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

Medicare Readmissions Penalties Rise

Medicare will impose more than $500 million in penalties in FY 2017 on hospitals that readmit too many Medicare patients within 30 days of their discharge from the hospital.
The penalties, part of Medicare’s hospital readmissions reduction program, represent a 20 percent increase over the penalties the program levied in FY 2016.
Under the program, most (but not all) hospitals are evaluated on their performance with patients with six medical conditions: heart attacks, heart failure, chronic lung disease, hip and knee replacement, and the need for coronary bypass surgery. The maximum penalty is three percent of hospitals’ Medicare payments and the average penalty in FY 2017 will be 0.73 percent – up from 0.61 percent in FY 2016.
The program is widely credited with driving a national reduction in the number of Medicare patients readmitted to the hospital within 30 days of discharge, although as the program’s FY 2017 penalties suggest, reducing those readmissions is proving a considerable challenge for some hospitals.
Ever since the program’s introduction, critics have maintained that hospitals that serve large numbers of low-income patients are treated unfairly by the program. Such patients, a growing body of research has found, are more difficult to treat and more likely to lack the financial, social, and family supports needed to recover from illnesses and injuries without requiring a return to the hospital. Pennsylvania’s safety-net hospitals serve especially large numbers of such patients.
Learn more about how the readmissions reduction program works and how it will treating hospitals in FY 2017 in this Kaiser Health News report.

PA Safety Net Admin2016-08-11T06:00:36+00:00August 11th, 2016|Uncategorized|Comments Off

Feds Announce Process for Phasing Out Medicaid Pass-Through Payments

A number of states supplement the Medicaid revenue of high-volume Medicaid hospitals – and draw down additional federal Medicaid matching funds – by making special pass-through payments through Medicaid managed care organizations. Such payments are often used to distribute the proceeds from state hospital taxes.
The Centers for Medicare & Medicaid Services has looked upon such payments with growing disapproval in recent years and has now advised state Medicaid programs on how it plans to phase out the practice entirely.
In a bulletin to state Medicaid directors titled “The Use of New or Increased Pass-Through Payments in Medicaid Managed Care Delivery Systems,” CMS has announced its intention to ban the pass-through payments over a period of years, with limited exceptions that meet specific new criteria.
In announcing the policy, CMS acknowledges the challenges inherent in ending the use of such payments and indicates its intention to address this issue, and the phase-out process, in future regulations
Such pass-through payments are an important of Pennsylvania’s Medicaid program and the state’s private safety-net hospitals benefit considerably from them.
Go here to see the CMS bulletin on a subject of interest to many high-volume Medicaid hospitals.

PA Safety Net Admin2016-08-09T06:00:39+00:00August 9th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

Report: Uncompensated Care Payments Insufficiently Aligned With Uncompensated Costs

Some of the payments Medicare makes to hospitals to help them with their uncompensated care costs are not well-aligned with actual hospital uncompensated care costs, the U.S. Government Accountability Office has concluded.
In a new report based on FY 2013 and FY 2014 data, the GAO found that

Medicare UC [uncompensated care] payments are not well aligned with hospital uncompensated care costs for two reasons. First, payments are largely based on hospitals’ Medicaid workload rather than actual hospital uncompensated care costs…Second, CMS [the Centers for Medicare & Medicaid Services] does not account for hospitals’ Medicaid payments that offset uncompensated care costs when making Medicare UC payments.

Medicare uncompensated payments to hospitals also are sometimes as Medicare disproportionate share (Medicare DSH) uncompensated care payments.
To address this problem, the GAO recommends that CMS

improve alignment of Medicare UC payments with hospital uncompensated care costs
account for Medicaid payments made when making Medicare UC payments to individual hospitals

The report notes that CMC agreed with these recommendations.
Pennsylvania’s safety-net hospitals typically receive Medicare uncompensated care payments.
To learn more about what the GAO found and what its implications might be for hospitals, go here for a link to the new GAO report Hospital Uncompensated Care: Federal Action Needed to Better Align Payments with Costs and to a summary of that report.

PA Safety Net Admin2016-08-05T06:00:54+00:00August 5th, 2016|Medicare, Pennsylvania safety-net hospitals|Comments Off

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its July 2016 newsletter.
phlp Included in this edition are stories about the unexpected rebidding of HealthChoices contracts for Medicaid-covered physical health services; passage of the state’s fiscal year 2017 budget; access for Medicaid beneficiaries to drugs to treat hepatitis C; the creation by the state legislature of a task force to explore barriers to access to treatment for substance abuse; and more.
Find the newsletter here.

PA Safety Net Admin2016-08-04T06:00:10+00:00August 4th, 2016|Uncategorized|Comments Off

New Series Examines Serving High-Need, High-Cost Patients

The Commonwealth Fund is launching a new series of case studies describing “innovative programs designed to address the needs of the nation’s high-need, high-cost patients, a group that accounts for a disproportionate share of health care spending.”
Among the types of programs it will profile are:

home-based primary care
enhanced primary care
programs of all-inclusive care (PACE)
accountable care for Medicaid populations
guided care

For a closer look at the new series and the programs it will profile go here, to the web site of the Commonwealth Fund.

