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

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

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

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