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

Changing Medicaid

House Chamber of the State House With policy-makers in Washington considering some changes, and possibly major changes, in the state/federal Medicaid partnership, the Health Affairs Blog has taken a look at some of the options those policy-makers might consider.
Among them are:

giving states greater flexibility in the design and implementation of their own Medicaid programs
requiring cost-sharing by some or all beneficiaries, such as through premiums and co-payments
limiting benefits
employing incentives to encourage healthy behaviors

The article also considers the manner in which individuals enroll in Medicaid and how that has evolved over the years.
Because Pennsylvania’s safety-net hospitals care for so many low-income and Medicaid patients, they could be affected by any major federal Medicaid policy changes far more than the typical Pennsylvania hospital.
Learn more about some of the options Congress will have as it looks at possible Medicaid reform in the Health Affairs Blog article “The Future Of Medicaid: When Improving Upon The Wheel, Start With Something Round,” which can be found here.

PA Safety Net Admin2017-02-16T06:00:00+00:00February 16th, 2017|Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

Wolf Asks Ryan to Preserve Medicaid Expansion

In a letter to House Speaker Paul Ryan, Pennsylvania Governor Tom Wolf urged Congress, no matter how it addresses the Affordable Care Act, to preserve that law’s expansion of access to Medicaid-covered health care services.
The governor specifically pointed to the many people who receive substance abuse treatment through those services.

If the Affordable Care Act, or Obamacare, is repealed and not replaced, over a million Pennsylvanians could lose access to health care and tens of thousands of people – people who are our friends, our neighbors, and our family members that are currently receiving treatment for a substance use disorder – would lose insurance coverage and no longer be able to afford their treatment.

See Governor Wolf’s complete letter to House Speaker Ryan here.

PA Safety Net Admin2017-02-15T06:00:28+00:00February 15th, 2017|Affordable Care Act, Uncategorized|Comments Off

Serving High-Need, High-Cost Medicare Patients

With Medicare beneficiaries who have four or more chronic conditions accounting for 90 percent of Medicare hospital readmissions and 74 percent of Medicare costs (both 2010 figures), policy-makers are constantly looking for better ways to serve such individuals.
Academic research suggests that these beneficiaries need a variety of non-medical social interventions and supports, most of which are not covered by Medicare.
With this in mind, the Bipartisan Policy Center has prepared a review of current regulatory, payment, and other barriers that prevent providers and insurers from meeting some of the non-medical needs of high-need, high-cost patients that result in such high health care costs and hospital readmissions rates.
Many of these high-need, high-cost patients live in low-income communities served by private urban safety-net hospitals, making this a subject of particular interest to NAUH and its members
Many of these high-need, high-cost patients live in low-income communities served by Pennsylvania’s safety-net hospitals, making this a subject of particular interest to SNAP and its members.
Among the care models this review considers are Medicare Advantage plans, Medicare Advantage Dual-Eligible Special Needs Plans, Medicare Shared Savings Program Accountable Care Organizations, Next Generation ACOs, Comprehensive Primary Care Plus Model Participants, and Programs for All-Inclusive Care for the Elderly (PACE).
Find this all in the Bipartisan Policy Center report Challenges and Opportunities in Caring for High-Need, High-Cost Medicare Patients, which is available here.

PA Safety Net Admin2017-02-13T06:00:02+00:00February 13th, 2017|Medicare, Pennsylvania safety-net hospitals|Comments Off

Governor Proposes FY 2018 Budget

On Tuesday Pennsylvania Governor Tom Wolf unveiled his proposed FY 2018 budget to the state’s General Assembly.
This budget proposal includes a number of provisions with potential implications for Pennsylvania’s safety-net hospitals.
The Safety-Net Association of Pennsylvania has prepared a detailed review of those provisions. Officials of safety-net hospitals who would like to receive a copy of this memo may request one by using the “contact us” link on the upper right-hand corner of this screen.
Find a news release from the governor’s office that outlines the proposed budget here and go here (scroll to the bottom of the screen) for links to budget overviews, the entire budget itself, the Wolf administration’s presentation on its plan to consolidate Pennsylvania’s Department of Human Services, Department of Health, Department of Aging, and Department of Drug and Alcohol Services into a single new Department of Health and Human Services, and other related materials.

PA Safety Net Admin2017-02-10T06:00:00+00:00February 10th, 2017|Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance, Pennsylvania proposed FY 2018 budget|Comments Off

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its January 2017 newsletter.
Included in this edition are stories about:

impending changes in the lineup of managed care providers that serve Medicaid participants in the state’s HealthChoices program for physical health services;
the status of the state’s implementation of its Community HealthChoices program of managed long-term services and supports for low-income, elderly Pennsylvanians who seek to continue living independently in the community;
the potential impact of a repeal of the Affordable Care Act on Pennsylvanians; and
Pennsylvania’s receipt of a Certified Community Behavioral Health Clinic demonstration grant from the federal government to improve services and care coordination for individuals on Medicaid or CHIP.

Go here for the latest edition of PA Health Law News.

PA Safety Net Admin2017-02-08T17:39:17+00:00February 8th, 2017|Affordable Care Act, HealthChoices PA, Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

ACA Replacement?

