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

Readmissions Down But Observation Status Up

New research suggests that the general decline in hospital readmissions may be leading to increased use of observation status.
According to new research in the journal Health Affairs,

Our independent analysis of Medicare data published by CMS revealed that the top 10 percent of hospitals with the largest drop (16 percent on average) in readmission rates between 2011 and 2012 also increased their use of observation status for Medicare patients returning within 30 days by an average 25 percent over the same time period.

The practice appears to be affecting privately insured patients, too, with the report noting that

…hospitals that reduced readmissions within 30 days also increased their share of returning observation patients in private plans. The top third of hospitals with the largest six-year (2009-2014) reduction in 30 day readmissions (26 percent on average) increased their share of returning observation patients in private plans by an average of 45 percent (Figure 2). Much of that increase started in 2012, the same year that Medicare hospital readmission penalties began.

The report concludes that

Our findings suggest that at least some hospitals are substituting observation status for inpatient readmissions, both for Medicare and privately insured patients. These trends raise a number of questions. For instance, do observation patients get the same quality of care as inpatients? Further, do drops in readmission rates truly mean that hospitals are providing better quality care? Or… is it merely that some hospitals are avoiding penalties by relabeling patients they previously would have readmitted as observation patients?

Learn more about the study, its findings, and its potential implications in the article “Is Observation Status Substituting For Hospital Readmission?” here, on the Health Affairs web site.

PA Safety Net Admin2015-11-11T06:00:09+00:00November 11th, 2015|Medicare|Comments Off

Slight Decline in Uninsured Children in PA

The number of uninsured children in Pennsylvania fell from 147,303 in 2013 to 139,000 in 2014, according to a new study released by the Pennsylvania Partnerships for Children and the Georgetown University Center for Children and Families.
The decline was driven part by the expansion of the state’s Medicaid program, which was enabled by the federal Affordable Care Act. Pennsylvania’s Medicaid expansion began in early 2014.
Learn more about uninsured children in Pennsylvania in this Pittsburgh Post-Gazette article.

PA Safety Net Admin2015-11-03T06:00:46+00:00November 3rd, 2015|Uncategorized|Comments Off

CMS Proposal Would Mandate Hospital Discharge Planning

Hospitals that participate in Medicare and Medicaid would be required to develop discharge plans for all inpatients and many outpatients under a new regulation proposed by the Centers for Medicare & Medicaid Services (CMS).
According to a CMS news release,

…hospitals, including inpatient rehabilitation facilities and long-term care hospitals, critical access hospitals, and home health agencies would be required to develop a discharge plan based on the goals, preferences, and needs of each applicable patient . Under the proposed rule, hospitals and critical access hospitals would be required to develop a discharge plan within 24 hours of admission or registration and complete a discharge plan before the patient is discharged home or transferred to another facility. This would apply to all inpatients and certain types of outpatients, including patients receiving observation services, patients who are undergoing surgery or other same-day procedures where anesthesia or moderate sedation is used, and emergency department patients who have been identified by a practitioner as needing a discharge plan. In addition, hospitals, critical access hospitals, and home health agencies would have to —

Provide discharge instructions to patients who are discharged home (proposed for hospitals and critical access hospitals only);
Have a medication reconciliation process with the goal of improving patient safety by enhancing medication management (proposed for hospitals and critical access hospitals only);
For patients who are transferred to another facility, send specific medical information to the receiving facility; and
Establish a post-discharge follow-up process (proposed for hospitals and critical access hospitals only).

The proposed regulation stresses the preferences and goals of patients in the development of their discharge plans, including the selection of post-acute-care providers to which they may be discharged or the home health providers that may serve them when they return home.
Significantly, from the perspective of Pennsylvania’s safety-net hospitals, the proposed regulation calls for hospitals to consider the socio-economic status of the patients for whom they are planning – although no requirements are associated with that status.
Interested parties have until January 3 to submit comments to CMS on the proposed regulation.
To learn more about what CMS is proposing and what it hopes to accomplish, see this CMS news release. Find the proposed regulation itself here.

PA Safety Net Admin2015-11-02T06:00:15+00:00November 2nd, 2015|Medicare|Comments Off

Medicare Cuts May be Part of Budget Deal

The agreement between the White House and congressional negotiators on a two-year budget deal and an increase in the federal debt ceiling will be paid for in part with reductions in Medicare payments.
Under the reported agreement, negotiators agreed to increase federal spending $80 billion over two years, and that increase will almost certainly need to be offset by spending cuts. The New York Times has reported that “The Medicare savings would come from cuts in payments to doctors and other health care providers.”
The budget agreement reportedly did not include specific spending cuts beyond extension of the current two percent Medicare sequestration cuts, although the publication The Hill reports that site-neutral Medicare outpatient payments may be part of the agreement; the additional cuts will need to be negotiated within Congress.
To learn more about the budget agreement and its possible implications for health care providers, see this New York Times article and this report from The Hill.

PA Safety Net Admin2015-10-27T16:31:46+00:00October 27th, 2015|Medicare|Comments Off

Low-Income Workers Rejecting Health Insurance

Low-wage workers offered health insurance by their employers are largely rejecting that option, according to a report in the New York Times.
According to the Times, most of the progress in reducing the number of unemployed Americans has been made through Medicaid expansion and subsidies offered through the federal and state health exchanges. As small businesses begin to be required to offer their workers unsubsidized insurance, however, they are finding that most of their lower-wage employees are rejecting the offer. As a result, 7.5 million people last year paid the Affordable Care Act fine for failing to obtain health insurance.
A review of the profile of those who choose not to purchase employer-sponsored health insurance found that workers who earn between $15,000 and $20,000 a year purchase insurance only 37 percent of the time and that only when income rises to $45,000 does the health insurance purchase rate increase significantly.
For more information about who is and is not buying employer-sponsored health insurance and why, see this New York Times article.

