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

Numbers Link Medicaid Expansion, Diabetes Diagnoses

One of the primary arguments made by the Safety-Net Association of Pennsylvania in favor of state Medicaid reimbursement policies that support the work of safety-net hospitals is that many of the low-income patients they serve have had sporadic contact with the health care system over the years and often present with medical problems that go well beyond the immediate reason that brings them to hospitals.
Now comes new information that supports that argument.
The medical testing company Quest Diagnostics has found that the number of Medicaid patients its testing has found to have diabetes has risen more than 24 percent during two recent six-month review periods in states that have expanded their Medicaid programs while the number of such patients found to have diabetes in states that did not expand their Medicaid programs saw only a 0.4 percent increase in diabetes diagnoses.
Pennsylvania did not expand access to Medicaid during the review periods covered by the Quest analysis but now that it has done so, the problem seems likely to arise in the state.
Because of where they are located, Pennsylvania’s safety-net hospitals serve higher proportions of low-income patients than the typical community hospital and are therefore more likely to be caring for these more challenging patients newly diagnosed with diabetes in the near future.
For more information about the Quest findings and their implications, see this New York Times article. In addition, the latest edition of the journal Diabetes Care presents a study on the subject. See that article here.

PA Safety Net Admin2015-03-26T06:00:08+00:00March 26th, 2015|Pennsylvania safety-net hospitals|Comments Off

OIG Reiterates Medicare, Medicaid Recommendations

Every year the U.S. Department of Health and Human Services’ Office of the Inspector General (OIG) examines the operations of various department offices, programs, and policies and offers recommendations for changes and improvements. Some of those recommendations are adopted and others are not.
The OIG annually publishes a document reiterating what it believes to be its most important and potentially useful recommendations that were not adopted, and that publication was just released.
Among the Medicare and Medicaid recommendations it has presented again are:

Establish accurate and reasonable Medicare payment rates for hospital inpatient services.
Establish accurate and reasonable Medicare payment rates for hospital transfers.
Reduce hospital outpatient department payment rates for ambulatory surgical center-approved procedures.
Prevent inappropriate payments to Medicare home health agencies.
Reduce inappropriate payments to skilled nursing facilities.
Prevent payments for ineligible Medicare beneficiaries.
Reconcile Medicare outlier payments in accordance with federal guidance and regulations.
Ensure that states calculate accurate costs for Medicaid services provided by local providers.
Ensure the collection of identified Medicare overpayments.
Improve oversight of management of Medicaid personal services.
Improve the Medicare appeals process at the administrative law judge level.
Enhance efforts to identify adverse events to ensure quality of care and safety.
Ensure that Medicare children receive all required preventive screening services.
Strengthen oversight of state access standards for Medicaid managed care.

In its Compendium of Unimplemented Recommendations/March 2015, the OIG presents the issues and its rationale for its recommendation and describes the status of implementation, including, in some cases, why CMS has chosen not to implement its recommendations.
Find the report here.

PA Safety Net Admin2015-03-25T06:00:00+00:00March 25th, 2015|Medicare|Comments Off

House May Address Doc Fix Bill This Week

Means-testing for Medicare beneficiaries.
Modest raises for doctors now and the promise of no cuts for a decade.
An extension of the Children’s Health Insurance Program (CHIP) for ten years.
These and other provisions are part of a new bill expected to move to the House this week that would eliminated the use of the Medicare sustainable growth rate formula (SGR) that threatens to cut Medicare payments to doctors 21 percent beginning on April 1.
For years Congress has implemented temporary measures to prevent similar cuts but now, it appears to be serious about addressing the problem permanently by eliminating the SGR formula and introducing in its place a new payment system for doctors that pays them based on the quality rather than the quantity of care they deliver.
What’s in this latest proposal? Kaiser Health News has published an FAQ that describes the issue, the proposed solutions, and the challenges those solutions face in the coming days. See that FAQ here.

PA Safety Net Admin2015-03-24T06:00:58+00:00March 24th, 2015|Medicare|Comments Off

PA Releases Document Outlining Transition to “Traditional Medicaid Expansion”

The Pennsylvania Department of Human Services (DHS) has posted a document outlining its plan for transitioning from the Healthy Pennsylvania Medicaid expansion to what it terms a “traditional Medicaid expansion.”
The document summarizes what the state is doing, why it is doing it, and how it plans to move from the previous approach to the new one. It also includes links to expansion-related documents and explanations, presents the cost of the transition and the new program, and explains to interested parties how they can comment on the state’s plans.
Find the notice document “Transition to Traditional Medicaid Expansion” here.

PA Safety Net Admin2015-03-23T06:00:57+00:00March 23rd, 2015|Pennsylvania Medicaid policy|Comments Off

States Turning More to Providers to Fund Medicaid

States are relying more on provider taxes and other sources to raise their share of Medicaid funding, a new study by the U.S. Government Accountability Office (GAO) has found.
According to the GAO, state use of such funding rose 21 percent from 2008 to 2012. Most of the money came from health care provider taxes, provider donations, intergovernmental transfers, and Medicaid certified public expenditures.
While the study examined the issue nation-wide it focused on Medicaid financing in three states: California, Illinois, and New York.
Use of provider taxes is of special interest to Pennsylvania safety-net hospitals because it appears the state’s proposed FY 2016 budget may call for funding more of the state’s Medicaid program with proceeds from hospital provider taxes.
To learn more about how states are financing their share of their Medicaid programs and why this is of interest to policy-makers, see the recently re-released GAO report States’ Increased Reliance on Funds from Health Care Providers and Local Governments Warrants Improved CMS Data Collection and a newly published companion to the report titled Questionnaire Data on States’ Methods for Financing Medicaid Payments from 2008 through 2012.

