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

New Medicare Payments to Help With High-Need Patients

New Medicare payment practices that took effect on January 1 will improve payments to physicians who care for high-need patients in the hope that those enhanced payments will improve the care such seniors receive.
Among those improved payments are:

payments to physicians for the time they spend working with specialists, families, pharmacists, caregivers, and others to coordinate services for seriously ill patients
improved payments for time spent coordinating seniors’ transitions between different care settings and home and connecting those patients with additional resources
separate payments to perform cognitive impairment assessments
payments for time physicians spend reviewing patient records and talking on the phone to patients and their caregivers
ayments for work physicians perform with their high-need patients’ behavioral health caregivers

Learn more about how Medicare is trying to improve care for its some of its highest-need, highest-cost patients in this Kaiser Health News report.

PA Safety Net Admin2017-01-05T06:00:05+00:00January 5th, 2017|Medicare|Comments Off

Medicaid Directors Set Goals for First 100 Days

The National Association of Medicaid Directors has published a paper detailing its objectives for its interaction with the Trump administration during that administration’s first 100 days in office.

We call upon the new Administration to convene with NAMD’s Board of Medicaid Directors to solidify specific areas for ongoing collaboration to be carried out and reflected throughout our respective agencies.

The Administration should make two updates to the process for developing federal Medicaid regulations and guidance. First, build in a step for engaging states during the pre-conceptual phase of work. Second, establish a distinct process whereby state Medicaid leaders can review federal regulations and guidance prior to finalization to ensure policies are operationally sound.

NAMD also calls for the administration to foster state-federal collaboration in the following areas:

Alternative Payment Methodologies
Medicare and Medicaid Dual Eligible Population
Prescription Drugs
Managed Care/Risk-Based Delivery Models
Behavioral Health Issues
Access to Services
Home and Community Based Services
Department of Labor & the Fair Labor Standards Act
Medicaid Management Information Systems
Transformed Medicaid Statistical Information Services
Other Existing Regulations

Learn more about NAMD’s goals for the first 100 days of the Trump administration in the association paper “The First 100 Days: Laying the Groundwork for a Successful Federal-State Medicaid Partnership.”

PA Safety Net Admin2017-01-04T06:00:47+00:00January 4th, 2017|Uncategorized|Comments Off

Expanded Access to Hep C Drugs Isn’t the Answer for Medicaid, Study Says

A new study suggests that greatly expanding access to new drugs that essentially “cure” Hepatitis C would cost Pennsylvania’s Medicaid program a great deal of money but save relatively few lives.
The study found that in many cases, Hepatitis C progresses so slowly that by the time many of the people who suffer from it truly need the new generation of expenses drugs they will be old enough for Medicare, which would leave the federal government, rather than the state, with the cost of paying for the treatment.
Prescription Medication Spilling From an Open Medicine Bottle Patient advocates maintain that all Medicaid beneficiaries with Hepatitis C should have access to the drugs and Pennsylvania’s Medicaid program appears to be on a path toward making that possible.
Learn more about the study and its findings in this Philadelphia Inquirer story.

PA Safety Net Admin2017-01-03T06:00:29+00:00January 3rd, 2017|Pennsylvania Medicaid policy|Comments Off

Patient Safety Authority Issues Newsletter

patient-safety-authority The Pennsylvania Patient Safety Authority has published its December 2016 newsletter.
Included in it are articles about drug interactions, infection control practices, wrong-site surgeries, the use of simulations in improving patient safety, and more.
Find the newsletter here.

PA Safety Net Admin2016-12-30T06:00:24+00:00December 30th, 2016|Uncategorized|Comments Off

New Study: Social Risk Factors Affect Provider Performance and Patient Outcomes

Medicare patients with social risk factors fare worse than others in programs that measure quality and the providers that serve them also perform worse than others on quality measures.
This news comes from a new report presented to Congress by the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Planning Evaluation.
The report, mandated by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, focused on nine Medicare payment programs:

the hospital readmissions reduction program
the hospital value-based purchasing program
the hospital acquired condition reduction program
the Medicare Advantage (Part C) quality star rating program
the Medicare shared savings program
the physician value-based payment modifier program
the end-stage renal disease quality incentive program
the skilled nursing facility value-based purchasing program
the home health value-based purchasing program

APSE concluded that:

Beneficiaries with social risk factors had worse outcomes on many quality measures, regardless of the providers they saw, and dual enrollment status was the most powerful predictor of poor outcomes.
Providers that disproportionately served beneficiaries with social risk factors tended to have worse performance on quality measures, even after accounting for their beneficiary mix. Under all five value-based purchasing programs in which penalties are currently assessed, these providers experienced somewhat higher penalties than did providers serving fewer beneficiaries with social risk factors.

Among the solutions suggested in the report for addressing these problems are:

adjusting quality and resource use measures
adjusting payments
addressing the underlying issues

The report also suggests that HHS’s strategy for accounting for social risk in Medicare’s value-based purchasing programs should consist of the following three steps:

measure and report quality for beneficiaries with social risk factors
set high, fair quality standards for all beneficiaries
reward and support better outcomes for beneficiaries with social risk factors

And in carrying out these steps, the report recommends that HHS

provide specific payment adjustments to reward achievement and/or improvement for beneficiaries with social risk factors, and
where feasible, provide targeted support for providers who disproportionately serve them.

Medicare beneficiaries who present with socio-economic risk factors are served by Pennsylvania safety-net hospitals in especially large numbers.
Learn more about the problems APSE found and its proposals for dealing with those problems by reading Report to Congress: Social Risk Factors and Performance Under Medicare’s Value-Based Purchasing Programs.

PA Safety Net Admin2016-12-30T06:00:20+00:00December 30th, 2016|Medicare, Pennsylvania safety-net hospitals|Comments Off

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

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