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

Congress Forms New Medicaid Task Force

The U.S. House Energy & Commerce Committee has created a new task force “to strengthen and sustain the critical program for the nation’s most vulnerable citizens.”
According to a committee news release, the task force “…will examine the program to determine how to ensure the program is best serving the needs of those who rely on it.”
The task force’s work will undoubtedly be of interest to Pennsylvania safety-net hospitals, all of which care for unusually large numbers of Medicaid patients.
For further information about the new task force, its members, and its mission, see this House Energy & Commerce Committee news release.

PA Safety Net Admin2015-11-18T06:00:34+00:00November 18th, 2015|Uncategorized|Comments Off

Study Looks at Social Determinants of Health

A new issue brief from the Kaiser Family Foundation looks at the social determinants of health and health outcomes.
The issue brief “Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity” reports that

Social determinants have a significant impact on health outcomes. Social determinants of health are “the structural determinants and conditions in which people are born, grow, live, work and age.” They include factors like socioeconomic status, education, the physical environment, employment, and social support networks, as well as access to health care (Figure 2). Based on a meta-analysis of nearly 50 studies, researchers found that social factors, including education, racial segregation, social supports, and poverty accounted for over a third of total deaths in the United States in a year. In the United States, the likelihood of premature death increases as income goes down. Similarly, lower education levels are directly correlated with lower income, higher likelihood of smoking, and shorter life expectancy. Children born to parents who have not completed high school are more likely to live in an environment that poses barriers to health. Their neighborhoods are more likely to be unsafe, have exposed garbage or litter, and have poor or dilapidated housing and vandalism. They also are less likely to have sidewalks, parks or playgrounds, recreation centers, or a library.

The issue brief also looks at different steps that are being pursued to address such challenges through the State Innovation Models Initiative (SIM), state Medicaid programs, community health centers, health insurers, local groups, and more.
The Safety-Net Association of Pennsylvania (SNAP) has long maintained that the patients it serves are fundamentally more challenging to treat than those served by the typical community hospital because of the very factors identified in this study.
To learn more, find the Kaiser Foundation issue brief here.

PA Safety Net Admin2015-11-17T06:00:21+00:00November 17th, 2015|Safety-Net Association of Pennsylvania, Uncategorized|Comments Off

Report on Hospital Performance in PA

The Pennsylvania Health Care Quality Alliance has released its annual report on the performance of the state’s hospitals.
The group compared hospital performance over time on 16 process measures: three heart attack measures, two heart failure measures, three pneumonia measures, six surgical care measures, and one prevention measure. It found that hospital performance in the state improved during the July 2013 to June 2014 over previous years and that those improvements mirrored similar improvements nationally. Overall, the group found that the performance of Pennsylvania’s hospitals on these measures was better than average nationally.
The alliance also evaluated patient satisfaction with Pennsylvania hospitals as quantified by hospital consumer assessment of healthcare providers and systems (HCAHPS) measures. It found modestly improved performance that generally mirrored national trends.
Finally, alliance reported on the delivery of care in hospital emergency rooms and found modestly improved performance that was very similar to hospitals’ performance nation-wide.
The Pennsylvania Health Care Quality Alliance is a voluntary group of health care organizations working together to improve the quality of health care in Pennsylvania. It report State of the State: Hospital Performance in Pennsylvania, October 2015, can be found here, on the organization’s web site.

PA Safety Net Admin2015-11-16T06:00:08+00:00November 16th, 2015|Uncategorized|Comments Off

GAO: More Information Needed About Supplemental Medicaid Payments

More data is needed about the supplemental Medicaid payments states make to hospitals and how those payments are financed, according to a new report from the U.S. Government Accountability Office (GAO).
According to the GAO, states are increasingly funding non-disproportionate share (Medicaid DSH) supplemental Medicaid payments to hospitals with funds from local governments and providers that are then matched by the federal government. In some states those supplemental payments, with the help of federal Medicaid matching funds, result in hospitals receiving reimbursement from Medicaid that exceeds the cost of the care they provide to their Medicaid patients.
Pennsylvania’s safety-net hospitals receive a number of such supplemental Medicaid payments.
In response to this concern, the GAO has urged the Centers for Medicare & Medicaid Services (CMS) to collect more and better data about how states finance their Medicaid programs and to do more to ensure that accuracy of that data. For its part, CMS maintains that its current efforts are adequate.
Learn more about this issue from the GAO report Improving Transparency and Accountability of Supplemental Payments and State Financing Methods, which can be found here.

PA Safety Net Admin2015-11-13T06:00:33+00:00November 13th, 2015|Medicaid supplemental payments, Pennsylvania safety-net hospitals|Comments Off

CMS Requires States to Monitor Medicaid Access

A new federal regulation requires states to monitor access to Medicaid-covered services.
According to a new regulation issued by the Centers for Medicare & Medicaid Services (CMS), states must submit to CMS plans for monitoring Medicaid beneficiary access to care in five service areas: primary care, physician specialists, behavioral care; pre- and post-natal care; and home health services.
State monitoring plans must address the extent to which Medicaid is meeting beneficiaries’ needs; the availability of care; changes in service utilization; and comparisons between Medicaid rates and rates paid by other public and private payers.
Interested parties have 60 days to submit comments to CMS about the new regulation.
For a closer look at the regulation, see this CMS fact sheet and the regulation itself here, in the Federal Register.

PA Safety Net Admin2015-11-12T12:09:56+00:00November 12th, 2015|Uncategorized|Comments Off

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

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