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

Docs Less Likely to Participate in ACOs in Disadvantaged Communities

A new study has found that physicians who practice in areas with higher proportions of low-income, uninsured, less-educated, disabled, and African-American residents are less likely than others to participate in accountable care organizations.
If ACOs ultimately are found to improve health care quality while better managing costs, their benefits might be limited in such communities, thereby exacerbating health care disparities. If this trend holds true in Pennsylvania, it could be harmful to many of the communities served by the state’s safety-net hospitals.
To learn more, go here to see the Health Affairs report “Physicians’ Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More Affluent Communities.”

PA Safety Net Admin2016-08-23T10:41:08+00:00August 23rd, 2016|Pennsylvania safety-net hospitals, Uncategorized|Comments Off

PA Announces Hospital Quality Incentive Program

Pennsylvania’s Medicaid program has announced plans to launch a new hospital quality incentive program that will focus on measuring preventable hospital admissions and will reward hospitals that improve their performance.
The program, part of a larger effort by the state to move away from volume-driven Medicaid payments and toward a greater focus on value and population health, will measure and reward incremental improvement in reducing preventable admissions and achieving the 25th or 50th percentile benchmark of a state-wide preventable event rate. Hospitals that meet their objectives will qualify for bonus payments from the state funded by proceeds from Pennsylvania’s state-wide hospital assessment.
HealthChoices, Pennsylvania’s Medicaid managed care program, seeks to purchase 7.5 percent of Medicaid services through value-based purchasing arrangements in calendar year 2017, 15 percent in 2018, and 30 percent in 2019. The Hospital Quality Incentive Program seeks to facilitate achieving these goals.
The Pennsylvania Department of Human Services has posted on its web site an explanation of the new program, a presentation on the program, and an FAQ. Find them here.

PA Safety Net Admin2016-08-18T06:00:42+00:00August 18th, 2016|HealthChoices PA, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

CMS Urges Improvements in Care for Physically, Mentally Disabled

New guidance issued by the Centers for Medicaid Services outlines how states can make better use of home care in serving physically and mentally disabled Medicaid beneficiaries.
Those steps include establishing open registries of home care workers; establishing qualifications for such workers; and paying wages that will help foster continuity of care for the clients of those home care workers.
cms In making these recommendations, CMS seeks to make greater use of managed long-term services and supports and home- and community-based services when serving individuals who might otherwise need costly nursing home care.
Pennsylvania is in the process of launching a new such program, called Community HealthChoices, that will offer dually eligible Medicare/Medicaid seniors the option of receiving managed long-term services and supports instead of entering nursing homes.
Learn more about CMS’s recommendations and why it made them in this informational bulletin from CMS to state Medicaid directors.

PA Safety Net Admin2016-08-18T06:00:05+00:00August 18th, 2016|Pennsylvania Medicaid policy|Comments Off

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

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