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

MACPAC Meets

The federal agency responsible for advising Congress on Medicaid and Children’s Health Insurance Program payment and access issues met last week in Washington, D.C.
According to the Medicaid and CHIP Payment and Access Commission,

The initial sessions of MACPAC’s September 2016 Commission meeting focused on hospital payment policy, first discussing MACPAC’s new work to develop an index of Medicaid inpatient payments across states and relative to Medicare, and later looking at how Affordable Care Act coverage expansions have affected hospitals serving a disproportionate share of low-income patients, including those with Medicaid coverage. The Commission then reviewed state policies for covering and paying for services in residential care settings, part of the drive to rebalance long-term services and supports from institutions to the community.

A briefing on MACPAC’s recent roundtable on improving service delivery to Medicaid beneficiaries with serious mental illness kicked off the afternoon sessions, followed by a discussion of Medicaid financing and its relationship to provider payment policies. At the final session of the day, the Commission reviewed the possible elements of a package of recommendations on children’s coverage and the future of CHIP.

The following are the presentation materials referenced during the meeting:

MACPAC’s deliberations often have implications for Pennsylvania safety-net hospitals.

PA Safety Net Admin2016-09-23T06:00:11+00:00September 23rd, 2016|Uncategorized|Comments Off

Medicare Readmissions Down Almost Everywhere

Hospitals in 49 of the 50 states have reduced their Medicare readmissions since the federal health care program introduced its readmissions reduction program in 2010.
Only hospitals in Vermont have failed to cut readmissions.
Nationally, readmissions fell more than five percent in 43 states and more than ten percent in 11 states. Overall, readmissions fell 100,000 in 2015 alone compared to 2010 and have fallen 565,000 since 2010.
As the program ages more medical conditions are being subjected to the readmissions reduction program’s requirements. In the coming year, the Centers for Medicare & Medicaid Services estimates it will penalize 2500 hospitals $538 million for failing to reduce their readmissions.
Learn more about CMS’s efforts to reduce readmissions among Medicare patients in this entry on the CMS Blog.

PA Safety Net Admin2016-09-22T06:00:36+00:00September 22nd, 2016|Medicare, Uncategorized|Comments Off

Senate May Tackle Socio-economic Risk Adjustment

With a House bill to adjust Medicare payment penalties based upon the socio-economic challenges posed by the patients some hospitals serve folded into a House bill that passed in June, the Senate may take up this issue during its fall session.
Health economists, policy experts, and providers generally agree that the performance of hospitals that serve especially large numbers of low-income patients is affected in a number of areas, including Medicare readmissions, meeting value-based purchasing criteria, and others.
And while the Centers for Medicare & Medicaid Services acknowledges the challenge, the agency has rejected calls for risk adjustment so far, repeatedly writing that it does not “want to mask potential disparities or minimize incentives to improve the outcomes of disadvantaged populations.”
Meanwhile, a growing body of research has documented that the anticipated impact of serving socioeconomically challenged patients is real and more and more people are joining the call for Congress or CMS to address the problem.
Compounding the challenge is that hospitals that serve such patients are faced with growing financial penalties from Medicare if they fail to perform at levels comparable to hospitals that face fewer challenges.
For a closer look at the issue, the arguments on both sides, and the prospects for congressional action this fall, see this article from CQ Roll Call presented by the Commonwealth Fund.

PA Safety Net Admin2016-09-20T06:00:19+00:00September 20th, 2016|Medicare|Comments Off

New ACO Model Targets Social Determinants of Health

The federal government is altering a previously announced accountable care organization model to help it target the social determinants of health of the patients it serves.
The Accountable Health Communities model, launched by the Centers for Medicare & Medicaid Services and the Center for Medicare and Medicaid Innovation in January, has been modified to target “community-dwelling Medicare and Medicaid beneficiaries with unmet health-related social needs.”
According to a CMS fact sheet,

The foundation of the Accountable Health Communities Model is universal, comprehensive screening for health-related social needs of community-dwelling Medicare, Medicaid, and dual-eligible beneficiaries accessing health care at participating clinical delivery sites. The model aims to identify and address beneficiaries’ health-related social needs in at least the following core areas:

Housing instability and quality,
Food insecurity,
Utility needs,
Interpersonal violence, and
Transportation needs beyond medical transportation.

Addressing the health-related associated with social determinants of health has long been one of the major challenges Pennsylvania’s safety-net hospitals face.
CMS anticipated participating ACOs serving their members through annual screenings of needs, increased dissemination of information about how to address health-related social needs, and appropriate referrals to community resources to meet those needs.
Among the organizations invited to apply to participate are community-based groups, health care organizations, hospitals and health systems, institutions of higher education, and government entities. In recognition of the need for a more patient-focused approach than CMS proposed in January, the number of members participating ACOs must serve has been reduced the potential award amount has been raised.
To learn more about the Accountable Health Communities model, why it has been modified, what it hopes to accomplish, and how it will operate, see this CMS fact sheet.

PA Safety Net Admin2016-09-19T09:40:14+00:00September 19th, 2016|Uncategorized|Comments Off

Federal Medicaid Per Capita Spending Limits?

As they have in the past, some members of Congress have suggested of late that Medicaid might benefit from being transformed into a program with limited spending per capita: that is, such an approach would limit the amount of money the federal government would provide to states on a per capita basis.
Such an approach would almost certainly have serious implications for Pennsylvania safety-net hospitals.
What issues would need to be addressed to develop such an approach? What data would be needed?
Earlier this year the chairmen of the Senate Finance Committee and the House Energy and Commerce Committee asked the U.S. Government Accountability Office to answer these and other questions. Now, the GAO has published its answers in a new report titled Key Policy and Data Considerations for Designing a Per Capita Cap on Federal Funding. Find that report here.

PA Safety Net Admin2016-09-16T06:00:12+00:00September 16th, 2016|Pennsylvania Medicaid laws and regulations, Pennsylvania safety-net hospitals|Comments Off

SNAP Comments on Proposed Medicaid DSH Regulation

The Safety-Net Association of Pennsylvania has written to the Centers for Medicare & Medicaid Services to object to how the agency proposes changing its methodology for calculating eligible hospitals’ Medicaid disproportionate share (Medicaid DSH) payments.
In particular, SNAP opposes the manner in which CMS would treat payments from Medicare and third-party payers made on behalf of Medicaid-eligible individuals.
In SNAP’s view, the letter notes,

…the hospital-specific DSH limit has come to penalize the very hospitals that Medicaid DSH payments were designed to support.

The SNAP letter explains that

What concerns SNAP at this time is CMS’s apparent decision to rationalize and codify in regulations a narrower interpretation of the Medicaid DSH limit than what Congress described in section 1923(g) of the Social Security Act.

Read SNAP’s complete letter here.

PA Safety Net Admin2016-09-15T06:00:48+00:00September 15th, 2016|Medicaid supplemental payments, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off

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

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