Leesa Allen, deputy secretary of the Pennsylvania Department of Human Services’ Office of Medical Assistance Programs and state Medicaid director, has been appointed to the board of directors of the National Association of Medicaid Directors.
See the Wolf administration’s news release about Ms. Allen’s appointment here.
With the state budget still lacking a plan to raise revenue to underwrite expenses, the Wolf administration is beginning to withhold payments to the state’s creditors.
Including those who provide services to the more than 2.8 million Pennsylvanians enrolled in the state’s Medicaid program.
Last week the Wolf administration announced that it withhold $1.2 billion in Medicaid provider payments.
Unless the problem is resolved, more state payments could be withheld in the coming weeks.
Learn more about what the Wolf administration is doing and how it might affect Medicaid and Medicaid providers in this Philadelphia Inquirer article.
Far fewer hospital emergency room visits are for medical problems better addressed in other settings, according to a new study.
In a review of six years worth of data encompassing 424 million ER visits, researchers found that only 3.3 percent of those visits were truly “avoidable,” with the avoidable visits mostly involving problems ERs are not equipped to address, such as dental and mental health issues.
This finding flies in the face of the conventional wisdom that people turn too quickly to hospital ERs for routine medical problems or use ERs because they lack access to more appropriate care.
Learn more about the study and its findings in this Fierce Healthcare article or go here for a link to the study “Avoidable emergency department visits: a starting point,” which was published in the International Journal for Quality in Health Care.
The Centers for Medicare & Medicaid Services should not significantly reduce Medicare payments for some prescription drugs.
Or so says one of CMS’s own advisory panels.
The agency’s Advisory Panel on Outpatient Prospective Payment reached this conclusion after listening to testimony from hospital industry stakeholders who told of the savings the federal government’s 340B prescription drug discount program produces and how those savings enable hospitals in low-income areas to help low-income patients who would not otherwise be able to afford their drugs and help improve access to care for low-income patients with very limited health care options.
The panel’s recommendation came just a month after CMS proposed reducing Medicare reimbursement for 340B drugs from its current level, average sales price plus six percent, to average sales price less 22.5 percent..
Critics of the program maintain that it is abused by hospitals, which are not required to reinvest their 340B savings in health care for the poor. Program supporters maintain that hospitals do use those savings for this very purpose.
Most Pennsylvania safety-net hospitals participate in the 340B program and consider it an essential part of their overall effort to serve the many low-income residents of the communities they serve.
CMS called for the change in the 340B program in a proposed regulation published in July. Interested parties have until September 11 to comment on the proposal.
Learn more about this issue and the CMS advisory panel’s recommendation in this Fierce Healthcare article.
The federal government should give states the option of monitoring Medicaid disproportionate share payments (Medicaid DSH) to hospitals through prospective DSH limit calculations rather than through retroactive DSH audits.
SNAP recently shared this view with the House Ways and Means Committee’s Health Subcommittee in response to that subcommittee’s request for suggestions from stakeholders on ways to improve the delivery of Medicare services and eliminate statutory and regulatory obstacles to more effective care delivery.
According to SNAP, retroactive DSH audits are cumbersome, burdensome, and expensive, give rise to many disputes and appeals, and in the end yield results very similar to much simpler prospective DSH limit calculations performed by the very state governments that distribute Medicaid DSH funds.
See SNAP’s comments to the Ways and Means Committee here.
Practices that served more socially high-risk patients had lower quality and lower costs, and practices that served more medically high-risk patients had lower quality and higher costs. These patterns were associated with fewer bonuses and more penalties for high-risk practices.
So concludes a new study that looked at the results of the first year of the Medicare Physician Value-Based Payment Modifier Program.
The study looked at 899 physician practices serving more than five million Medicare beneficiaries, and it points to the continuing challenge of how best to serve patients who pose greater socio-economic risks than the average patient.
Pennsylvania safety-net hospitals serve far more high-risk patients than the typical hospital.
Learn more these findings and how they were reached in the study “Association of Practice-Level Social and Medical Risk With Performance in the Medicare Physician Value-Based Payment Modifier Program,” which can be found here, on the web site of the Journal of the American Medical Association.
The Affordable Care Act has reduced socioeconomic disparities in access to health care in the U.S.
According to a new study published in the journal Health Affairs,
Health care access for people in lower socioeconomic strata improved in both states that did expand eligibility for Medicaid under the ACA and states that did not. However, gains were larger in expansion states. The absolute gap in insurance coverage between people in households with annual incomes below $25,000 and those in households with incomes above $75,000 fell from 31 percent to 17 percent (a relative reduction of 46 percent) in expansion states and from 36 percent to 28 percent in nonexpansion states (a 23 percent reduction). This serves as evidence that socioeconomic disparities in health care access narrowed significantly under the ACA.
Addressing socioeconomic barriers to access to care has long been one of the major roles Pennsylvania safety-net hospitals play in their individual communities.
Learn more about how the study was conducted and what it revealed in the article “The Affordable Care Act Reduced Socioeconomic Disparities In Health Care Access,” which can be found here, on the Health Affairs web site.
The House Ways and Means Committee’s Health Subcommittee has launched a new initiative to attempt to improve the delivery of Medicare services and eliminate statutory and regulatory obstacles to more effective care delivery.
The subcommittee describes its “Medicare Red Tape Relief Project” as
…a new initiative to deliver relief from the regulations and mandates that impede innovation, drive up costs, and ultimately stand in the way of delivering better care for Medicare beneficiaries.
In support of this initiative, the committee has announced a three-part approach in which it will seek feedback from stakeholders, host roundtables with stakeholders across the country, and pursue congressional action to address the problems identified through this process.
As part of the first step, the Health Subcommittee is inviting stakeholders to submit information about regulatory and statutory obstacles they have encountered and how they believe the federal government should address those obstacles.
Learn more about the Medicare Red Tape Relief Project and how stakeholders can report problems and recommend improvements from this subcommittee news release.
Last week the House Energy and Commerce Committee took a look at the 340B prescription drug discount program, which requires pharmaceutical companies to sell discounted drugs for outpatient use to hospitals that care for especially large numbers of low-income patients.
The previous week, the Centers for Medicare & Medicaid Services issued a proposed Medicare regulation calling for significant reductions in Medicare payments for such drugs.
The hearing touched on the CMS proposal to reduce Medicare payments for 340B drugs, the high prices of prescription drugs, the 340B program’s growth over the years, the possibility that the program is being abused by hospitals and clinics, and more.
The 340B program is an essential tool in the efforts of Pennsylvania safety-net hospitals to help the many low-income residents of the communities they serve.
Learn more about the hearing and the issues raised during it this Kaiser Health News report.
The combination of Congress attempting either to repeal and replace or repair the Affordable Care Act and Pennsylvania facing a multi-billion budget shortfall has led some policy-makers in Harrisburg to begin talking about ways to better manage or reduce the state’s Medicaid costs.
Those costs climbed from $3.9 billion in 2004 to $6 billion in 2014.
Among the possibilities state lawmakers are discussing: tighter rules for participation, greater efficiency, work and work search requirements for able-bodied Medicaid recipients, charging premiums for high-income families for which Medicaid provides coverage for their profoundly disabled children, and a pilot program to test whether a recipient care management program might eliminate medical errors, improve recipient health, and reduce health care costs.
Learn more about some of the Medicaid ideas Pennsylvania policy-makers are considering in this PennLive article.