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

DSH/340B Hospitals Have Lower Medicare Drug Costs

Medicare disproportionate share (Medicare DSH) hospitals that qualify for the federal 340B prescription drug discount program have lower Medicare Part B drug costs than other Medicare providers.
So concludes a new study performed for 340B Health, an association that represents more 1100 public and non-profit hospitals and health systems that participate in the 340B drug pricing program.
According to the organization 340B Health,

Medicare pays disproportionate share hospitals in the 340B drug discount program on average 13 percent less for separately payable drugs reimbursed through Medicare Part B. This is in comparison to what it pays other hospitals and physician practices in the Part B market. The study also shows that 340B DSH hospitals are treating more vulnerable patients than other providers in terms of race, age, disability, and dual eligibility.

The study also found that 340B-eligible hospitals are

Nearly four times as likely as non-340B providers to treat patients with end-stage renal disease
More than twice as likely to treat patients dually eligible for Medicare and Medicaid
More than twice as likely to treat patients who are disabled
More than twice as likely to treat Black, Hispanic, and North American Native patients

All of Pennsylvania’s safety-net hospitals are Medicare DSH hospitals and many participate in the 340B prescription drug pricing program as well.
For a closer look at the study and its findings, go here to see a 340B Health news release on the study and go here to see the study Analysis of Separately Billable Part B Drug Use Among 340B DSH Hospitals and Non-340B Providers.

PA Safety Net Admin2016-02-19T06:00:39+00:00February 19th, 2016|Medicare, Pennsylvania safety-net hospitals|Comments Off

GAO Suggests Changes in Federal Medicaid Funding Formula

The U.S. Government Accountability Office has recommended changes in how the federal government matches state Medicaid funding for its share of overall Medicaid spending.
In testimony submitted to the House Energy and Commerce Committee’s Health Subcommittee, GAO reminded Congress that in the past

…GAO has examined multiple concerns regarding how the FMAP [federal medical assistance formula] allocates funds among states, including during times of economic downturn, and has suggested improvements.

In particular, the GAO is concerned about how the FMAP formula’s use of per capita income in targeting federal Medicaid matching funds may not accurate reflect economic conditions at the state level, especially during economic downturns, and fail to respond to states’ individual needs during those downturns.
In response to these concerns, the GAO suggested

…that Congress could consider an FMAP formula that targets variable state Medicaid needs and provides automatic, timely, and temporary assistance in response to national economic downturns.

For a closer look at what the GAO investigated, what it concluded, and what it recommended to Congress, go here to see the GAO report Medicaid: Changes to Funding Formula Could Improve Allocation of Funds to States.

PA Safety Net Admin2016-02-18T06:00:32+00:00February 18th, 2016|Uncategorized|Comments Off

Wolf Administration Weighs Addressing Balance Billing

The Wolf administration is floating a proposal that would end medical balance billing in situations in which out-of-network providers are involved in the delivery of care patients receive from providers they believe to be in their health insurer’s provider network.
Such situations typically arise when patients receive inpatient care at hospitals they know to be within their insurer’s provider network but some of the professionals involved in providing that care are not part of that network.
The results can be large bills for services their insurers do not cover.
The Pennsylvania Insurance Department has published draft legislation to address such balance billing and is seeking public comment on the proposal. See that draft legislation here.

PA Safety Net Admin2016-02-18T06:00:29+00:00February 18th, 2016|Uncategorized|Comments Off

Report on One Year of Medicaid Expansion in PA

Taking advantage of the Affordable Care Act, Pennsylvania expanded its Medicaid program a little more than a year ago. Now, Department of Human Services Secretary Ted Dallas reflects on that year, offering statistics on how many people have taken advantage of enhanced access to Medicaid coverage, who those people are, and where they live.
Secretary Dallas also offers his perspectives on how the transition to the expanded Medicaid program went and how the new program differs from the old.
Read Secretary Dallas’s report here, on the Wolf administration’s blog.

