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

CMS Posts Tentative List of Essential Community Providers

The Centers for Medicare & Medicaid Services has posted on its web site a draft list of essential community providers for 2018.
To qualify as essential community providers, organizations must serve predominantly low-income, medically underserved patients. Qualified health plans must contract with at least 30 percent of the essential community providers in their markets and must offer contracts in good faith to at least one such provider in each of six categories, including federally qualified health centers, hospitals, and family planning providers.
Providers that believe they have mistakenly been excluded from the list may petition for inclusion.
Find the draft list here.

PA Safety Net Admin2016-09-08T06:00:07+00:00September 8th, 2016|Uncategorized|Comments Off

There’s More to Quality Than Readmissions, Study Suggests

Hospitals with high readmissions rates may also have lower mortality rates for some conditions, according to a new study.
The study, published in the Journal of Hospital Medicine, found that patients suffering from heart failure, stroke, and chronic obstructive pulmonary disease who are served in hospitals with higher readmission rates have a slightly better chance of survival than if they were treated in hospitals with lower readmission rates.
Such findings call into question the value of focusing on readmissions as a measure of the quality of care hospitals provide – a focus exemplified by Medicare’s hospital readmissions reduction program.
Find the study “Associations between hospital-wide readmission rates and mortality measures at the hospital level: Are hospital-wide readmissions a measure of quality?” here and find a summary of the study in this article in McKnight’s Long-Term Care News.

PA Safety Net Admin2016-09-07T13:00:05+00:00September 7th, 2016|Medicare|Comments Off

Hospital Group Models Risk-Adjusted Medicare Readmissions

The Missouri Hospital Association has published data that demonstrates that risk-adjusting Medicare readmissions based on social determinants of health reduces the readmission rates of hospitals that care for large numbers of low-income patients.
The data, modeling, and risk adjustment methodology, developed by the association based on data from Missouri hospitals, published on the association’s “Focus on Hospitals” web site, and described in an article on the NEJM Catalyst web site, showed that

SDS [note: sociodemographic status)-enriched models yielded significant relative reductions in the range of risk-standardized readmission ratios for each of…6 outcomes…Overall, SDS enrichment best improved the 30-day readmission assessments of hospitals that served higher concentrations of Medicaid patients and higher-poverty communities.

The lack of risk adjustment for socioeconomic risk factors has been a controversial aspect of Medicare’s hospital readmissions reduction, with a growing body of research suggesting that without such risk adjustment, the program is unfair to hospitals that care for especially large numbers of low-income patients- hospitals like Pennsylvania’s private safety-net hospitals.
Learn more about the work done by the Missouri Hospital Association, and its implications, in its report Risk Adjustment for Sociodemographic Status in 30-Day Hospital Readmissions and this description of and commentary on the association’s research on the NEJM Catalyst web site.

PA Safety Net Admin2016-09-07T06:00:05+00:00September 7th, 2016|Medicare, Uncategorized|Comments Off

Amid Rising Improper Medicaid Payments, CMS Offers Help

With improper Medicaid payments nearly twice as high as they were just a few years ago, the Centers for Medicare & Medicaid Services is reaching out to state Medicaid programs with suggestions for how to reduce those improper payments.
The problem?
According to CMS,

States are facing greater challenges keeping pace with stricter enrollment requirements, tracking providers who have been excluded from other States’ or Federal health care programs, and generally adapting to changing regulations for qualifications of certain provider types.

In a new e-alert, CMS identifies factors that contribute to improper payments – things like ineligible and excluded providers, provider identity theft, medical services not provided, phantom or invalid provider addresses and ID numbers, and more. For each factor it identifies in the new e-alert CMS suggests solutions and directs interested parties to resources that can help them with those solutions.
To learn more about the extent of improper Medicaid payments and their recent increase, what has contributed to that rise, and possible solutions go here to see the CMS e-alert “Medicaid Improper Payments.”

PA Safety Net Admin2016-09-06T06:00:22+00:00September 6th, 2016|Uncategorized|Comments Off

NIH Launches Research on Health Disparities in Disadvantaged Communities

The National Institutes of Health is launching a new Transdisciplinary Collaboratives Centers for Health Disparities Research on Chronic Disease Prevention program that seeks to respond to

…the need for more robust, ecological approaches to address chronic diseases among racial and ethnic minority groups, under-served rural populations, people of less privileged socio-economic status, along with groups subject to discrimination who have poorer health outcomes often attributed to being socially disadvantaged. Two centers will focus their research efforts on development, implementation, and dissemination of community-based, multilevel interventions to combat chronic diseases such as heart disease, cancer and diabetes.

