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

Fewer People Skipping Care for Financial Reasons

Fewer Americans are choosing not to pursue medical care for financial reasons, according to new information from the Centers for Disease Control and Prevention.
According to the CDC’s National Health Interview Survey, 4.5 percent of the people surveyed reported not getting medical attention they needed for financial reasons in 2015, down from 6.9 percent in 2009 and 2010.
This suggests that the Affordable Care Act’s changes in providing access to health insurance are making a different in the ability of people to get the care they believe they need.
Prior to the reform law’s passage, the proportion of people reporting that they chose not to seek care for financial reasons had been rising steadily since 1998.
This is good news for Pennsylvania safety-net hospitals, which often must deal with the medical and financial implications of serving especially large numbers of patients who, for financial reasons, have had limited and sporadic contact with the health care system over the years.
To learn more about the survey’s findings see this CQ HealthBeat report presented by the Commonwealth Fund and go here to see the CDC report Early Release of Selected Estimates Based on Data From the 2015 National Health Interview Survey.

PA Safety Net Admin2016-06-06T06:00:03+00:00June 6th, 2016|Affordable Care Act, Pennsylvania safety-net hospitals|Comments Off

2015 Financial Performance Mixed for PA Hospitals

Most Pennsylvania acute-care hospitals fared well financially in 2015.
But not all of them.
According to a new report issued by the Pennsylvania Health Care Cost Containment Council, total acute-care hospital margins fell 0.01 percentage points in 2015 but operating margins rose 1.21 percentage points.
49 of the state’s 170 acute-care hospitals lost money on operations and 46 lost money overall.
phc4 Other highlights:

uncompensated care fell 8.6 percent
inpatient days declined for the eighth straight year
outpatient visits rose 2.5 percent
53.7 percent of net patient revenue came from inpatient care

Go here for a news release summarizing PHC4’s finding and go here to see the complete report Financial Analysis 2015: An Annual Report on the Financial Health of Pennsylvania Hospitals, which includes state-wide analyses and performance data on individual hospitals.

PA Safety Net Admin2016-06-03T06:00:51+00:00June 3rd, 2016|Uncategorized|Comments Off

Homeless Health Care Costs Driven More by Hospital Stays Than ER Visits

Extended hospital stays and not frequent visits to hospital emergency rooms constitute the greatest cost in caring for homeless Medicaid patients, a new analysis has found.
A review of 1100 homeless people served by the Boston Health Care for the Homeless Program found that while repeated visits to the ER do constitute a problem for caregivers, the cost of those visits is dwarfed by costs associated with the same patients spending long periods of time in the hospital.
According to the review, 30 percent of the group’s Medicaid costs were for hospital stays while only four percent were for ER services. The homeless frequently spend more time in the hospital because they are in such poor overall health.
In recent years, providers have focused much of their attention on frequent ER visitors – so-called “frequent flyers” or “super-utilizers” – but the experience of the Boston program suggests that conditions that lead to long periods of hospitalization among the homeless may need more attention as well.
Because of where they are located, Pennsylvania safety-net hospitals serve far more homeless patients than the typical hospital.
For a closer look at the Boston program and what its leaders learned, see this Boston Herald article.

PA Safety Net Admin2016-06-01T06:00:44+00:00June 1st, 2016|Pennsylvania safety-net hospitals, Uncategorized|Comments Off

Bill Proposes Modifying Ban on Higher Medicare Outpatient Payments

A new bill introduced in the House Ways and Means Committee would limit a recent prohibition on establishing new off-campus hospital outpatient facilities that can receive hospital-based Medicare outpatient payments.
Under the Bipartisan Budget Act of 2015, new off-campus, hospital-based outpatient facilities would be paid for Medicare-covered outpatient services like regular physician offices and not like hospital outpatient departments. The Helping Hospitals Improve Patient Care Act of 2016, however, would permit new outpatient departments that were in “mid-build” at the time the 2015 law passed to be exempt from that law’s limits on outpatient payments.
According to a Ways and Means summary of the bill,

