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

Bill Proposes Risk-Adjusting Medicare Readmissions Program

A new bill introduced in the House Ways and Means Committee would apply risk adjustment for socio-economic factors to Medicare’s hospital readmissions reduction program.
According to a committee summary of the bill, The Helping Hospitals Improve Patient Care Act of 2016 includes a provision that would direct the Secretary of Health and Human Services to

… implement a transitional risk adjustment methodology to serve as a proxy of socio-economic status for the Hospital Readmissions Reduction Program. In addition to the transitional adjustment, the section clarifies that the Secretary is able to permanently use a more refined methodology following the analysis required by the Improving Medicare Post-Acute Care Transformation Act of 2014. The section also requires a study by the Medicare Payment Advisory Commission (MedPAC), and allows for an analysis of “V-codes” and an exploration of potential exclusions.

The bill would be beneficial for Pennsylvania’s private safety-net hospitals because they serve more low-income patients who are more challenging to treat than typical hospital patients and are more likely to require post-discharge readmission to address continuing medical and social issues.
For a closer look at the bill’s socio-economic risk adjustment provision and other proposals, go here to see the committee’s summary of H.R. 5273, The Helping Hospitals Improve Patient Care Act of 2016, and go here to see the bill itself.

PA Safety Net Admin2016-05-23T06:00:17+00:00May 23rd, 2016|Medicare, Pennsylvania safety-net hospitals|Comments Off

Socio-Economic Factors Leading Cause in Pediatric Asthma Readmissions

African-American children suffering from asthma are readmitted to hospitals more often than other children primarily because of socio-economic factors, a new study published in JAMA Pediatrics has concluded.
In a study conducted in Cincinnati, according to the report, “Socioeconomic hardship variables explained 53% of the observed disparity” in readmissions among African-American children with asthma. The study also found that

A total of 80% of the observed readmission disparity between African American and white children could be explained after statistically balancing available biologic, environmental, disease management, access to care, and socioeconomic and hardship variables across racial groups.

These findings are especially relevant to Pennsylvania safety-net hospitals because the communities they serve often have especially large numbers of low-income and low-income African-American children.
Read more about the study, its findings, and its implications in the JAMA Pediatrics article “Explaining Racial Disparities in Child Asthma Readmission Using a Causal Inference Approach, “which can be found here.

PA Safety Net Admin2016-05-19T06:00:21+00:00May 19th, 2016|Uncategorized|Comments Off

Covered by Medicare But Underinsured

Nearly a quarter of the country’s 50 million Medicare beneficiaries are underinsured and ill-equipped financially to handle the program’s cost-sharing responsibilities.
Or so concludes a new report from the Commonwealth Fund.
According to the report, Medicare’s cost-sharing requirements – premiums, co-pays, deductibles, and services not covered by the program, such as dental and vision care – far outstrip the resources of more than 11 million low-income program participants, leaving many to spend more than 20 percent of their income on health care costs.
In its new report “On Medicare But At Risk: A State-Level Analysis of Beneficiaries Who Are Underinsured or Facing High Total Cost Burdens,” the Commonwealth Fund describes the health care costs Medicare does and does not cover, defines what constitutes “underinsured” and ill-equipped to handle health care costs, delineates the out-of-pocket costs for which beneficiaries are responsible, and offers a state-by-state breakdown of where the uninsured can be found and the proportion of total income they spend on medical services.
Because they serve communities with especially large numbers of low-income residents, Pennsylvania’s safety-net hospitals care for disproportionate numbers of such underinsured Medicare patients. As a result, they face the prospect of providing significant amounts of uncollectible uncompensated care as a result of Medicare patients who cannot afford their co-pays and deductibles.
Find the Commonwealth Fund report here.

PA Safety Net Admin2016-05-16T06:00:34+00:00May 16th, 2016|Medicare, Pennsylvania safety-net hospitals|Comments Off

PA Proposes Medicaid Observation Rate

Pennsylvania_Bulletin_logo Under a newly proposed policy, Pennsylvania would pay hospitals and physicians an observation rate for Medicaid patients who are treated in their emergency departments but for whom they cannot make an immediate decision on the need for admission.
As described in a Pennsylvania Bulletin notice published last Saturday,

Observation services are a well-defined set of clinically appropriate and medically necessary services, which include short-term treatment, assessment and reassessment, that are furnished while a decision is made as to whether to admit an MA beneficiary to the inpatient hospital setting for further treatment or to discharge the MA beneficiary from the hospital outpatient setting. The Department is recognizing the need for observation services because a physician may not be able to initially determine whether an inpatient hospital admission is medically necessary.

