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

Medicare Program Biased Against Selected Hospitals

Medicare’s hospital-acquired conditions program unfairly penalizes large, large urban, and teaching hospitals, according to a new study.
According to “Complication Rates, Hospital Size, and Bias in the CMS Hospital-Acquired Condition Reduction Program,” published recently in the American Journal of Medical Quality, the hospital-acquired conditions program, which last year penalized nearly 800 hospitals, disproportionately penalizes large, large urban, and teaching hospitals because its threshold for identifying poor-performing hospitals is too broad, it relies on results that in many cases are not statistically different, and it fails to recognize when hospital performance improves.
To correct these biases, the study’s authors recommend adding risk-adjustment components, such as hospital size, to identify poor performers.
Many of Pennsylvania’s safety-net hospitals are large and have teaching programs.
Learn more about the study, its findings, and its recommendation in this Fierce Healthcare article or go here to read the study on the web site of the American Journal of Medical Quality.

PA Safety Net Admin2016-12-29T06:00:36+00:00December 29th, 2016|Medicare, Pennsylvania safety-net hospitals|Comments Off

PA Health Law Project Newsletter

phlp The Pennsylvania Health Law Project has published its November-December 2016 newsletter.
Included in this edition are stories about a new effort to enroll children in the state’s Medicaid and Children’s Health Insurance Program, the new fees for Medicare Part A and Part B for 2017, a delay in the implementation of the state’s proposed Community HealthChoices program of managed long-term services and supports, and more.
Go here for the latest edition of PA Health Law News.

PA Safety Net Admin2016-12-28T06:00:04+00:00December 28th, 2016|Medicare, Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

PA Chosen for Behavioral Health Services Demo

Pennsylvania will be one of eight states to participate in a new federal two-year Certified Community Behavioral Health Clinic demonstration program.
samhsa According to the federal Substance Abuse and Mental Health Services Administration, the program is

…designed to improve behavioral health services in their communities. This demonstration is part of a comprehensive effort to integrate behavioral health with physical health care, increase consistent use of evidence-based practices, and improve access to high quality care for people with mental and substance use disorders.

A federal spokesperson explained that

The demonstration program will improve access to behavioral health services for Medicaid and CHIP beneficiaries, and will help individuals with mental and substance use disorders obtain the health care they need to maintain their health and well-being.

The program is authorized under Section 223 of the Protecting Access to Medicare Act of 2014. Last year the federal government awarded 24 states planning grants under the law. Nineteen of those states applied to participate in the program and eight, including Pennsylvania, were ultimately chosen.
As part of its application, Pennsylvania designated ten sites for program implementation:

Berks Counseling Center, Berks County
Cen Clear Child Services, Clearfield County
Cen Clear Punxsy, Jefferson County
Community Council Health Systems, Philadelphia County
NHS Human Services, Delaware County
Northeast Treatment Centers, Philadelphia County
Pittsburgh Mercy, Allegheny County
Resources for Human Development, Montgomery County
Safe Harbor Behavioral Health of UPMC Hamot, Erie County
The Guidance Center, McKean County

According to the state, the programs at these sites will:

enhance access to behavioral health services for Medicaid and CHIP beneficiaries,
help individuals with mental health and substance use disorders obtain the health care they need to maintain their health and well-being,
allow individuals to have access to a wide array of services at one location, and
remove the barriers that too often exist across physical and behavioral health systems.

Learn more about the demonstration from this news release from the U.S. Department of Health and Human Services. Learn more about Pennsylvania’s plans for its demonstration program from this news release from the state’s Department of Human Services.

PA Safety Net Admin2016-12-27T06:00:17+00:00December 27th, 2016|Pennsylvania Medicaid, Uncategorized|Comments Off

Feds Launch Medicare-Medicaid ACO Model

The Center for Medicare and Medicaid Innovation has announced a new Medicare-Medicaid Accountable Care Organization Model that it says

…is focused on improving quality of care and reducing costs for Medicare-Medicaid enrollees. The MMACO Model builds on the Medicare Shared Savings Program (Shared Savings Program), in which groups of providers take on accountability for the Medicare costs and quality of care for Medicare patients. Through the Model, CMS will partner with interested states to offer new and existing Shared Savings Program ACOs the opportunity to take on accountability for the Medicaid costs for their assigned Medicare-Medicaid enrollees.

cms In this new model, the Innovation Center

… seeks to encourage participation from safety-net providers in Alternative Payment Models. Medicare-Medicaid ACOs that qualify as “Safety-Net ACOs” will be eligible to receive pre-payment of Medicare shared savings to support the ACO’s investment in care coordination infrastructure.

The Innovation Center envisions pursuing such undertakings with six states, which will be chosen on a competitive basis.
Learn more about the Medicare-Medicaid Accountable Care Organization model here, on the Innovation Center’s web site.

