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

Hospitals, Especially Safety-Net Hospitals, Struggle With Heart Failure Readmissions

For all the emphasis on reducing readmissions to hospitals, providers continue to struggle to prevent readmissions of patients suffering heart failure.
Or so concludes a new study published in the Journal of Cardiac Failure.
According to the study, there has been only a slight reduction in readmissions rates for heart failure patients over the past four years.
In addition, Fierce Healthcare reports that

…2014 research revealed that safety-net hospitals and those with largely low-income patient populations are at particular risk for heart failure readmissions; patients from lower-income neighborhoods, researchers found, were nearly 17 percent more likely to be readmitted within six months of discharge.

This finding supports the Safety-Net Association of Pennsylvania’s long-time contention that the distinct challenges Pennsylvania’s safety-net hospitals face in serving their especially low-income, medically challenged communities speak to the need for public policy that reflects those special challenges.
To learn more about this issue, see this Fierce Healthcare report.

PA Safety Net Admin2015-10-02T06:00:12+00:00October 2nd, 2015|Medicare, Uncategorized|Comments Off

Better Medicaid Data Needed, Governors Say

States need better data to meet the needs of Medicaid recipients with complex medical needs, according to the National Governors Association (NGA).
One of the biggest costs in state Medicaid programs is “super-utilizers”: patients who consume a significant amount of health care services. Although relatively few in number, these patients account for a significant proportion of state Medicaid expenditures.
The group’s conclusion is based on the NGA Center for Best Practices’ experience working with seven states to find better ways to meet the needs of these patients with better but less-expensive care.
According to the report,

Before state leaders can begin to address their super-utilizer populations, they first need to understand who those patients are, how they use the health care system, and how the state might adapt its system to meet patient needs.

To do this, state Medicaid programs need more and better data so they can

understand the characteristics of complex populations
identify and target specific patients
ensure effective management and evaluation

Pennsylvania’s safety-net hospitals routinely serve significant numbers of such patients.
To learn more about the NGA’s recommendation and how it reached it, go here to see its report Using Data to Better Serve the Most Complex Patients: Highlights from NGA’s Intensive Work with Seven States.

PA Safety Net Admin2015-10-01T06:00:52+00:00October 1st, 2015|Pennsylvania Medicaid policy|Comments Off

Court Rebuffs HHS on Medicare Two-Midnight Rule Pay Cut

A federal court has told the U.S. Department of Health and Human Services that it will have to do more to justify a 0.2 percent cut in inpatient payment rates that is part of the controversial Medicare two-midnight rule.
The court decided that in addition to providing a better rationale for the pay cut, Medicare also will need to have a public comment period for that rationale.
Medicare had already delayed implementation of the two-midnight rule.
To learn more about this court decision, see this McKnight Long-Term Care News article.

PA Safety Net Admin2015-09-30T06:00:46+00:00September 30th, 2015|Medicare|Comments Off

DHS Explains Latest Medicaid Initiatives

The Pennsylvania Department of Human Services describes two recent steps to improve the delivery of health care to low-income Pennsylvanians – the introduction of its new “Community HealthChoices” program and the re-bidding of managed care organization contracts for its HealthChoices physical health program – in the latest edition of its newsletter The Impact.
Find that edition here.

PA Safety Net Admin2015-09-29T06:00:21+00:00September 29th, 2015|HealthChoices PA, Pennsylvania Medicaid policy|Comments Off

PA Puts New HealthChoices Contracts Up for Bid

The Pennsylvania Department of Human Services (DHS) has issued a request for proposals (RFP) for organizations interested in serving the state’s Medicaid population through its HealthChoices Medicaid managed care program.
The HealthChoices program, introduced in 1997, currently serves nearly 2.5 million Pennsylvanians. Among them, 200,000 have enrolled in the program since the state’s Medicaid expansion began in January.
The contracts will put a greater emphasis on value-based purchasing and will require participating insurers to provide at least 30 percent of their services in a value-based or outcomes-based manner within three years. Among the tools managed care organizations are expected to employ to achieve this goal are accountable care organizations, bundled payments, and patient-centered homes.
With a projected value of about $17 billion, the RFP is expected to attract interest from national organizations that have not necessarily served Pennsylvania’s Medicaid population in the past.
To learn more about the state’s HealthChoices plans, see this news release from the Department of Human Services and this Philadelphia Inquirer article. Find the RFP itself here.

PA Safety Net Admin2015-09-23T06:00:50+00:00September 23rd, 2015|HealthChoices PA, Meetings and notices|Comments Off

Medicare Readmissions Program Unfair to Safety-Net Hospitals, Study Finds

Medicare’s readmissions reduction program penalizes hospitals based largely on the patients they serve rather than their performance serving them, a new study has concluded.
According to the report “Patient Characteristics and Differences in Hospital Readmission Rates,” published in the journal JAMA Internal Medicine,

Patient characteristics not included in Medicare’s current risk-adjustment methods explained much of the difference in readmission risk between patients admitted to hospitals with higher vs lower readmission rates. Hospitals with high readmission rates may be penalized to a large extent based on the patients they serve.