PA Safety Net Admin2016-02-12T06:00:38+00:00February 12th, 2016|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

Governor Proposes FY 2017 Medicaid Budget

On Tuesday, February 9, Pennsylvania Governor Tom Wolf presented his proposed FY 2017 budget to the state legislature.
That budget proposal calls for changes in some current Medicaid spending, including reductions of some supplemental payments and the elimination of others, as well as changes in funding the state’s share of Medicaid and the rate at which the federal government will match Pennsylvania’s own spending on Medicaid in the coming year.
In addition, the budget calls for new and increased spending in selected areas within the purview of the state’s Department of Human Services and Health Department.
SNAP has prepared a detailed memo outlining the potential implications of the proposed FY 2017 budget for safety-net hospitals. The memo also addresses the complications posed by the state’s incomplete FY 2016 budget. Representatives of safety-net hospitals may request a copy of this memo by using the “contact us” link at the top of this screen.

PA Safety Net Admin2016-02-11T06:00:41+00:00February 11th, 2016|Pennsylvania proposed FY 2017 budget, Pennsylvania state budget issues, Proposed FY 2017 Pennsylvania state budget, Safety-Net Association of Pennsylvania|Comments Off

MACPAC: Medicaid DSH Payments Not Always Reaching Targeted Providers

In many cases, Medicaid disproportionate share payments (Medicaid DSH) are being made to hospitals that do not necessarily serve especially large proportions of Medicaid and other low-income patients.
So concludes a new report from The Medicaid and CHIP Payment and Access Commission (MACPAC), is a non-partisan legislative branch agency that performs policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on issues affecting Medicaid and the State Children’s Health Insurance Program (CHIP).
According to a new MACPAC report,

Medicaid DSH payments provide substantial support to safety-net hospitals by helping to offset uncompensated care costs for Medicaid and uninsured patients. In 2014, Medicaid made a total of $18 billion in DSH payments ($8 billion in state funds and $10 billion in federal funds). About half of all U.S. hospitals receive such payments, with most going to hospitals that serve a particularly high share of Medicaid and other low-income patients, known as deemed DSH hospitals. But more than one-third of DSH payments are made to hospitals that do not meet this standard.

To remedy this problem, MACPAC recommends more and better data collection, noting that

The current variation in state DSH allotments stems from the variations that existed in state DSH spending in 1992.

Medicaid DSH has long been a subject of great interest to Pennsylvania’s safety-net hospitals because, serving so many Medicaid and low-income patients, they are the very providers for which Medicaid DSH payments have always been intended.
The MACPAC analysis Report to Congress on Medicaid Disproportionate Share Hospital Payments covers a broad range of Medicaid DSH-related issues. Find it here, on the MACPAC web site.

PA Safety Net Admin2016-02-08T06:00:14+00:00February 8th, 2016|Pennsylvania safety-net hospitals, Uncategorized|Comments Off

New Medicaid Regulation Clarifies Access to Home Health Services

Under a new regulation unveiled by the Centers for Medicare & Medicaid Services, physicians and other authorized providers now must document their face-to-face encounters with patients when they are authorizing home health services but those encounters can be conducted through telehealth.
This approach, already part of the Medicare program, applies only to Medicaid fee-for-service patients and not to those served by managed care plans.
In addition, the rule regulates how recently providers must have their encounters with patients when prescribing home health services and provides those services in settings other than the home.
For a closer look at the new regulation, see this Fierce Healthcare article and this CMS fact sheet.

PA Safety Net Admin2016-02-04T06:00:48+00:00February 4th, 2016|Uncategorized|Comments Off

Feds Issue Guidance on Reducing Medicare Readmissions

The Centers for Medicare & Medicaid Services has issued a new report advising hospitals how to reduce readmissions among their racially and ethnically diverse Medicare patients.
According to a CMS news release, the guidance

…is designed to assist hospital leaders and stakeholders focused on quality, safety, and care redesign in identifying root causes and solutions for preventing avoidable readmissions among racially and ethnically diverse Medicare beneficiaries.