While both the Trump administration and Congress insist that they will repeal and replace the Affordable Care Act, neither has yet provided information about what that replacement might look like.
But one place worth looking for a possible glimpse into the future is the Affordable Care Act replacement plan proposed by Rep. Tom Price (R-GA), President Trump’s nominee to serve as Secretary of the Department of Health and Human Services.
In 2015, Rep. Price proposed the Empowering Patients First Act as a vehicle for replacing the Affordable Care Act. While the bill was not adopted by Congress at the time, Dr. Price should soon be in a position to exert meaningful influence over the manner in which the Trump administration and Congress go about replacing the Affordable Care Act.
The Kaiser Family Foundation has prepared a summary of Dr. Price’s 2015 proposal. Go here to see that summary and to find a link to the legislation itself.

PA Safety Net Admin2017-01-24T06:00:29+00:00January 24th, 2017|Affordable Care Act|Comments Off

MedPAC: Small Pay Raise for Hospital Inpatient, Outpatient Services

The independent agency that advises Congress on Medicare payment matters has recommended modest increases in Medicare payments for hospital inpatient and outpatient services in FY 2018.
The Medicare Payment Advisory Commission voted in support of a market basket increase of approximately 1.85 percent for Medicare outpatient and inpatient services in FY 2018.
MedPAC also voted to recommend a 0.5 percent increase in payments to physicians but no increase for ambulatory surgery centers.
MedPAC will formally submit its recommendations to Congress in March.
Learn more about these and other MedPAC recommendations for changes in Medicare provider reimbursement in this article on the Provider web site.

PA Safety Net Admin2017-01-20T06:00:54+00:00January 20th, 2017|Medicare|Comments Off

Implications of ACA Repeal for Medicaid

How might repeal of the Affordable Care Act affect Medicaid?
Medicaid beneficiaries?
States and providers?
Because they care for so many Medicaid patients, including many who enrolled in Medicaid as a result of the Affordable Care Act, the answers to these questions are of special importance to Pennsylvania safety-net hospitals.
These issues and more are considered in the new Commonwealth Fund report “Medicaid’s Future: What Might ACA Repeal Mean?” Find it here.

PA Safety Net Admin2017-01-19T06:00:04+00:00January 19th, 2017|Affordable Care Act|Comments Off

ACOs Serving High Proportions of Racial and Ethnic Minorities Lag in Quality Performance

Accountable care organizations that serve large numbers of minority patients score lower on Medicare quality measures than other ACOs, a new study has found.
According to the study, ACOs serving larger numbers of minority patients perform worse than other ACOs on 25 of 44 Medicare performance measures – and that performance does not improve over time.
The study also pointed out that the minority patients served by ACOs are generally poorer and sicker than other ACO participants.
These are the very patients typically served in especially large numbers by Pennsylvania’s safety-net hospitals.
Learn more about these and other findings in the report “ACOs Serving High Proportions of Racial and Ethnic Minorities Lag in Quality Performance,” which can be found here.

PA Safety Net Admin2017-01-17T06:00:42+00:00January 17th, 2017|Medicare|Comments Off

Academies Completes Work on Social Risk Factors in Health Care

Completing its assignment from the U.S. Department of Health and Human Services, the Health and Medicine Division of the National Academies of Science, Engineering, and Medicine has published its fifth and final report on social risk factors that affect health outcomes for Medicare beneficiaries and how to account for those risk factors in Medicare payments.
Among other things, the report notes that

Although VBP [value-based purchasing] programs have catalyzed health care providers and plans to address social risk factors in health care delivery through their focus on improving health care outcomes and controlling costs, the role of social risk factors in producing health care outcomes is generally not reflected in payment under current VBP design. This misalignment has led to concerns that trends toward VBP could harm socially at-risk populations: Providers disproportionately serving socially at-risk populations are more likely to score poorly on performance/quality rankings, more likely to be penalized financially, and less likely to receive bonus payments under VBP. VBP may be taking resources from the organizations that need them the most.

The risk factors the Academies considered were socioeconomic position; race, ethnicity, and cultural context; gender; social relationships; and residential and community context.
The Academies’ fifth and final report brings together its first four efforts.

The first report, Accounting for Social Risk Factors in Medicare Payment Programs: Identifying Social Risk Factors, presented a conceptual framework and the results of a literature search linking social risk factors to health-related measures.
The second report, System Practices for the Care of Socially At-Risk Populations, explored six patient-centered systems practices that show potential for improving care for socially at-risk communities.
The third report, Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods, offered guidance on social risk factors might be incorporated into future Medicare payment systems.
The fourth report, Accounting for Social Risk Factors in Medicare Payment: Data, offered data strategies and solutions for collecting data to measure social risk factors that might be addressed in future Medicare payment systems.

The fifth and final report, Accounting for Social Risk Factors in Medicare Payment, offers additional thoughts and recommendations for next steps.
The subject of socio-economic risk adjustment is of interest to Pennsylvania safety-net hospitals because so many of the patients they serve present with such risk factors.
Find the new report here.

PA Safety Net Admin2017-01-13T06:00:16+00:00January 13th, 2017|Medicare, Pennsylvania safety-net hospitals, Uncategorized|Comments Off

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