Section 201 provides for an exception to section 603 of the Bipartisan Budget Act of 2015 (BBA’15) for those hospital outpatient departments (HOPDs) that were defined as “mid-build” prior to November 2, 2015. “Mid-build” is defined as a provider that had a binding written agreement with an outside, unrelated, party for the actual construction of the HOPD. To qualify as “mid-build,” each HOPD will be required to submit a certification from the provider’s Chief Executive Officer/Chief Operating Officer that the HOPD meets the definition of mid- build prior to July 1, 2016. Further, each mid-build HOPD will be required to submit an attestation that it meets the requirements of being provider-based (42 Code of Federal Regulations 413.65) by July 1, 2016. In addition, the section also requires the Secretary to audit the accuracy of these attestations. HOPDs that meet all of above requirements will receive the full HOPD payment rate beginning January 1, 2018 instead of the lower physician fee schedule or ambulatory surgical center payments required under the BBA’ 15. Finally, those off-campus HOPDs that submitted a voluntary attestation prior to December 2, 2015 will receive the full HOPD payment rate beginning January 1, 2017.

To learn more about this and other provisions of H.R. 5273, the Helping Hospitals Improve Patient Care Act of 2016, go here to see the Ways and Means Committee’s summary of the bill and go here to see the bill itself.

PA Safety Net Admin2016-05-26T06:00:30+00:00May 26th, 2016|Medicare|Comments Off

Help on the Way for Those With Hepatitis C?

Pennsylvanians insured by Medicaid who have Hepatitis C have often found themselves blocked from access to new treatments that can cure the disease.
But that may be changing.
Prescription Medication Spilling From an Open Medicine Bottle While states’ finances have been groaning under the cost of new budget-busting treatments, a growing trend is to increase access to the costly treatments rather than keep it very limited.
Last week the Pharmacy and Therapeutics Committee of the state’s Medicaid program voted to ease the state’s current limits on access to treatment that costs between $31,000 and $58,000 a patient. Currently, about 30,000 Pennsylvania Medicaid beneficiaries suffer from Hepatitis C and another 10,000 are thought to be infected but not yet suffering.
The committee’s vote is advisory; the final decision rests with Department of Human Services Secretary Ted Dallas.
Learn more about the state of Hepatitis C treatment in Pennsylvania’s Medicaid program and the changes that may be coming in this Philadelphia Inquirer article.

PA Safety Net Admin2016-05-25T06:00:28+00:00May 25th, 2016|Pennsylvania Medicaid policy|Comments Off

New Report Highlights Benefits of 340B Program

A new report describes how the federal government’s 340B Drug Pricing Program works, how it serves low-income participants, what might happen if the program were curtailed, and why the program remains as important as ever despite the declining number of uninsured Americans.
The program, created in the early 1990s, requires pharmaceutical companies to provide outpatient drugs to eligible health care providers at significantly reduced prices. Providers qualify based on the number of low-income and uninsured patients they serve and they must be non-profit organizations.
Most Pennsylvania safety-net hospitals participate in the program.
Amid a considerable increase in the number of eligible providers, drug companies have been calling on the federal government to scale back the program.
Learn more about the 340B program in the new report “340B Program Helps Hospitals Provide Services to Vulnerable Patients: Results From a Survey of 340B Health Members,” released by the advocacy organization 340B Health. Find the report here.

PA Safety Net Admin2016-05-24T06:00:03+00:00May 24th, 2016|Pennsylvania safety-net hospitals|Comments Off

Bill Proposes Risk-Adjusting Medicare Readmissions Program

A new bill introduced in the House Ways and Means Committee would apply risk adjustment for socio-economic factors to Medicare’s hospital readmissions reduction program.
According to a committee summary of the bill, The Helping Hospitals Improve Patient Care Act of 2016 includes a provision that would direct the Secretary of Health and Human Services to

… implement a transitional risk adjustment methodology to serve as a proxy of socio-economic status for the Hospital Readmissions Reduction Program. In addition to the transitional adjustment, the section clarifies that the Secretary is able to permanently use a more refined methodology following the analysis required by the Improving Medicare Post-Acute Care Transformation Act of 2014. The section also requires a study by the Medicare Payment Advisory Commission (MedPAC), and allows for an analysis of “V-codes” and an exploration of potential exclusions.