PA Safety Net Admin2016-08-02T06:00:47+00:00August 2nd, 2016|Health care reform|Comments Off

ACA Slowly, Surely Improving Health Status

A new survey has found that the combination of Affordable Care Act-driven enhanced access to health insurance and improved performance by health care providers is producing better health status in communities across the U.S.
The survey looked at health status in 306 regional health care markets based on factors such as access to care, quality, avoidable hospital use, health care costs, and health outcomes found modest improvements in these areas and attributed those improvements to expanded access to health insurance and government quality programs introduced through the Affordable Care Act. The gains the survey documented occurred from 2011 through 2014.
To learn more about how the survey was administered and what it found and to see and compare health status in individual communities, go here to read the Commonwealth Fund report Scorecard on Local Health System Performance.

PA Safety Net Admin2016-07-21T06:00:22+00:00July 21st, 2016|Affordable Care Act|Comments Off

Report to CMS on Risk Adjustment of Medicare Payments

The National Academies of Sciences, Engineering, and Medicine has issued its latest report to the Centers for Medicare & Medicaid Services on how to adjust Medicare payments to hospitals based on the socio-economic risk factors hospitals’ patients pose.
At the request of CMS, the Academies created an expert committee to

…identify criteria for selecting social risk factors, specific social risk fascinators Medicare could use, and methods of accounting for those factors in Medicare quality measurement and payment applications.

The committee created for this purpose viewed its goal to be

…to guide the selection of social risk factors that could be accounted for in VBP [value-based purchasing] so that providers or health plans are rewarded for delivering quality care and value, independent of whether they serve patients with relatively low or high levels of social risk factors.

Now, the committee has issued its third report to CMS, and in that report it offers three overarching considerations and five criteria to determine “whether a social risk factor should be accounted for in performance indicators used in Medicare VBP programs.” They are:

The social risk factor is related to the outcome.

The social risk factor has a conceptual relationship with the outcome of interest.
The social risk factor has an empirical association with the outcome of interest.

The social risk factor precedes care quality and is not a consequence of the quality of care.

The social risk factor is present at the start of care.
The social risk factor is not modifiable through provider actions.

The social risk factor is not something the provider can manipulate.

The social risk factor is resistant to manipulation or gaming.

Medicare’s readmissions reduction program and other value-based purchasing programs create special challenges for providers like Pennsylvania’s safety-net hospitals that serve especially large numbers of low-income patients.
To learn more about what the committee proposed and why it proposed it, see this news release describing its work, this summary of its work, and the full report, titled Accounting for Social Risk Factors in Medicare Payment Criteria, Factors, and Methods.

PA Safety Net Admin2016-07-20T06:00:58+00:00July 20th, 2016|Medicare, Pennsylvania safety-net hospitals, Uncategorized|Comments Off

PA Pursues New Approach to Opioid Addiction Treatment

Pennsylvania has secured federal funding to underwrite the creation of 20 centers of excellence to help people overcome opioid-related substance abuse problems.
According to a Department of Human Services news release,

The COEs [centers of excellence] coordinate care for people with Medicaid. Rather than just treating the addiction, DHS will treat the entire person through team-based treatment, with the explicit goal of integrating behavioral health and primary care and, when necessary, evidence-based medication assisted treatment.

Prescription Medication Spilling From an Open Medicine Bottle The 20 centers of excellence, which will be licensed by the state’s Department of Drug and Alcohol Programs, are expected to be open by October 1.
To learn more about the state’s new approach to serving those with opioid abuse problems and to find a list of the 20 centers of excellence, see this Department of Human Services news release.

PA Safety Net Admin2016-07-19T06:00:36+00:00July 19th, 2016|Pennsylvania Medicaid policy|Comments Off

New PA Budget Boosts PA Safety-Net Hospitals

Pennsylvania’s recently adopted FY 2017 budget restores to safety-net hospitals selected supplemental Medicaid payments that were not included in the budget Governor Tom Wolf originally proposed in February.
Financial paperwork The state’s FY 2017 budget restores, to FY 2016 levels, Medicaid OB/NICU, burn center, trauma center, and critical access hospital payments. All had been targeted for reduction or elimination in the governor’s budget proposal.
The new budget includes modest increases for the Medicaid fee-for-service program, for managed care spending, and for physician practice plans. It also designates an additional $3.75 million for academic medical centers.
The human services code revisions needed to direct the Department of Human Services to make these Medicaid payments also have been adopted.

PA Safety Net Admin2016-07-18T06:00:27+00:00July 18th, 2016|Pennsylvania proposed FY 2017 budget|Comments Off

Medicaid Directors Seek Help With Hepatitis C Drugs

The combination of new cures for hepatitis C, the high cost of those cures, and the large population of low-income people suffering from the disease has the nation’s Medicaid directors asking for help from Congress.
“Medicaid programs have decades of experience providing care to medically complex patients, but Hepatitis C is the first real case where a very high per patient cost has been combined with a very large patient population needing treatment,” the National Association of Medicaid Directors declared in a recent news release.
To help them address the high cost of providing a new generation of drugs to the estimated one million Medicaid recipients with hepatitis C, Medicaid directors have asked Congress to introduce policies that reduce the prices of those drugs or give states bigger rebates for purchasing them, noting that states have neither “…the financial capacity to cover the full cost of these treatments” nor “…the clear statutory authority to effectively and efficiently administer the program.”
Pennsylvania is in the midst of examining its policies regarding authorizing the use of expensive drugs to treat Medicaid patients with hepatitis C and is expected to make those drugs more widely available in the near future.
Learn more about the challenges state Medicaid programs face when serving beneficiaries with hepatitis C and the help they seek from Congress in this news release from the National Association of Medicaid Directors.

PA Safety Net Admin2016-07-12T06:00:12+00:00July 12th, 2016|Pennsylvania Medicaid policy, Uncategorized|Comments Off

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