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

30-Day Readmission Standard Flawed, Study Suggests

A new study raises the possibility that Medicare’s policy of penalizing hospitals that readmit patients within 30 days of their discharge may be flawed.
According to a new report in the Annals of Internal Medicine, risk factors for readmission often change within those 30 days.
In addition, patients with chronic medical problems are more likely to need readmission. Even the time of day of discharge appears to affect patients’ likelihood of readmission, with those discharged between 8 a.m. and 1:00 p.m. less likely to be readmitted.
The study also found that social determinants and insurance status also increase the likelihood of readmission within 30 days of discharge.
Together, these and other findings appear to raise questions about the fairness of Medicare’s hospital readmissions reduction program.
These findings also mirror a growing body of research that suggests that the program is inherently unfair to safety-net hospitals that serve large numbers of low-income patients who have had limited and sporadic access to medical care during their lives.
To learn more, see this Fierce Healthcare report. Find the study “Differences Between Early and Late Readmissions Among Patients: A Cohort Study” here, on the web site of the Annals of Internal Medicine.

PA Safety Net Admin2015-06-08T06:00:26+00:00June 8th, 2015|Medicare|Comments Off

PA Seeks to Establish Health Insurance Marketplace

In anticipation of a possible Supreme Court decision that could jeopardize the health insurance of an estimated 382,000 Pennsylvanians, the Wolf administration has applied to the federal government to establish a state-based health insurance marketplace.
The Supreme Court is currently weighing a challenge to the use by some states of the federal health insurance marketplace and the contention of litigants that the Affordable Care Act specifies that insurance subsidies would only be available through state-based exchanges. If the court rules against the federal government, the insurance of residents of states that did not establish their own exchanges and who instead obtained their insurance and federal subsidies through the federal exchange will be in jeopardy.
The move by the Wolf administration is a contingency plan and does not commit the state to developing its own exchange.
For further information about the state’s application to establish a health insurance exchange, see this Wolf administration news release.

PA Safety Net Admin2015-06-05T06:00:42+00:00June 5th, 2015|Affordable Care Act, Health care reform|Comments Off

SNAP Holds Legislative Breakfast

On Tuesday, June 2, the Safety-Net Association of Pennsylvania held a legislative breakfast in Harrisburg to talk to members of the state legislature and their staffs about issues of importance to Pennsylvania’s safety-net hospitals and to present SNAP’s position on various aspects of Governor Wolf’s proposed FY 2016 budget.
In particular, SNAP addressed a number of proposed cuts in state Medicaid spending that would have an especially serious effect on Pennsylvania’s 41 private safety-net hospitals.
Among those who attended were numerous members of the state House and Senate from across the commonwealth: Democrats and Republicans, members of leadership and key budget and health care committees, and individuals with a keen interest in the work being done by Pennsylvania’s safety-net hospitals.
During the meeting SNAP also unveiled a brief document outlining its position on the proposed FY 2016 budget and the Medicaid cuts it includes. Find that document here.

PA Safety Net Admin2015-06-04T06:00:32+00:00June 4th, 2015|Proposed FY 2016 Pennsylvania state budget|Comments Off

But Does Coverage Mean Access?

More than 12 million people have joined the Medicaid rolls in the U.S. since the Affordable Care Act’s voluntary expansion of Medicaid eligibility began in January of 2014.
Historically, however, many Medicaid patients have had a difficult time finding doctors willing to serve them because in many states, Medicaid payments are so low that doctors choose not to participate in the program.
Is that still the case today? What challenges do Medicaid patients face when they need medical care?
In a new article titled “You’ve Got Medicaid – Why Can’t You See the Doctor?”, U.S. News & World Report takes a look at this issue. Find its report here.

PA Safety Net Admin2015-06-03T06:00:53+00:00June 3rd, 2015|Affordable Care Act|Comments Off

Feds Release First SIM Grant Performance Evaluation

In 2013, the federal Center for Medicare & Medicaid Innovation (CMMI) awarded its first State Innovation Model grants. Now, the agency has released its first evaluations of the performance of grant recipients.
State Innovation Model or SIM grants, established under the Affordable Care Act, were created to support the development of innovative payment and care delivery models that reduce state health care spending while preserving or improving the quality of care. The law set aside $10 billion to support the program, which generally provides financial and technical support to states for the development and testing of multi-payer payment and delivery models.
Now, CMMI has published its first evaluations of the performance of states awarded SIM grants. See those evaluations here and here; the latter document includes an extensive description of Pennsylvania’s SIM planning activities.

PA Safety Net Admin2015-06-02T11:33:28+00:00June 2nd, 2015|Affordable Care Act|Comments Off

Senate Takes Testimony on Medicare Observation Status

The Senate Special Committee on Aging recently heard testimony about the challenges posed by the “observation status” designation conferred on some Medicare patients in hospitals.
Among the concerns raised at the hearing were the financial vulnerability of some seniors hospitalized only under observation and not as inpatients; the possibility that some hospitals may be using observation status to avoid Medicare penalties for readmitting recently discharged payments; the punitive actions of Medicare recovery audit contractors (RAC auditors); and more. Intertwined with this is Medicare’s two-midnight rule and the challenges the program has faced attempting to implement this rule.
Testifying before the committee were representatives of the Medicare Payment Advisory Commission (MedPAC), the Centers for Medicare & Medicaid Services (CMS), the American Hospital Association, and others.
For a closer look at the hearing, a link to a video of the hearing, and copies of some of the testimony, see this Fierce Healthcare article.

