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

Congress Looks at 340B Program

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.

PA Safety Net Admin2017-07-25T06:00:27+00:00July 25th, 2017|Medicare, Pennsylvania safety-net hospitals, Uncategorized|Comments Off

Confluence of State, Federal Activity Prompts Medicaid Talk in Harrisburg

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.
House Chamber of the State House 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.

PA Safety Net Admin2017-07-20T06:00:46+00:00July 20th, 2017|Pennsylvania Medicaid policy|Comments Off

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its latest Health Law News.
Included in the June/July edition are articles about the status of Pennsylvania’s FY 2018 budget, including possible changes in the state human services code; a delay in awarding new HealthChoices contracts; new quality initiatives in the state’s contracts with HealthChoices managed care organizations; an update on the implementation of Community HealthChoices, the state’s new program of managed long-term services and supports; and more.
Find the newsletter here.

PA Safety Net Admin2017-07-18T13:59:58+00:00July 18th, 2017|Pennsylvania Medicaid policy|Comments Off

Medicaid Enrollees: Access and Quality Are Good

Medicaid beneficiaries are generally satisfied with their access to care and the quality of care they receive.
Or so reports a new study based on results of the federal Medicaid Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey for December of 2014 to July of 2015.
According to the survey, nearly half of Medicaid patients rated their overall care 7.9 or greater on a scale of 10; 84 percent reported that they had been able to receive all of the care they needed over the past six months; and most were generally satisfied with the coverage. Relatively few reported problems finding providers willing to accept their Medicaid coverage.
Survey results generally were slightly more positive in Medicaid expansion states than in non-expansion states.
Pennsylvania safety-net hospitals serve especially large numbers of Medicaid patients.
Learn more about how Medicaid beneficiaries view the quality and accessibility of the care they receive in the JAMA Internal Medicine report “What Enrollees Think of Medicaid | Health Care Reform,” which can be found here.

PA Safety Net Admin2017-07-12T14:02:19+00:00July 12th, 2017|Pennsylvania safety-net hospitals|Comments Off

PHC4 Looks at “Super-Utilizers”

The Pennsylvania Health Care Cost Containment Council has released a new research brief on so-called super-utilizers: a small portion of the population that consumes an inordinate amount of health care. Super-utilizers are defined as individuals with five or more hospital admissions a year.
According to the PHC4 report,

Three percent of hospitalized patients accounted for 10 percent of hospital payments, or $1.25 billion, in 2016.
Super-utilizers accounted for three percent of hospitalized patients, 10 percent of hospital payments, 12 percent of hospital admissions, and 15 percent of hospital days.
46 percent of that care was paid for by Medicare, 19 percent by Medicaid, and 19 percent was for dually eligible patients.
The top three reasons for admissions among super-utilizers were sepsis, heart failure, and mental health disorders.
Diabetes and alcohol and substance abuse disorders were among the leading causes of admission for Medicaid patients.
The highest rates of super-utilizers were among blacks, low-income individuals, and older people.

The PHC4 report breaks down super-utilizers by county and shows the reasons for super-utilizers’ hospital admissions. Its side-by-side comparison of 2012 and 2016 shows a decline in super-utilizer admissions to hospitals, perhaps because of efforts by hospitals to reduce admissions and avoid Medicare penalties for avoidable hospital readmissions.
Go here to find the PHC4 report Pennsylvania’s “Super-Utilizers” of Hospital Care.

PA Safety Net Admin2017-06-21T11:29:59+00:00June 21st, 2017|Uncategorized|Comments Off

SNAP Joins Others in Letter to PA Senators

SNAP was among 27 Pennsylvania health care organizations to send a joint letter to senators Bob Casey and Pat Toomey pointing out aspects of the House-passed American Health Care Act that could jeopardize access to care for medically vulnerable Pennsylvanians.
Safety-Net Association of Pennsylvania logo Among the issues addressed in the letter are how the House-passed proposal would detract from the role of Medicaid in fighting the state’s opioid crisis; the proposed reduction in tax credits to help purchase health insurance; the challenge posed by a per capita approach to Medicaid financing; the potential loss of health care jobs; the likelihood of large numbers of Pennsylvanians losing their health insurance and state Medicaid costs rising significantly; and the erosion of consumer protections.
See the complete letter here.

PA Safety Net Admin2017-06-13T06:00:29+00:00June 13th, 2017|American Health Care Act, Federal Medicaid issues, Pennsylvania Medicaid, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its May newsletter.

