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

Uninsured Patients, Provider Taxes Hurt Adequacy of Medicaid Payments

While Medicaid payments now typically cover more than the cost of Medicaid services in many states, they do not cover the costs of caring for low-income patients after providers care for uninsured patients and pay Medicaid provider taxes, a new study has found.
According to a Health Affairs report,

After accounting for supplemental payments, we found that in 2011, disproportionate-share hospitals, on average, received gross Medicaid payments that totaled 108 percent of their costs for treating Medicaid patients but only 89 percent of their costs for Medicaid and uninsured patients combined. However, these payments were reduced by approximately 4–11 percent after we accounted for provider taxes and local government contributions that are used to help finance Medicaid payments.

Because they are all disproportionate share hospitals, this is especially a challenge for Pennsylvania’s urban safety-net hospitals.
To learn more, go here to see the Health Affairs analysis “For Disproportionate-Share Hospitals, Taxes And Fees Curtail Medicaid Payments.”

PA Safety Net Admin2016-12-20T06:00:49+00:00December 20th, 2016|Pennsylvania safety-net hospitals, Uncategorized|Comments Off

Impact of “Repeal and Replace” on PA?

With the president-elect and congressional leaders vowing to repeal and replace the Affordable Care Act, the question arises about how such actions might affect Pennsylvania.
Health Benefits Claim Form That includes 680,000 Pennsylvanians who enrolled in the state’s Medicaid program after the reform law allowed for that program’s expansion, more than 400,000 people who signed up for insurance on the federal health insurance exchange, the state’s taxpayers who might be left with the bill for some or all of these costs if the reform law’s financial support were to disappear in the near future, and others.
The Pittsburgh Tribune-Review considers these and other questions and offers answers from some of those closest to the situation. See its story here.

PA Safety Net Admin2016-12-19T06:00:38+00:00December 19th, 2016|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

New Approach to Helping Patients With Complex Needs

Five foundations have joined forces to pursue new approaches to serving patients with complex medical needs.
The Commonwealth Fund, the John A. Hartford Foundation, the Peterson Center on Healthcare, the Robert Wood Johnson Foundation, and The SCAN Foundation engaged the Institute for Healthcare Improvement to identify promising ways of better serving patients with complex medical needs. Many such patients, the foundations believe, have adequate access to medical care yet struggle to find the coordination needed between medical, behavioral, and social services to stay well and avoid costly hospitalizations.
The group’s first public product is The Playbook, which it describes as

…a dynamic website that highlights the challenges facing adults with complex health and social needs and provides direction on how to meet those needs through a variety of resources that detail care models, policies, and more.

The Playbook offers a variety of resources to caregivers, such as an intensive outpatient care program toolkit, a quick reference to promising care models, recommendations for tailoring complex care management for high-need, high-cost patients, and more.
Serving patients with complex medical problems can be especially challenging for Pennsylvania safety-net hospitals because they often have so many such patients.
Find The Playbook here.

PA Safety Net Admin2016-12-16T06:00:46+00:00December 16th, 2016|Pennsylvania safety-net hospitals|Comments Off

MedPAC Talks Payments

At public meetings in Washington, D.C. last week, members of the Medicare Payment Advisory Commission discussed the adequacy of current Medicare payments and whether they need updating in the next fiscal year.
Among the payment areas MedPAC reviewed were inpatient services, outpatient services, physician and health professional services, ambulatory surgical center services, skilled nursing facilities, home health services, inpatient rehabilitation hospitals, long-term-care facilitiies, outpatient dialysis services, and hospices.
Find the issue briefs and presentations used to guide these discussions here, on MedPAC’s web site.

PA Safety Net Admin2016-12-13T06:00:37+00:00December 13th, 2016|Medicare|Comments Off

PA Improves Access to Contraceptives

Citing the challenges and risks associated with unplanned pregnancies that occur within two years of a delivery, Pennsylvania’s Medicaid program is making long-acting contraceptives more readily available to program participants.
Pennsylvania State Map Beginning on December 1, Medicaid will pay for long-acting contraceptives administered after delivery and also will increase payments to doctors who provide those contraceptives. Currently, those costs are generally borne by hospitals in the lump-sum payment Medicaid makes for deliveries.
Learn more about the state’s new policy for encouraging the use of contraceptives among Medicaid beneficiaries who have delivered babies in this Lancaster Online article.

PA Safety Net Admin2016-12-09T06:00:58+00:00December 9th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid policy|Comments Off

A Look at Medicaid’s Immediate Future

With a new president taking office in January who vows to repeal and replace the Affordable Care Act, it is not clear what will happen to Medicaid, which currently covers 73 million Americans.
A new paper from the Kaiser Family Foundation looks at some of the major questions that will arise in the coming months, including:

How would ACA repeal affect Medicaid?
What would changes in the financing structure mean for Medicaid?
How could Medicaid be changed through administrative actions?

For this and more, go here to see the Kaiser paper “Key Medicaid Questions Post-Election.”

PA Safety Net Admin2016-12-08T09:21:04+00:00December 8th, 2016|Affordable Care Act|Comments Off

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

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