The bill would be beneficial for Pennsylvania’s private safety-net hospitals because they serve more low-income patients who are more challenging to treat than typical hospital patients and are more likely to require post-discharge readmission to address continuing medical and social issues.
For a closer look at the bill’s socio-economic risk adjustment provision and other proposals, go here to see the committee’s summary of H.R. 5273, The Helping Hospitals Improve Patient Care Act of 2016, and go here to see the bill itself.

PA Safety Net Admin2016-05-23T06:00:17+00:00May 23rd, 2016|Medicare, Pennsylvania safety-net hospitals|Comments Off

Socio-Economic Factors Leading Cause in Pediatric Asthma Readmissions

African-American children suffering from asthma are readmitted to hospitals more often than other children primarily because of socio-economic factors, a new study published in JAMA Pediatrics has concluded.
In a study conducted in Cincinnati, according to the report, “Socioeconomic hardship variables explained 53% of the observed disparity” in readmissions among African-American children with asthma. The study also found that

A total of 80% of the observed readmission disparity between African American and white children could be explained after statistically balancing available biologic, environmental, disease management, access to care, and socioeconomic and hardship variables across racial groups.

These findings are especially relevant to Pennsylvania safety-net hospitals because the communities they serve often have especially large numbers of low-income and low-income African-American children.
Read more about the study, its findings, and its implications in the JAMA Pediatrics article “Explaining Racial Disparities in Child Asthma Readmission Using a Causal Inference Approach, “which can be found here.

PA Safety Net Admin2016-05-19T06:00:21+00:00May 19th, 2016|Uncategorized|Comments Off

Covered by Medicare But Underinsured

Nearly a quarter of the country’s 50 million Medicare beneficiaries are underinsured and ill-equipped financially to handle the program’s cost-sharing responsibilities.
Or so concludes a new report from the Commonwealth Fund.
According to the report, Medicare’s cost-sharing requirements – premiums, co-pays, deductibles, and services not covered by the program, such as dental and vision care – far outstrip the resources of more than 11 million low-income program participants, leaving many to spend more than 20 percent of their income on health care costs.
In its new report “On Medicare But At Risk: A State-Level Analysis of Beneficiaries Who Are Underinsured or Facing High Total Cost Burdens,” the Commonwealth Fund describes the health care costs Medicare does and does not cover, defines what constitutes “underinsured” and ill-equipped to handle health care costs, delineates the out-of-pocket costs for which beneficiaries are responsible, and offers a state-by-state breakdown of where the uninsured can be found and the proportion of total income they spend on medical services.
Because they serve communities with especially large numbers of low-income residents, Pennsylvania’s safety-net hospitals care for disproportionate numbers of such underinsured Medicare patients. As a result, they face the prospect of providing significant amounts of uncollectible uncompensated care as a result of Medicare patients who cannot afford their co-pays and deductibles.
Find the Commonwealth Fund report here.

PA Safety Net Admin2016-05-16T06:00:34+00:00May 16th, 2016|Medicare, Pennsylvania safety-net hospitals|Comments Off

PA Proposes Medicaid Observation Rate

Pennsylvania_Bulletin_logo Under a newly proposed policy, Pennsylvania would pay hospitals and physicians an observation rate for Medicaid patients who are treated in their emergency departments but for whom they cannot make an immediate decision on the need for admission.
As described in a Pennsylvania Bulletin notice published last Saturday,

Observation services are a well-defined set of clinically appropriate and medically necessary services, which include short-term treatment, assessment and reassessment, that are furnished while a decision is made as to whether to admit an MA beneficiary to the inpatient hospital setting for further treatment or to discharge the MA beneficiary from the hospital outpatient setting. The Department is recognizing the need for observation services because a physician may not be able to initially determine whether an inpatient hospital admission is medically necessary.

The proposed policy, to take effect at the beginning of the state’s 2017 fiscal year (July 1, 2016), addresses and prescribes payments for hospitals and physicians, including new procedure codes.
According to the notice, Pennsylvania anticipates spending $10.229 million in state funds, and $28.28 million overall, for such services in FY 2017.
Interested parties have 30 days from the notice’s publication (May 14) to submit written comments about the proposed policy.
Find the Pennsylvania Bulletin notice introducing this proposed policy here.

PA Safety Net Admin2016-05-16T06:00:04+00:00May 16th, 2016|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

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