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

Integrating Medicaid Supplemental Payments into Value-Based Purchasing

New health care delivery and reimbursement systems and new federal regulations will result in changes in how states deploy their Medicaid resources through supplemental payments in the coming years.
A new Commonwealth Fund report describes the kinds of supplemental Medicaid payments states currently make to hospitals – such as disproportionate share and upper payment limit payments – and notes the differing degree to which individual states use such supplemental payments.
It also describes how those supplemental payments may be restructured in the coming years to foster greater use of value-based purchasing and to reward achieving state-created quality goals through new delivery and reimbursement systems such as accountable care organizations, bundled payments, shared savings program, capitated arrangements, and shared risk.
Such changes have potentially serious implications for Pennsylvania safety-net hospitals – as SNAP members learned first-hand from state Medicaid director Leesa Allen when she met with them in November in Philadelphia to discuss the commonwealth’s plans for value-based purchasing and changes in Medicaid reimbursement.
Learn more about what the future may have in store for Medicaid supplemental payments in the Commonwealth Fund report Integrating Medicaid Supplemental Payments into Value-Based Purchasing.

PA Safety Net Admin2016-12-07T06:00:49+00:00December 7th, 2016|Medicaid supplemental payments, Pennsylvania Medicaid policy|Comments Off

Profile of Nominee to Head CMS

President-elect Donald Trump has nominated Seema Verma, a health care consultant, to serve as administrator of the Centers for Medicare & Medicaid Services. That agency runs the Medicare and Medicaid programs.
In this capacity she would have enormous influence on the development of new Medicare and Medicaid initiatives, including many proposals for change from the incoming administration and Congress – all matters of vital concern to Pennsylvania safety-net hospitals.
Go here to see a Kaiser Health News profile of Ms. Verma and learn more about her past work, especially on Medicaid issues.

PA Safety Net Admin2016-12-06T06:00:58+00:00December 6th, 2016|Medicare, Pennsylvania Medicaid|Comments Off

Social Determinants and Health Care

Amid growing recognition that social factors play at least much a role in the health of communities as medical care, growing attention is being paid to how best to address those social determinants in a health care system.
With increasing use of alternative delivery models such as accountable care organizations, some approaches place health care at the heart of a hub-and-spoke model to address population health, supported by functions such as affordable housing, home health care, job training, and more. Another approach places community organizations at the hub of care models, with the health care system as a spoke feeding into that hub.
Socio-economic issues that affect the health of communities are among the biggest challenges Pennsylvania safety-net hospitals face – challenges that take them well beyond their ability to provide quality care to their patients.
A recent article on the Health Affairs Blog explores the hub-and-spoke approach to addressing the social determinants that play such a major role in population health. Go here to read the blog article “Defining The Health Care System’s Role In Addressing Social Determinants And Population Health.”

PA Safety Net Admin2016-12-01T06:00:04+00:00December 1st, 2016|Pennsylvania safety-net hospitals|Comments Off

Financial Performance Strong at PA Non-General Acute Hospitals

For non-general acute-care hospitals in Pennsylvania, FY 2015 was generally a good year.
Long-term acute-care hospitals saw their average operating margins rise from 5.24 percent to 8.04 percent.
Operating margins for rehabilitation hospitals rose from 12.7 percent to 12.87 percent.
phc4 And while operating margins for psychiatric and specialty hospitals declined, they still remain generally strong at 8.81 percent and 7.78 percent, respectfully.
Learn more about the financial performance of non-acute-care hospitals in Pennsylvania in Financial Analysis 2015: An Annual Report on the Financial Health of Pennsylvania Non-GAC Hospitals, a new report from the Pennsylvania Health Care Cost Containment Council.

PA Safety Net Admin2016-11-28T06:00:44+00:00November 28th, 2016|Uncategorized|Comments Off

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its October 2016 newsletter.
phlp Included in this edition are stories about problems older adults are encountering when they seek to enroll in the state’s Aging Waiver program; an update on the implementation of Community HealthChoices, the new state program of managed long-term services and supports for qualified seniors; upcoming Medicare changes and enrollment and application deadlines; coverage of diabetes testing supplies for dual eligibles; new state guidelines addressing access to treatment for mental health conditions and substance abuse disorders; and more.
Go here for the latest edition of PA Health Law News.

PA Safety Net Admin2016-11-03T06:00:54+00:00November 3rd, 2016|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

PA Hospitals Reducing Readmissions, Mortality

Pennsylvania hospitals have seen a state-wide decrease in their mortality and readmission rates, according to new data released by the Pennsylvania Health Care Cost Containment Commission.
phc4 According to the new numbers, which cover hospital performance from January 1 through September 30 of 2015, hospital mortality rates fell for ten of the 16 conditions PHC4 tracks while readmissions fell for nine of the 13 conditions for which the agency collects data.
PHC4 estimates that this improved performance saved 3900 lives and avoided 2700 hospital readmissions.
For a closer look at the data PHC4 collected, the conditions it tracked, and a hospital-by-hospital, region-by-region, and state-wide look at hospital performance go here, to the PHC4 web site, to find a summary of the report, the news release that accompanied its publication, and three separate reports with all of the numbers and findings.