PA Safety Net Admin2015-03-19T06:00:57+00:00March 19th, 2015|Pennsylvania safety-net hospitals, Proposed FY 2016 Pennsylvania state budget|Comments Off

Safety-Net Hospitals Struggle With Medicare’s Value-Based Purchasing

Safety-net hospitals are more likely than others to fare poorly under Medicare’s value-based purchasing program.
Or so concludes a new study published in the journal Health Affairs.
Researchers examined the impact of the addition of patient mortality measures to the program in 2014, and according to the abstract of the new study,
We found that safety-net hospitals were more likely than other hospitals to be penalized under the VBP program as a result of their poorer performance on process and patient experience scores. In 2014, 63 percent of safety-net hospitals versus 51 percent of all other sample hospitals received payment rate reductions under the program.
See the new study “Safety-Net Hospitals More Likely Than Other Hospitals To Fare Poorly Under Medicare’s Value-Based Purchasing” here, on the Health Affairs web site.

PA Safety Net Admin2015-03-18T06:00:35+00:00March 18th, 2015|Uncategorized|Comments Off

Congress Mulls Another Medicare Doc Fix

With a March 31 deadline looming before Medicare payments to physicians are scheduled to decline more than 20 percent, it appears Congress may be considering permanent repeal of the underlying root of the problem rather than yet another short-term patch.
At the heart of the problem is the sustainable growth rate formula, or SGR, that determines how Medicare pays physicians. For years Congress has applied short-term solutions to the SGR problem and paid for those solutions with short-term spending cuts. Now it appears congressional leaders are contemplating a permanent repeal of the troublesome formula.
The cost of doing so is about $175 billion for ten years, and Congress reportedly is considering cuts in both benefits and provider payments.
Because many Pennsylvania safety-net hospitals own physician practices, this issue is very important to them.
The Wall Street Journal has taken a closer look at this matter, examining the issue, the stakes, and both the policy and the political challenges congressional negotiators now face. See its report here.

PA Safety Net Admin2015-03-17T06:00:59+00:00March 17th, 2015|Uncategorized|Comments Off

Congress to Consider Adding Risk Adjustment to Medicare Readmissions Program

A new bill introduced in Congress last week would require Medicare to consider the socio-economic status of the patients individual hospitals serve as part of its hospital readmissions reduction program.
The Establishing Beneficiary Equity in the Hospital Readmissions Program Act of 2015 was introduced as S. 688 in the Senate, sponsored by Senators Rob Portman (R-OH) and Joe Manchin (D-WV), and in the House by Representatives Jim Renacci (R-OH) and Eliot Engel (D-NY) as H.R. 1343.
Rep. Renacci introduced a similar measure last year. This year’s version has bipartisan sponsorship in both the House and Senate.
Since the launch of Medicare’s readmissions reduction program several years ago, a number of studies have suggested that the program is unfair to hospitals that serve especially large numbers of low-income patients. The new proposal seeks to address that unfairness.
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 this proposal, see this news release announcing the bill. Find the bill itself here.

PA Safety Net Admin2015-03-16T06:00:53+00:00March 16th, 2015|Uncategorized|Comments Off

New Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its February newsletter.
This edition features articles on Medicaid expansion in Pennsylvania; problems posed by Healthy Pennsylvania for individuals who receive drug and alcohol or mental health services and how the state is addressing those problems; and the new, special enrollment period for those who are uninsured to sign up through the federal marketplace and avoid the fine for failing to secure health insurance.
The newsletter also lists upcoming state legislative budget hearings that will address health care issues and raises the possibility of the state establishing an Affordable Care Act-authorized “Community First Choice” program, which gives a state access to additional federal matching funds to pay for attendant services for Medicaid beneficiaries with severe intellectual or physical disabilities.
Find the latest edition of Health Law PA News here.

PA Safety Net Admin2015-03-13T06:00:18+00:00March 13th, 2015|Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy|Comments Off

PA Restores Substance Abuse Services to Medicaid Patients

Pennsylvania’s Department of Human Services (DSH) has restored access to drug and alcohol treatment services to Medicaid recipients who were placed in new Medicaid private coverage option plans that do not cover such care.
At fault was a glitch in the implementation of the Healthy Pennsylvania Medicaid expansion in which some Medicaid recipients were placed in “low risk” insurance plans that do not cover drug and alcohol treatment. DHS staff combed the rolls of Medicaid recipients who joined those plans in search of recipients who needed those services and shifted them into plans that provide such coverage.
About 8500 Medicaid beneficiaries affected by the problem have been moved into plans that enable them to resume resume treatment.
Some providers chose to continue treating their Medicaid patients who lost their coverage and have suffered financial problems as a result. The state intends to address those situations on a case-by-case basis, according to acting DHS secretary Ted Dallas.
Some of those recipients may eventually be on the move again as the Wolf administration continues phasing out the Healthy Pennsylvania program in favor of expanding the state’s pre-Healthy Pennsylvania Medicaid program.
For a close look at this problem, how it affects patients and providers, and how the state corrected it, see this Philadelphia Inquirer article.

PA Safety Net Admin2015-03-12T06:00:39+00:00March 12th, 2015|Pennsylvania Medicaid policy|Comments Off

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