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

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

Pennsylvania Health Law Project Newsletter

phlp The Pennsylvania Health Law Project has published its September 2016 newsletter.
Included in this edition are stories about the selection of managed care organizations to participate in the state’s new Community HealthChoices program to provide community-based managed long-term services and supports to individuals who receive both Medicaid and Medicare and who are eligible for nursing home care; the open enrollment period for Medicare and Medicare Part D drug plans; the awarding of six “Navigator grants” to Pennsylvania organizations that counsel people interested in obtaining health insurance through the federal health insurance marketplace; and actions take by the state to improve access to pediatric shift nursing and home health aide services for children covered by Medicaid.
Find the newsletter here.

PA Safety Net Admin2016-10-10T06:00:18+00:00October 10th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

MACPAC Looks at Medicaid DSH

With Medicaid disproportionate share payments (Medicaid DSH) facing future reductions, the agency charged with advising Congress on Medicaid and Children’s Health Insurance payment and access matters is considering what changes the federal supplemental Medicaid payment program might need.
At a recent meeting in Washington, D.C., the Medicaid and CHIP Payment and Access Commission discussed the changing role and purpose of Medicaid DSH as more Americans obtain health insurance through private or public sources. MACPAC commissioners noted that hospital uncompensated care is falling, especially in states that have taken advantage of the Affordable Care Act to expand their Medicaid programs.
A new Medicaid DSH formula set to be used for FY 2018, based more heavily than the current formula on the number of uninsured people in individual states, is expected to result in larger-than-average reductions for hospitals in Medicaid expansion states.
Among the steps commissioners discussed were examining how hospitals use their Medicaid DSH funds; considering how any changes in the distribution of Medicaid DSH funds might affect other parts of states’ health care systems; and the role states should play in determining the allocation of Medicaid DSH funds.
Medicaid DSH funds are a vital source of support to help Pennsylvania safety-net hospitals care for their many uninsured patients.
For a closer look at the issue and MACPAC’s deliberations, see this CQ Roll Call article presented by the Commonwealth Fund.

PA Safety Net Admin2016-09-26T06:00:26+00:00September 26th, 2016|Affordable Care Act, Medicaid supplemental payments, Pennsylvania safety-net hospitals|Comments Off

MACPAC Meets

The federal agency responsible for advising Congress on Medicaid and Children’s Health Insurance Program payment and access issues met last week in Washington, D.C.
According to the Medicaid and CHIP Payment and Access Commission,

The initial sessions of MACPAC’s September 2016 Commission meeting focused on hospital payment policy, first discussing MACPAC’s new work to develop an index of Medicaid inpatient payments across states and relative to Medicare, and later looking at how Affordable Care Act coverage expansions have affected hospitals serving a disproportionate share of low-income patients, including those with Medicaid coverage. The Commission then reviewed state policies for covering and paying for services in residential care settings, part of the drive to rebalance long-term services and supports from institutions to the community.

A briefing on MACPAC’s recent roundtable on improving service delivery to Medicaid beneficiaries with serious mental illness kicked off the afternoon sessions, followed by a discussion of Medicaid financing and its relationship to provider payment policies. At the final session of the day, the Commission reviewed the possible elements of a package of recommendations on children’s coverage and the future of CHIP.

The following are the presentation materials referenced during the meeting:

MACPAC’s deliberations often have implications for Pennsylvania safety-net hospitals.

PA Safety Net Admin2016-09-23T06:00:11+00:00September 23rd, 2016|Uncategorized|Comments Off

Medicare Readmissions Down Almost Everywhere

Hospitals in 49 of the 50 states have reduced their Medicare readmissions since the federal health care program introduced its readmissions reduction program in 2010.
Only hospitals in Vermont have failed to cut readmissions.
Nationally, readmissions fell more than five percent in 43 states and more than ten percent in 11 states. Overall, readmissions fell 100,000 in 2015 alone compared to 2010 and have fallen 565,000 since 2010.
As the program ages more medical conditions are being subjected to the readmissions reduction program’s requirements. In the coming year, the Centers for Medicare & Medicaid Services estimates it will penalize 2500 hospitals $538 million for failing to reduce their readmissions.
Learn more about CMS’s efforts to reduce readmissions among Medicare patients in this entry on the CMS Blog.

PA Safety Net Admin2016-09-22T06:00:36+00:00September 22nd, 2016|Medicare, Uncategorized|Comments Off

Senate May Tackle Socio-economic Risk Adjustment

With a House bill to adjust Medicare payment penalties based upon the socio-economic challenges posed by the patients some hospitals serve folded into a House bill that passed in June, the Senate may take up this issue during its fall session.
Health economists, policy experts, and providers generally agree that the performance of hospitals that serve especially large numbers of low-income patients is affected in a number of areas, including Medicare readmissions, meeting value-based purchasing criteria, and others.
And while the Centers for Medicare & Medicaid Services acknowledges the challenge, the agency has rejected calls for risk adjustment so far, repeatedly writing that it does not “want to mask potential disparities or minimize incentives to improve the outcomes of disadvantaged populations.”
Meanwhile, a growing body of research has documented that the anticipated impact of serving socioeconomically challenged patients is real and more and more people are joining the call for Congress or CMS to address the problem.
Compounding the challenge is that hospitals that serve such patients are faced with growing financial penalties from Medicare if they fail to perform at levels comparable to hospitals that face fewer challenges.
For a closer look at the issue, the arguments on both sides, and the prospects for congressional action this fall, see this article from CQ Roll Call presented by the Commonwealth Fund.

PA Safety Net Admin2016-09-20T06:00:19+00:00September 20th, 2016|Medicare|Comments Off

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