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Feds Issue Guidance on Reducing Medicare Readmissions

cmsThe 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.

2016-02-02T06:00:41+00:00February 2nd, 2016|Medicare|Comments Off on Feds Issue Guidance on Reducing Medicare Readmissions

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.
phlpFind the latest edition of Health Law News here.

2016-01-28T17:41:49+00:00January 28th, 2016|HealthChoices PA, long-term care, Pennsylvania Medicaid policy|Comments Off on Pennsylvania Health Law Project Releases Monthly Newsletter

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.
academiesThe 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.

2016-01-25T06:00:01+00:00January 25th, 2016|Medicare, Pennsylvania safety-net hospitals, Uncategorized|Comments Off on Report on Social Risk Factors in Medicare Payments

CMS Demonstration to Tie Medical, Service Needs

A new federal demonstration program will attempt to help low-income Medicare and Medicaid recipients gain access to services that ultimately will improve their health.
The Accountable Health Communities project, developed by the Center for Medicare and Medicaid Innovation and launched by the Centers for Medicare & Medicaid Services (CMS), is a $157 million demonstration program that
… 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.

cmsThe federal government intends to provide grants of up to $4.5 million to as many of 44 projects that pursue better ways to identify selected patients’ non-medical needs and connect those patients with available services in their communities. The grant funding will pay for the programs, not the services themselves, and will be evaluated to determine their impact on the health of program participants and the health care services utilization of those participants in light of the program’s central objectives of testing whether addressing the targeted needs will improve participants’ health and reduce their health care utilization.
For further information about the Accountable Health Community project, see this Kaiser Health News report; this CMS news release; this CMS fact sheet; and “Accountable Health Communities — Addressing Social Needs through Medicare and Medicaid,” a New England Journal of Medicine article that describes the program, its goals, and its underlying rationale.

2016-01-07T06:00:43+00:00January 7th, 2016|Uncategorized|Comments Off on CMS Demonstration to Tie Medical, Service Needs

DHS Secretary Describes Initiatives

In an op-ed piece in the Scranton Times-Tribune, Pennsylvania Department of Human Services Secretary Ted Dallas has outlined his organization’s major achievements of 2015 and its plans for 2016.
ted dallasAmong them are the state’s expansion of its Medicaid program and its plans to establish new contracts with HealthChoices managed care organizations that seek to shift the program’s emphasis from volume of care to value and outcomes through greater use of accountable care organizations (ACOs), bundled payments, patient-centered medical homes, and other value-based initiatives.
Find Secretary Dallas’s commentary here.

2016-01-04T11:40:53+00:00January 4th, 2016|HealthChoices PA, Pennsylvania Medicaid policy|Comments Off on DHS Secretary Describes Initiatives

Dual Eligible Programs Show Mixed Results

The Affordable Care Act-inspired effort to find more effective ways to serve the so-called dual eligible population – mostly the disabled and low-income elderly covered by both Medicare and Medicaid – is not providing the kind of results policy-makers expected when they initiated new efforts to serve this high-cost population.
But not all of the news is bad.
medical-563427__180On one hand, enrollment figures for those eligible to participate have not met expectations, with some of those eligible afraid they might lose their providers and some of those providers persuading their patients not to participate. In addition, some health plans that participated in the earliest efforts have withdrawn in the face of declining enrollment.
On the other hand, employing care managers to serve members has shown signs of reducing hospitalizations and Medicare costs and individuals who do participate have expressed satisfaction with the service they are receiving.
Programs that serve dually eligible individuals are of special interest to Pennsylvania safety-net hospitals because the communities they serve typically have especially large numbers of such residents.
For a closer look at the effort’s expectations, where it has succeeded, and where it has encountered challenges, see this Wall Street Journal article.

2015-12-30T06:00:59+00:00December 30th, 2015|Medicare, Pennsylvania Medicaid policy|Comments Off on Dual Eligible Programs Show Mixed Results

Latest Edition of Health Law News

The Pennsylvania Health Law Project has released the latest edition of its newsletter.
phlpThe December 2015 edition includes features about Community HealthChoices, the state’s proposed plan of mandatory long-term services and supports for selected Pennsylvanians; the extension of the state’s contract with its current enrollment broker for participation in the Office of Long-Term Living’s waiver programs; the expansion of a pilot program for pregnant women with substance abuse disorders; and more.
Find the newsletter here.

2015-12-28T06:00:32+00:00December 28th, 2015|Pennsylvania Medicaid policy|Comments Off on Latest Edition of Health Law News

CHIP On the Move

Pennsylvania Governor Tom Wolf has signed a bill that shifts responsibility for Pennsylvania’s Children’s Health Insurance Program (CHIP) from the state’s Insurance Department to its Department of Human Services (DHS).
PA_CHIP_logoThe move is designed to streamline the administration of the program and improve the delivery of services for the more than 150,000 children currently enrolled in CHIP.
DHS already administers the state’s Medicaid program, which serves more than 2.5 million Pennsylvanians.
Go here to see a state news release announcing the change.

2015-12-23T11:38:14+00:00December 23rd, 2015|Pennsylvania Medicaid policy|Comments Off on CHIP On the Move

PHC4 Reports on Hospital Performance

The Pennsylvania Health Care Cost Containment Council (PHC4) has issued a report that offers a wide range of statistics describing the performance and quality of care provided by the state’s acute-care hospitals.
phc4The report presents regional and hospital-by-hospital mortality and readmission rates for a wide variety of medical conditions, doing so on a regional basis.
It also tallies the volume of hospital patients according to medical conditions and describes who is paying for the different types of care hospitals are providing.
Go here to see the PHC4 report Hospital Performance Report: 2014 Data.
 

2015-12-18T06:00:37+00:00December 18th, 2015|Uncategorized|Comments Off on PHC4 Reports on Hospital Performance

MedPAC Meets, Discusses Payment Issues

Last week the commissioners serving on the Medicare Payment Advisory Commission (MedPAC) met in Washington, D.C. to discuss the group’s future recommendations to Congress.
 
While MedPAC’s recommendations are not binding on Congress or the administration, they are highly respected and often find themselves worked into new law or regulations.
medpacAmong the issues MedPAC addressed during two days of public meetings were:

  • Medicare inpatient and outpatient payments
  • the Medicare Advantage program star rating system
  • payments to ambulatory surgery centers, skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals
  • payments for physician services, home health services, hospice care, and outpatient dialysis

Find issue briefs on each subject, and copies of the presentations MedPAC staff made to commissioners, here on MedPAC’s web site.

2015-12-14T15:53:19+00:00December 14th, 2015|Medicare|Comments Off on MedPAC Meets, Discusses Payment Issues
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