The guidance also notes that

Racial and ethnic minority populations are more likely than their white counterparts to be readmitted within 30 days of discharge for certain chronic conditions, such as heart failure, heart attack, and pneumonia, among others. Social, cultural, and linguistic barriers contribute to these higher readmission rates.

The document presents an overview of issues affecting readmissions and offers what it calls “high level recommendations” for hospital officials to “move the needle” on those readmissions. Those recommendations:

Create a stronger radar.
Identify the root causes.
Start from the start.
Deploy a team.
Consider systems and social determinants
Focus on culturally competent, communication-sensitive, high-risk scenarios.
Foster community partnerships to promote continuity of care.

According to the report,

Some studies have shown that certain patient-level factors, such as race, ethnicity, language proficiency, age, socioeconomic status, place of residence, and disability, among others—when tied to particular costly and complicated medical conditions such as heart failure, pneumonia, and acute myocardial infarction, to name a few—may be predictors of readmission risk and readmissions. In fact, research has demonstrated—and evaluations of the HRRP to date have found—that minority and other vulnerable populations are more likely to be readmitted within 30 days of discharge for chronic conditions, such as congestive heart failure, than their white counterparts. Given the cost and quality implications of these findings, addressing readmissions while caring for an increasingly diverse population has become a significant concern for hospitals and hospital leaders. In sum, there is a need for additional guidance on how hospitals can focus both system-wide redesign as well as targeted and specific efforts at preventing readmissions among minority and vulnerable populations.

To learn more about the new CMS document Guide to Preventing Readmissions Among Racially and Ethnically Diverse Medicare Beneficiaries, go here to read a CMS news release on its report and find the report itself here.

PA Safety Net Admin2016-02-02T06:00:41+00:00February 2nd, 2016|Medicare|Comments Off

Pennsylvania Health Law Project Releases Monthly Newsletter

The Pennsylvania Health Law Project has published the January 2016 edition of Health Law News, its monthly newsletter. Included in this edition are an update on the state’s proposed Community HealthChoices program, which would require dual-eligible Pennsylvanians to receive long-term services and supports through new managed care organizations; a summary of the Pennsylvania Health Law Project’s formal comments about that proposed program; and information about the state’s Medical Assistance Transportation Program and its proposed transition plan for home and community-based services.
Find the latest edition of Health Law News here.

PA Safety Net Admin2016-01-28T17:41:49+00:00January 28th, 2016|HealthChoices PA, long-term care, Pennsylvania Medicaid policy|Comments Off

Report on Social Risk Factors in Medicare Payments

As Medicare continues to move toward making provider payments based on patient outcomes rather than services provided, the National Academies of Sciences, Engineering, and Medicine has issued a new report on the potential impact of socio-economic factors on those patient outcomes.
The report, commissioned by the U.S. Department of Health and Human Services, is based on a literature search and identifies five socio-economic risk factors that could affect Medicare patient outcomes and quality measures: socio-economic status; race, ethnicity, and cultural context; gender; social relationships; and residential and community context. HHS asked the Academies to look into this issue because of the growing perception that Medicare payment policies may be unfair to providers that care for especially large numbers of socio-economically disadvantaged Medicare patients. This is the very kind of challenge that Pennsylvania’s safety-net hospitals face because of the especially large numbers of low-income patients they serve.
The Academies report, Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors (2016), is the first of an expected five Academies reports on the subject. The second report will identify best practices in serving socio-economically disadvantaged communities; the third will seek to identify factors that are and are not within providers’ control; the fourth will present recommendations; and the fifth, expected in 2019, will summarize the first four.
Find the National Academies of Sciences, Engineering, and Medicine report Social Risk Factors in Medicare Payment: Identifying Social Risk Factors (2016) here, on the Academies’ web site.

PA Safety Net Admin2016-01-25T06:00:01+00:00January 25th, 2016|Medicare, Pennsylvania safety-net hospitals, Uncategorized|Comments Off

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