Included in this edition are articles on new criteria for Medicaid coverage of high-cost hepatitis C drugs and the release of a draft of the state’s proposed Medicaid quality strategy; an update on Community HealthChoices, Pennsylvania’s new program of Medicaid managed long-term services and supports; an overview of Medicaid-covered behavioral health services; a summary of recent federal proposals with implications for the state’s Medicaid program; and a report on the nomination of Teresa Miller to lead the new Department of Health and Human Services that Governor Wolf has proposed establishing.

Find the newsletter here.

PA Safety Net Admin2017-06-02T06:00:28+00:00June 2nd, 2017|Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

The Prospect of a Medicaid Work Requirement

Over the past three years a dozen states have proposed establishing a work requirement for eligibility for their Medicaid programs and in its proposed FY 2018, the Trump administration has called for extending the ability to impose such a requirement to all states.
But how would a Medicaid work requirement work? To whom would it apply and what kinds of work might satisfy such a requirement for the approximately 22 million Medicaid recipients (out of 76 million total recipients) to whom it might apply?
Work requirements would have significant implications for the patients and communities that Pennsylvania safety-net hospitals serve, and possibly for the hospitals as well.
A new Commonwealth Fund report looks at these and other issues. Go here to find the article “What Might a Medicaid Work Requirement Mean?”

PA Safety Net Admin2017-06-01T06:00:06+00:00June 1st, 2017|Federal Medicaid issues|Comments Off

New Book Addresses Social Risk Factors in Medicare

In the new book, the National Academies of Sciences, Engineering, and Medicine addresses the question of what social risk factors might be worth considering in Medicare value-based payment programs and how those risk factors might be reflected in value-based payments.
The book, the culmination of a five-part NASEM process, focuses on five social risk factors:

socio-economic position
race, ethnicity, and cultural context
gender
social relationships
residential and community context

Addressing such factors in Medicare value-based payments, the book finds, can help achieve four important goals:

reduce disparities in access, quality, and outcomes
improve the qualify and efficiency of care for all patients
foster fair and accurate reporting
compensate provides fairly

Doing so also can help prevent five types of unintended consequences from a failure to address social risk factors in Medicare payment policy:

providers avoiding patients with social risk factors
reducing incentives to improve the quality of care for patients with social risk factors
underpaying providers that serve disproportionately large numbers of patients with social risk factors
a perception of different medical standards for different populations
obscuring disparities in care and outcomes

The kinds of patients these social risk factors seek to identify are precisely those served by Pennsylvania safety-net hospitals in far greater numbers than other community hospitals throughout the state.
Learn more about social risk factors and their potential role in Medicare value-based payment policy in the new book Accounting for Social Risk Factors in Medicare Payment, which can be downloaded free of charge here, from the web site of the National Academies of Sciences, Engineering, and Medicine.

PA Safety Net Admin2017-05-24T13:10:08+00:00May 24th, 2017|Pennsylvania safety-net hospitals|Comments Off

PA Medicaid to Expand Access to Hep C Drugs

Pennsylvania’s Medicaid program will make treatment for hepatitis C more readily available to Medicaid beneficiaries beginning on July 1, state officials have announced.
In recent years, new drugs have become available that effectively cure hepatitis C but their exceptionally high costs led many insurers, including most state Medicaid programs, to limit access to those drugs until patients show more advanced signs of the disease. A year ago the Pennsylvania Department of Human Services’ pharmacy and therapeutics committee recommended expanding access to these drugs for Pennsylvania Medicaid beneficiaries and now, that recommendation has been adopted and that expansion will begin with the new state fiscal year on July 1.
Under the new criteria, patients with lower scores of severity of hepatitis C will become eligible for treatment. Previously, Medicaid patients were required to show more advanced signs of illness before the medicine was provided to them.
Learn more about the Pennsylvania Medicaid program’s revised approach to serving Medicaid patients with hepatitis C in this Philadelphia Inquirer article.

PA Safety Net Admin2017-05-18T06:00:32+00:00May 18th, 2017|Pennsylvania Medicaid policy|Comments Off

SNAPShots

SNAPShots

About PA Safety Net Admin

Home / About Us / Advocacy / Why Join? / SNAPShots / Contact Us

Home / About Us / Advocacy / Why Join? / SNAPShots / Contact Us