PA Safety Net Admin2016-10-21T06:00:42+00:00October 21st, 2016|Uncategorized|Comments Off

PA Uninsured Rate Declines

Pennsylvania’s uninsured rate has fallen to 6.4 percent, according to the U.S. Census Bureau.
That’s less than half the state-wide rate of 13 percent in 2011 and 2012.
Since that time the state’s Medicaid expansion has added 670,000 Pennsylvanians to the ranks of the insured, with others purchasing insurance through the federal health insurance marketplace.
Learn more about the decline in the number of uninsured Pennsylvanians in this news release from the office of Governor Tom Wolf.

PA Safety Net Admin2016-10-19T09:30:43+00:00October 19th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

A New Approach to Serving High-Cost, High-Need, High-Risk Medicaid Patients

A partnership consisting of a county government, a public hospital, a county-run Medicaid managed care plan, and a federally qualified health center, Hennepin Health is an accountable care organization that seeks to serve high-cost, high-need, high-risk Medicaid patients in the greater Minneapolis area.
Hennepin Health targets such individuals – all childless adults who became eligible for Medicaid when the state expanded its Medicaid program in 2011 – with the help of algorithms, identifies those most likely to incur high medical costs. It then offers a blend of social services, preventive care, and other services to address members’ medical conditions while bringing stability and order to their lives. Seventy-five percent of the program’s members are male, 70 percent are non-white, half lack stable housing, two-thirds suffer from mental illness, 80 percent have substance abuse problems, and 19 percent suffer from chronic pain.
These are the very kinds of patients typically served in especially high numbers by Pennsylvania safety-net hospitals.
The results of the program have been encouraging: the program has improved participants’ access to primary care, reduced emergency room visits, and stabilized the health of participants with chronic medical conditions. While hospitalizations have not declined, medical costs have fallen an average of 11 percent a year since 2012.
Led by the county government, Hennepin Health currently serves 12,000 members whose care is financed by Medicaid, with the county assisting with the cost of social services. All four ACO partners invested an initial $1.6 million for staff and data infrastructure and have assumed full financial risk for the venture.
Learn more about how one program is seeking to make a difference in the lives of high-risk, high-need patients while reducing high health care costs in the article “Hennepin Health: A Care Delivery Paradigm for New Medicaid Beneficiaries,” which can be found here, on the web site of The Commonwealth Fund.

PA Safety Net Admin2016-10-17T06:00:48+00:00October 17th, 2016|Pennsylvania safety-net hospitals|Comments Off

Perspective on Medicaid

A new report looks at how Medicaid has affected the health and health care of people throughout the country.
The Commonwealth Fund report “Understanding the Value of Medicaid” examines the impact of the Affordable Care Act’s expansion of Medicaid and notes that the program currently serves 73 million children, seniors, low-income working adults, and people with disabilities.
It also examines how Medicaid expansion has enhanced access to care and even given some people medical benefits comparable to those offered by private insurance.
Finally, the report notes that safety-net hospitals that serve especially large numbers of low-income patients now serve fewer uninsured patients and are better able to invest in new staff, clinics, and equipment, thereby enhancing the quality of care they deliver.
For a closer look at the impact Medicaid has on the American health care system, see this Commonwealth Fund report.

PA Safety Net Admin2016-10-14T06:00:35+00:00October 14th, 2016|Pennsylvania safety-net hospitals|Comments Off

New Study Questions 30-Day Readmissions as Measure of Hospital Quality

Hospital readmissions within 30 days of discharge may not be a good way of judging the quality of care hospitals provide, a new study suggests.
Seven days may be more like it.
According to a new study published in the journal Health Affairs, the impact of the quality of care a hospital provides appears to be most evident immediately upon patients’ discharge from the hospital.
Further, the study suggests,

… most readmissions after the seventh day postdischarge were explained by community- and household-level factors beyond hospitals’ control.

The researchers’ conclusion?

Shorter intervals of seven or fewer days might improve the accuracy and equity of readmissions as a measure of hospital quality for public accountability.

The findings call into question the approach employed by Medicare through its’ hospital readmissions reduction program. Some of the issues the study cites – community and household factors – are the very kinds of challenges that Pennsylvania’s safety-net hospitals face far more often than the typical community hospital in the state.
To learn more about how the study was performed and what its implications might be, go here to see the Health Affairs study “Rethinking Thirty-Day Hospital Readmissions: Shorter Intervals Might Be Better Indicators Of Quality Of Care.’

PA Safety Net Admin2016-10-12T06:00:20+00:00October 12th, 2016|Medicare, Pennsylvania safety-net hospitals|Comments Off

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