while pharmaceutical companies and now, CMS, view the program with increasing skepticism?
Kaiser Health News has taken a look at these and other 340B questions. Read its story here.
Pennsylvania has launched a new website called Pennsylvania Link to Community Care to help seniors and people with disabilities find resources to help them address the challenges they face in their lives.
The site, a collaboration between the state’s Human Services and Aging departments, lists services in 12 categories: advocacy, behavioral health, employment, finance, health care, housing, in-home services, legal, meals, protection from abuse, support groups, and transportation. It also provides information to and links about programs, organizations, and services.
To learn more, see this state news release about the new site or go here to see the Pennsylvania Link to Community Care site itself.
Hospital admissions for diabetes rose 13 percent in Pennsylvania between 2000 and 2016. While admissions among older Pennsylvanians declined, the rate for younger people under the age of 45 increased 38 percent over that period of time.
Diabetes admissions in Pennsylvania resulted in $205 million in payments to hospitals in 2016, but according to the Pennsylvania Health Care Cost Containment Council, about 86 percent of 2016 adult admissions could have been prevented with more timely and appropriate care and disease management.
Learn more about the prevalence of diabetes admissions in Pennsylvania in the new PHC4 research brief
“Pennsylvania Hospital Admissions for Diabetes,” which can be found here.
The Pennsylvania Health Law Project has published its latest Health Law News.
Included in the November edition are articles about:
Find these stories here in the latest edition of Health Law News.
Legislation introduced in Congress would block the attempt by the Centers for Medicare & Medicaid Services to slash $1.6 billion in annual payments to hospitals for prescription drugs for outpatients prescribed through the federal section 340B prescription drug discount program.
Earlier this month CMS finalized its plan to reduce controversial 340B payments and shift $1.6 billion in savings into Medicare provider payments. If adopted, the bipartisan legislation co-sponsored by Representatives David McKinley (R-WV) and Mike Thompson (D-CA) would prevent the reduction of 340B payments, which are made to hospitals that care for especially large proportions of low-income patients.
The 340B program is an essential source of resources for private Pennsylvania safety-net hospitals and many stand to lose hundreds of thousands of dollars, or even millions of dollars a year, if the payment cut is not reversed.
Go here to see Rep. McKinley’s news release on the bill and here to see the bill itself, which is H.R. 4392, “To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes.”
New guidance from the Centers for Medicare & Medicaid Services on the use of directing additional Medicaid resources to hospitals through Medicaid managed care organizations is good news for Pennsylvania safety-net hospitals.
Such payments have been routed through the state’s Medicaid managed care plans for several years, but as the state and hospital industry continue negotiating renewal of the state’s hospital tax – its “Quality Care Assessment” – it was not entirely clear whether the federal government would permit continued use of this mechanism.
An early November bulletin from CMS, however, clarifies that this approach is still permissible, which is good news for Pennsylvania safety-net hospitals and SNAP members hoping to benefit from the state’s hospital assessment.
Go here to see the CMS memo “Delivery System and Provider Payment Initiatives under Medicaid Managed Care Contracts.”