PA Safety Net Admin2015-10-22T06:00:38+00:00October 22nd, 2015|Affordable Care Act|Comments Off

Increases in Medicaid Enrollment Should Slow

Growth in Medicaid enrollment, significant this year and last, should slacken in 2016, according a new Kaiser Family Foundation report.
That growth – 8.3 percent in 2014 and 13.8 percent in 2015 – should fall to approximately four percent next year. The upswing is the result of Medicaid expansion authorized by the Affordable Care Act and most of the growth was in states that expanded their Medicaid programs, although in 2015 every state experienced an increase in Medicaid enrollment.
Growth in Medicaid spending, too, is expected to decline, from 14.3 percent in 2014 and 13.9 percent in 2015 to a projected 6.9 percent in 2016.
To learn more about how, where, and why Medicaid enrollment and spending continue to grow, see this CQ HealthBeat report presented by the Commonwealth Fund.

PA Safety Net Admin2015-10-22T06:00:01+00:00October 22nd, 2015|Affordable Care Act|Comments Off

Patient-Centered Care Needs Closer Scrutiny, Study Says

While the growing emphasis on patient-centered care has turned from a theory into an active tool in the development of public health care policy, a greater emphasis must be placed on cataloguing and examining more closely those efforts.
Or so says a new study from the Urban Institute.
According to the study, policy-makers need “…a clearer picture of where current policies have already taken us and where they are heading.”
The study also notes that “… efforts in HHS and elsewhere in the federal government should be comprehensively catalogued and subjected to the same strategic scrutiny as other care improvement activities” and that “The pace of change also underlines the need for better measures and more information on effective implementation.”
For a closer look at the study’s findings, go here, to the Urban Institute’s web site, to find the study “The Road to Making Patient-Centered Care Real.”

PA Safety Net Admin2015-10-20T06:00:33+00:00October 20th, 2015|Medicare|Comments Off

Members of Congress Seek Increased Medicare Rates

Members of Congress have written to Centers for Medicare & Medicaid Services (CMS) acting administrator Andrew Slavitt asking him to reconsider his agency’s proposal to reduce the rates Medicare will pay providers for outpatient services.
In July, CMS proposed reducing those outpatient rates 0.2 percent in calendar year 2016.
The letter notes that

According to MedPAC, Medicare already pays hospitals less than 88 cents on the dollar for outpatient services and this rule will make that situation worse for our constituents – both hospitals and patients alike.

The letter also states that

Medicare already pays providers less than the cost of care. Prescribing a negative update to OPPS [note: outpatient prospective payment system] payment rates will only make it more difficult for hospitals to serve their patients and their communities, particularly as they move to adopt delivery system reforms.

To see the letter, including the names of the 95 Democrats and Republicans who signed it, go here.

PA Safety Net Admin2015-10-13T06:00:53+00:00October 13th, 2015|Medicare|Comments Off

GAO Questions Impact of Medicare Value-Based Purchasing Program

Medicare’s value-based purchasing program may not be having much of an impact on the quality of care hospitals provide, according to a new report by the U.S. Government Accountability Office.

According to a GAO summary of its report Hospital Value-Based Purchasing: Initial Results Show Modest Effects on Medicare Payments and No Apparent Change in Quality-of-Care Trends,

GAO’s analysis found no apparent shift in existing trends in hospitals’ performance on the quality measures included in the HVBP [note: hospital value-based purchasing] program during the program’s initial years.
The agency did note, however, that

…shifts in quality trends could emerge in the future as the HVBP program continues to evolve.

The study also evaluated how safety-net hospitals fare under the program.

GAO found that safety net hospitals, which provide a significant amount of care to the poor, consistently had lower median payment adjustments – that is, smaller bonuses or larger penalties – than hospitals overall in the program’s first three years. However, this gap narrowed over time.

For a closer look at the GAO study and what it means, see this Kaiser Health News report. Find the study itself here, on the GAO web site.

PA Safety Net Admin2015-10-08T06:00:16+00:00October 8th, 2015|Uncategorized|Comments Off

Study Considers How Best to Prevent Readmissions

A five-year study performed by researchers from the Yale School of Public Health has found that while many hospitals have successfully reduced the rate of readmission for their Medicare patients, few specific strategies have emerged as best practices for tackling this challenge.
In fact, only one strategy appears to be universally effective: discharging patients with their follow-up appointments already made.
Beyond that, researchers found that hospitals lowered their readmission rates by employing a number of tools and that most successful hospitals employed at least three such tools – although which tools they employed differed and more tools did not produce better results.
Hospitals have been working to lower their readmissions in response to Medicare’s hospital readmissions reduction program, which imposes financial penalties for hospitals that readmit “too many” of their Medicare patients.
The study’s conclusion:

Hospital readmission rates result from the confluence of diverse patient, provider, and organizational factors. Despite a wide range of hospitals and five years of study, we found little evidence that specific strategies conferred improvements across hospitals, aside from booking follow-up appointments before discharge. Rather, adopting at least three strategies, tailoring implementation efforts to local circumstances, and persistence over time seemed to be keys to success.

Find the Yale study “National Campaigns to Reduce Readmissions: What Have We Learned?” here, on the web site of the Commonwealth Fund, which underwrote the research.

PA Safety Net Admin2015-10-05T06:00:55+00:00October 5th, 2015|Medicare|Comments Off

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