PA Safety Net Admin2016-12-22T14:27:49+00:00December 22nd, 2016|Uncategorized|Comments Off

Improving Social Conditions May Improve Health

A new study has found that interventions that address patient problems such as difficulty affording food, housing, and medicine may lead to better health for those patients.
According to a new study published in JAMA Internal Medicine, when the group Health Leads screened patients for unmet basic needs and helped address those needs, those patients showed significant improvement in blood pressure and cholesterol levels.
While not conclusive – the interventions did not improve blood glucose levels – the study suggests that the kinds of patients served by Pennsylvania safety-net hospitals, who often turn to such hospitals for care with significant socio-economic risk factors, would benefit from a broader array of services than hospitals alone typically provide.
Learn more by going here to view the JAMA Internal Medicine report “Addressing Unmet Basic Resource Needs as Part of Chronic Cardiometabolic Disease Management.”

PA Safety Net Admin2016-12-21T06:00:30+00:00December 21st, 2016|Pennsylvania safety-net hospitals|Comments Off

Uninsured Patients, Provider Taxes Hurt Adequacy of Medicaid Payments

While Medicaid payments now typically cover more than the cost of Medicaid services in many states, they do not cover the costs of caring for low-income patients after providers care for uninsured patients and pay Medicaid provider taxes, a new study has found.
According to a Health Affairs report,

After accounting for supplemental payments, we found that in 2011, disproportionate-share hospitals, on average, received gross Medicaid payments that totaled 108 percent of their costs for treating Medicaid patients but only 89 percent of their costs for Medicaid and uninsured patients combined. However, these payments were reduced by approximately 4–11 percent after we accounted for provider taxes and local government contributions that are used to help finance Medicaid payments.

Because they are all disproportionate share hospitals, this is especially a challenge for Pennsylvania’s urban safety-net hospitals.
To learn more, go here to see the Health Affairs analysis “For Disproportionate-Share Hospitals, Taxes And Fees Curtail Medicaid Payments.”

PA Safety Net Admin2016-12-20T06:00:49+00:00December 20th, 2016|Pennsylvania safety-net hospitals, Uncategorized|Comments Off

Impact of “Repeal and Replace” on PA?

With the president-elect and congressional leaders vowing to repeal and replace the Affordable Care Act, the question arises about how such actions might affect Pennsylvania.
Health Benefits Claim Form That includes 680,000 Pennsylvanians who enrolled in the state’s Medicaid program after the reform law allowed for that program’s expansion, more than 400,000 people who signed up for insurance on the federal health insurance exchange, the state’s taxpayers who might be left with the bill for some or all of these costs if the reform law’s financial support were to disappear in the near future, and others.
The Pittsburgh Tribune-Review considers these and other questions and offers answers from some of those closest to the situation. See its story here.

PA Safety Net Admin2016-12-19T06:00:38+00:00December 19th, 2016|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

New Approach to Helping Patients With Complex Needs

Five foundations have joined forces to pursue new approaches to serving patients with complex medical needs.
The Commonwealth Fund, the John A. Hartford Foundation, the Peterson Center on Healthcare, the Robert Wood Johnson Foundation, and The SCAN Foundation engaged the Institute for Healthcare Improvement to identify promising ways of better serving patients with complex medical needs. Many such patients, the foundations believe, have adequate access to medical care yet struggle to find the coordination needed between medical, behavioral, and social services to stay well and avoid costly hospitalizations.
The group’s first public product is The Playbook, which it describes as

…a dynamic website that highlights the challenges facing adults with complex health and social needs and provides direction on how to meet those needs through a variety of resources that detail care models, policies, and more.

The Playbook offers a variety of resources to caregivers, such as an intensive outpatient care program toolkit, a quick reference to promising care models, recommendations for tailoring complex care management for high-need, high-cost patients, and more.
Serving patients with complex medical problems can be especially challenging for Pennsylvania safety-net hospitals because they often have so many such patients.
Find The Playbook here.

PA Safety Net Admin2016-12-16T06:00:46+00:00December 16th, 2016|Pennsylvania safety-net hospitals|Comments Off

MedPAC Talks Payments

At public meetings in Washington, D.C. last week, members of the Medicare Payment Advisory Commission discussed the adequacy of current Medicare payments and whether they need updating in the next fiscal year.
Among the payment areas MedPAC reviewed were inpatient services, outpatient services, physician and health professional services, ambulatory surgical center services, skilled nursing facilities, home health services, inpatient rehabilitation hospitals, long-term-care facilitiies, outpatient dialysis services, and hospices.
Find the issue briefs and presentations used to guide these discussions here, on MedPAC’s web site.

PA Safety Net Admin2016-12-13T06:00:37+00:00December 13th, 2016|Medicare|Comments Off

PA Improves Access to Contraceptives

Citing the challenges and risks associated with unplanned pregnancies that occur within two years of a delivery, Pennsylvania’s Medicaid program is making long-acting contraceptives more readily available to program participants.
Pennsylvania State Map Beginning on December 1, Medicaid will pay for long-acting contraceptives administered after delivery and also will increase payments to doctors who provide those contraceptives. Currently, those costs are generally borne by hospitals in the lump-sum payment Medicaid makes for deliveries.
Learn more about the state’s new policy for encouraging the use of contraceptives among Medicaid beneficiaries who have delivered babies in this Lancaster Online article.

PA Safety Net Admin2016-12-09T06:00:58+00:00December 9th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

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