Anticipated funding over the first five years of the program is approximately $20 million.
In announcing the program, the NIH noted that

Heart disease, stroke, cancer, diabetes, and arthritis are among the most common, costly and preventable of all health problems. Many of these conditions disproportionately affect health disparity populations and in advanced stages can lead to significant limitations in activities of daily living.

These are the very health challenges that Pennsylvania’s safety-net hospitals tackle regularly – and far more often than the typical community hospital.
To learn more about what the program seeks to accomplish and the health challenges it anticipates addressing, see this NIH news release.

PA Safety Net Admin2016-09-02T06:00:16+00:00September 2nd, 2016|Uncategorized|Comments Off

Journal Looks at Health Disparities

The journal Health Affairs looks at health disparities and social determinants of health in its Augusts 2016 issue.
The article “Evaluating Strategies For Reducing Health Disparities By Addressing The Social Determinants Of Health” looks at interventions that focus on social determinants of health, addresses how such interventions can reduce health disparities and improve population health, and considers the challenges to implementing such approaches. Find it here.
The article “Achieving Health Equity: Closing The Gaps In Health Care Disparities, Interventions, And Research” also looks at health care disparities and how to address them, focusing on cardiovascular disease and cancer. Find it here.
Communities served by Pennsylvania’s safety-net hospitals usually suffer from the very health disparities policy-makers are currently working to address.

PA Safety Net Admin2016-09-01T06:00:22+00:00September 1st, 2016|Pennsylvania safety-net hospitals|Comments Off

PA Launches Prescription Drug Monitoring Program

Pennsylvania’s Department of Health has launched its much-anticipated prescription drug monitoring program.
Previously operated by the state’s office of the attorney general but assigned to the state’s Health Department through 2014 legislation, the program requires those authorized to prescribe controlled substance prescription drugs to collect and submit information to the PDMP each time they do so within 72 hours. That information is then stored in a database that is available to health care professionals to help them identify patients who may have problems with controlled substances or may even be going from provider to provider to gain additional prescriptions.
department of health The state Health Department has created a web site for the program that includes FAQs about how the PDMP works for those who prescribe and dispense controlled substances. Visit that web site here.

PA Safety Net Admin2016-08-31T06:00:46+00:00August 31st, 2016|Uncategorized|Comments Off

PA Ratchets Up Battle Against Opioid Abuse

The Commonwealth of Pennsylvania will create 25 new Opioid Use Disorder Centers of Excellence, joining 20 similar centers established last year.
According to a news release from the office of Pennsylania Governor Tom Wolf,

The additional COEs announced today will serve at least 5,600 additional individuals. The COEs are a central, efficient hub around which treatment revolves. These centers will have navigators to assist people with opioid-related substance use disorders through the medical system, and ensure they receive behavioral and physical health care, as well as any evidence-based medication-assisted treatment needed.

wolf The centers are funded in part by state behavioral health funds, in part by state Medicaid funds, and in part by federal Medicaid matching funds.
Learn more about the Centers of Excellence approach to combating opioid abuse and find a list of the new centers in this Wolf administration news release.

PA Safety Net Admin2016-08-30T13:08:35+00:00August 30th, 2016|Uncategorized|Comments Off

Who’s Still Uninsured?

Hispanics.
Young people between the ages of 19 and 34.
Men.
Low-income people, especially those living in states that have not expanded their Medicaid programs.
People in the South – again, especially those living in states that have not expanded their Medicaid programs.
Those who work for small companies.
The uninsured rate in the U.S., 20 percent before the Affordable Care Act took effect, is now 13 percent.
Learn more about how the Affordable Care Act has changed the rate at which different groups of Americans are insured in this Commonwealth Fund survey.

PA Safety Net Admin2016-08-29T06:00:54+00:00August 29th, 2016|Affordable Care Act|Comments Off

CMS Proposes Medicaid DSH Rule

The Centers for Medicare & Medicaid Services has proposed a new rule that would clarify the basis for eligible hospitals’ Medicaid disproportionate share hospital payments (Medicaid DSH).
Individual hospitals’ Medicaid DSH payments are based on their uncompensated care costs and the rule clarifies that only uncompensated costs for Medicaid patients for whom hospitals receive no other payments, such as from Medicare, state or local governments, or third-party payers, would count toward their hospital-specific Medicaid DSH limit.
See the rule here. Interested parties have until September 15, 2016 to submit formal comments to CMS about its proposal.
Representatives of Pennsylvania safety-net hospitals who would like to know more about how this proposal might affect their hospital can use the “contact us” link on this screen to seek further information.

PA Safety Net Admin2016-08-25T06:00:21+00:00August 25th, 2016|Medicaid supplemental payments, Pennsylvania safety-net hospitals|Comments Off

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