The proposed policy, to take effect at the beginning of the state’s 2017 fiscal year (July 1, 2016), addresses and prescribes payments for hospitals and physicians, including new procedure codes.
According to the notice, Pennsylvania anticipates spending $10.229 million in state funds, and $28.28 million overall, for such services in FY 2017.
Interested parties have 30 days from the notice’s publication (May 14) to submit written comments about the proposed policy.
Find the Pennsylvania Bulletin notice introducing this proposed policy here.

PA Safety Net Admin2016-05-16T06:00:04+00:00May 16th, 2016|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

Congressional Task Force Considers Medicaid Reforms

A House Energy and Commerce Committee group is looking at potential Medicaid reforms for 2017.
The task force, consisting entirely of Republican members, was created late last year to “… strengthen and sustain the critical program for the nation’s most vulnerable citizens.”
At a recent event at George Mason University, task force chairman Brett Guthrie (R-KY), cited continued high Medicaid spending as a reason to consider reform and noted that the degree to which the task force could tackle Medicaid in 2017 would depend on which party occupies the White House and controls Congress. He suggested that the task force would look for ways to prevent people from needing to choose between getting jobs and keeping health insurance. Among the potential legislative vehicles for reform, Guthrie said, are reauthorization of the Children’s Health Insurance Program and Medicare extenders.
Because they serve so many Medicaid and low-income patients, the task force’s deliberations will be of particular interest to Pennsylvania’s safety-net hospitals.
Learn more about the House Energy and Commerce Committee’s Medicaid Task Force here and about Rep. Guthrie’s remarks at the George Mason University forum here.

PA Safety Net Admin2016-05-13T06:00:47+00:00May 13th, 2016|Uncategorized|Comments Off

Patient Safety Authority Issues Annual Report

The Pennsylvania Patient Safety Authority has issued its 2015 annual report.
Go here for a news release summarizing the report and here for the report itself.

PA Safety Net Admin2016-05-12T06:00:39+00:00May 12th, 2016|Uncategorized|Comments Off

Affordability a Challenge for Many Newly Insured

Many Americans who have obtained private health insurance through the Affordable Care Act continue to have problems affording health care.
According to a Kaiser Family Foundation report based on focus groups six states, low-income individuals with new private insurance report continued problems with:

medical debt
affording care that is not covered by their insurance plans
handling out-of-pocket expenses, including deductibles
unexpected bills for treatment they thought was covered

Such patients pose a challenge for many Pennsylvania safety-net hospitals because of their inability to afford their co-pays and deductibles, leaving these hospitals with unexpected uncompensated care and bad debt. Because they care for more low-income patients than the average hospital, this is a bigger problem for the state’s safety-net hospitals.
For a closer look at how the study and focus groups were conducted and what they found, go here for the Kaiser Family Foundation report Is ACA Coverage Affordable for Low-Income People? Perspectives from Individuals in Six Cities.

PA Safety Net Admin2016-05-11T06:00:32+00:00May 11th, 2016|Affordable Care Act, Uncategorized|Comments Off

New Tools for Addressing Old Medicaid Problems

The new federal Medicaid managed care regulation gives state Medicaid programs new tools with which to address longstanding Medicaid challenges.
In an article titled “The Medicaid Managed Care Rule: The Major Challenges States Face,” the Commonwealth Fund describes the tools the rule does and does not offer for addressing five major Medicaid challenges:

reaching medically underserved communities
unstable eligibility and enrollment
organizing coverage an care and developing effective payment incentives
aligning managed care with health, education, nutrition, and social services
information technology

Find the article here, on the Commonwealth Fund’s web site.

PA Safety Net Admin2016-05-10T06:00:30+00:00May 10th, 2016|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

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PA Safety Net Admin2016-05-10T03:48:21+00:00May 10th, 2016|Uncategorized|Comments Off

Background Information on Payment Methodologies and Benefit Design

The Urban Institute has issued two new papers with background information on health care payment methodologies and the design of health care benefits packages.
The first paper, Payment Methods: How They Work, describes nine payment methodologies:

fee schedules
primary care capitation
per diem payments to hospitals for inpatient visits
DRG-based payments to hospitals for inpatient visits
global budgeting for hospitals
bundled payments
global capitation for organizations
shared savings
pay for performance

The second paper, Benefit Designs: How They Work, explains seven different types of benefit designs:

value-based design
high-deductible health plans
tiered networks
narrow networks
reference pricing
centers of excellence
benefit design for alternative sites of care

A third paper, Matching Payment Methods with Benefit Designs to Support Delivery Reforms, describes how to match benefit designs with payment methods.
Go here to find Payment Methods: How They Work.
Go here to find Benefit Designs: How They Work.
And go here to find Matching Payment Methods with Benefit Designs to Support Delivery Reforms.

PA Safety Net Admin2016-05-09T06:00:00+00:00May 9th, 2016|Health care reform|Comments Off

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