PA Safety Net Admin2015-06-01T06:00:59+00:00June 1st, 2015|Medicare|Comments Off

Feds Propose New Medicaid Managed Care Regs

The Centers for Medicare & Medicaid Services (CMS) has proposed its first major changes in regulations governing Medicaid managed care in more than a decade.
In a 653-page draft regulation published on Monday, CMS proposes imposing a medical-loss ratio on Medicaid managed care plans; establishing new standards for adequate provider networks; partially lifting the ban on payments to institutions for mental diseases; pursuing greater transparency in rate-setting; and new quality initiatives that mirror those of Medicare and the federal marketplace.
In addition, the proposed regulation calls for new marketing guidelines for Medicaid managed care plans, improved access to information for Medicaid beneficiaries, and new program integrity measures. It also proposes better aligning the governance of CHIP with Medicaid, new requirements for managed long-term services and supports, and new tools for fostering delivery system reform at the state level.
With virtually all Medicaid recipients in Pennsylvania now enrolled in managed care plans, this regulation will be significant for the state’s safety-net hospitals.
Interested parties have until July 27 to submit comments to CMS about the proposals.
To learn more about this major regulatory proposal, see this Kaiser Health News article; find the regulation here; and see this CMS fact sheet on the draft regulation.

PA Safety Net Admin2015-05-28T06:00:35+00:00May 28th, 2015|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

Underinsurance Remains a Problem

Twenty-three percent of American adults are uninsured, according to a new survey by the Commonwealth Fund.
Among them, 14 million had deductibles that exceeded five percent of their income while another 24 million had deductibles that fell below that threshold but had out-of-pocket health care costs – deductibles, co-insurance, co-payments, and out-of-network payments – that exceeded ten percent of their income.
The figures are for 2012 and reflected no change since 2010 but were nearly twice those found in 2003.
In addition, the survey found that the proportion of the insured with high-deductible plans has more than tripled, from three percent to 11 percent, since 2003. This is believed to reflect the proliferation of high-deductible plans in recent years – a proliferation that has increased with implementation of the Affordable Care Act and the many high-deductible plans offered through the federal exchange and state exchanges. This survey, however, did not distinguish between pre- and post-Affordable Care Act insurance policies.
Another category of the uninsured is those with income less than 200 percent of the federal poverty level whose out-of-pocket health care costs are greater than five percent of their income. Such individuals can pose a special challenge to safety-net hospitals because they often are unable to pay their co-pays, deductibles, and some of their medical costs.
For a closer look at the numbers, who is underinsured, the role of high-deductible plans in being underinsured, the effect of being underinsured on gaining access to care and addressing health problems, and more, see The Problem of Underinsurance and How Rising Deductibles Will Make it Worse, an issue brief summarizing the Commonwealth Fund survey.

PA Safety Net Admin2015-05-26T06:00:35+00:00May 26th, 2015|Affordable Care Act|Comments Off

PHC4 Reports on Hospital Financial Performance

The Pennsylvania Health Care Cost Containment Council (PHC4) has released its annual report on the financial performance of the state’s acute-care hospitals.
Among the highlights (changes in performance are from 2013 to 2014):

The total margin of hospitals state-wide declined 0.36 percentage points, from 6.06 percent to 5.7 percent.
The operating income of acute-care hospitals fell from $1.8 billion to $1.7 billion.
Thirty-four percent of hospitals lose money on operations and 28 percent lost money overall.
Uncompensated care rose 2.2 percent, or $22 million, to $1.07 billion.
The number of hospital discharges and patient days declined.
The number of outpatient visits fell 3.2 percent.
Outpatient services accounted for 44.8 percent of net patient revenue.

To learn more about what PHC4 learned, see its new report Financial Analysis 2014: Volume One: General Acute Care Hospitals.

PA Safety Net Admin2015-05-22T06:00:44+00:00May 22nd, 2015|Uncategorized|Comments Off

Medical Malpractice Suits Fall in PA

Since new laws designed to reduce the number of medical malpractice suits in Pennsylvania were passed in 2003 and 2004, the number of such suits has been cut in half.
Last year, 1463 medical malpractice suits were filed in Pennsylvania. In 2002, 2904 such suits were initiated.
And possibly related, the number of physicians practicing medicine in Pennsylvania has risen – a development that follows a nation-wide trend but is doing so at a rate that exceeds the growth in the number of doctors in other states.
To learn more about what Pennsylvania did to reduce medical malpractice lawsuits, how those laws are working, and how this may or may not be affecting the state’s supply of practicing physicians, see this Pittsburgh Post-Gazette article.

PA Safety Net Admin2015-05-21T06:00:46+00:00May 21st, 2015|Uncategorized|Comments Off

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