Among those two dozen socio-economic factors: patient income, education, and ability to bathe, dress, and feed themselves.
The study found, for example, that the worst-performing hospitals under Medicare’s hospital readmissions reduction program have 50 percent more patients with less than a high school education than the program’s best performers.
Pennsylvania’s safety-net hospitals serve especially large numbers of low-income patients and have been especially vulnerable to the readmissions reduction program’s penalties.
To learn more about the study, see this Washington Post story. To find the study itself, go here, to the web site of JAMA Internal Medicine.

PA Safety Net Admin2015-09-22T06:00:25+00:00September 22nd, 2015|Medicare|Comments Off

PA to Push for Value-Based Purchasing of Care

The Secretary of Pennsylvania’s Department of Health has issued a call for greater use of value-based purchasing of health care services in the state.
At a conference hosted by the Pittsburgh Business Group on Health, Secretary Karen Murphy invited insurers and employers to work together to pursue a value-based approach to the purchase of health care that would reduce the cost of care while improving the results of the care patients receive.
To support this initiative, Secretary Murphy has created a new innovation center in the state’s Health Department and appointed a deputy secretary to lead this effort.
Learn more about the state’s intentions in this Pittsburgh Business Times article.

PA Safety Net Admin2015-09-18T06:00:48+00:00September 18th, 2015|Uncategorized|Comments Off

DHS Issues RFI for Vendors to Help Monitor Payments

Pennsylvania’s Department of Human Services (DHS), which administers the state’s Medicaid program, is seeking information from vendors that offer data mining and predictive analytics that might help the state monitor Medicaid and other payments.
DHS seeks to use such services to “…detect patterns of waste, fraud, and abuse in its programs on a prospective or retrospective basis.”
Among the challenges such vendors might address in their responses, as stated in the RFI, are:

Identifying claim review strategies that efficiently and proactively prevent or address potential errors (e.g., prepayment edit specifications or parameters).
Providing mechanisms to investigate patterns that may indicate abuse of services by clients.
Producing innovative views of utilization or billing patterns that illuminate potential errors.
Maximizing recoveries by identifying high volume or high cost services that are widely over utilized.
Identifying areas of potential errors (e.g., services which may be non-covered or not correctly coded) that poses the greatest risk or vulnerability.
Establishing baseline data to enable DHS to dynamically recognize unusual trends, changes in utilization over time, or schemes to inappropriately maximize reimbursement. Adapting systems, rules, and algorithms on an ad hoc basis in order to be responsive to emerging trends, patterns, and issues as they are identified.
Clearly distinguishing which applications are standardized as part of the product package and which applications will need to be purchased as a system enhancement.
Establishing baseline data and recommendations to improve the client experience related to access to services and the quality of the services received.

The call for vendors is a request for information (RFI) and not a request for proposals (RFP) but it appears likely that the state will issue an RFP after it has had an opportunity to review the information submitted to it.
RFI submissions are due on November 9. See the RFI document here.

PA Safety Net Admin2015-09-17T06:00:51+00:00September 17th, 2015|Meetings and notices|Comments Off

MedPAC Looks at Various Issues at September Public Meeting

The independent federal agency that advises Congress on Medicare payment issues held its monthly public meeting in Washington, D.C.
During the two days of meetings, the Medicare Payment Advisory Commission (MedPAC) discussed its work on six specific issues:

developing a unified payment system for post-acute care
a preliminary analysis of Medicare Advantage encounter data for Part B services
factors affecting variation in Medicare Advantage plan star ratings
Medicare drug spending
emergency department services provided at stand-alone facilities
payments from drug and device manufacturers to physicians and teaching hospitals

Each discussion was accompanied by an issue brief and a presentation; find those documents here.

PA Safety Net Admin2015-09-16T06:00:54+00:00September 16th, 2015|Medicare|Comments Off

Medicare Proposes Addressing Health Disparities

The Centers for Medicare & Medicaid Services (CMS) has unveiled its first plan to reduce health disparities among Medicare beneficiaries.
The plan, produced by CMS’s Office of Minority Health and titled “The CMS Equity Plan for Improving Quality in Medicare,” will seek to improve care for

…Medicare populations that experience disproportionately high burdens of disease, lower quality of care, and barriers to accessing care. These include racial and ethnic minorities, sexual and gender minorities, people with disabilities, and those living in rural areas.

This is the very population served in disproportionate numbers by many of Pennsylvania’s private safety-net hospitals.
The program will focus on six priorities:

expanding the collection, reporting, and analysis of standardized data
evaluating disparity impacts and integrating equity solutions across Medicare programs
developing and dissemination promising approaches to reducing health disparities
increasing the ability of the health care workforce to meet the needs of vulnerable populations
improving communication and language access for individuals with limited English proficiency and persons with disabilities
increasing physical accessibility of health care facilities

To learn more about The CMS Equity Plan for Improving Quality in Medicare, see this CMS news release.

PA Safety Net Admin2015-09-15T06:00:58+00:00September 15th, 2015|Medicare, Pennsylvania safety-net hospitals|Comments Off

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