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

MedPAC Considers FY 2016 Pay Boost for Inpatient, Outpatient Payments

Medicare payments to hospitals for inpatient and outpatient care could rise 3.25 percent in the coming fiscal year.
At least that is what members of the Medicare Payment Advisory Commission (MedPAC) discussed recommending to Congress when they met last week in Washington.
During MedPAC’s two-day public meeting, members discussed recommending to Congress a 3.25 percent increase in Medicare inpatient and outpatient payments in FY 2016. They will vote on their recommendation at their next meeting.
A presentation to MedPAC members by their staff also offered a number of observations about Medicare services:

Demand for hospital services is stable.
With hospital occupancy down to 60 percent, it appears hospitals have excess capacity.
The quality of care hospitals provide is improving according to several metrics.
Hospital cost growth is down.
Hospitals’ Medicare margins are steady, although they remain negative, especially for outpatient services.
MedPAC should consider recommending policies to reduce or eliminate differences between payments to hospitals and doctors’ offices for selected outpatient services.

For a closer look at the Medicare inpatient and outpatient issues MedPAC examined at its December meeting, see the presentation on this subject here, on MedPAC’s web site.

PA Safety Net Admin2014-12-23T06:00:27+00:00December 23rd, 2014|Uncategorized|Comments Off

PA Issues Bulletin Detailing Healthy PA Benefits

The benefits offered through Pennsylvania’s “Healthy Pennsylvania” Medicaid expansion program are detailed in a new Medical Assistance Bulletin issued by the state’s Department of Human Services.
In addition to describing both the benefits and the processes the state will employ for seeking exceptions to the established benefits, the Bulletin includes several attachments: a benefit plan comparison chart; automatic benefit limit exceptions for APR-DRG; automatic benefit limit exceptions for radiology and imaging; automatic benefit limit exceptions for laboratory services; automatic benefit limit exceptions for durable medical equipment; and automatic benefit limit exceptions for medical supplies.
The program, the benefits, and the new guidelines take effect on January 1.
Find this Medical Assistance Bulletin here.

PA Safety Net Admin2014-12-22T06:00:27+00:00December 22nd, 2014|Healthy PA, Medical Assistance Bulletin, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

Unemployment Plays Major Role in Hospital Readmissions

A new study has found that employment status is the leading socioeconomic indicator of hospital readmissions for patients who have suffered heart attacks, heart failure, and pneumonia.
Using 2011 and 2012 data from the Centers for Medicare & Medicaid Services, researchers examined readmissions for these conditions based on nine factors that constitute what is known as the Community Needs Index: elderly poverty, single parent poverty, child poverty, lack of health insurance, minority, no high school, renting, unemployment, and limited English. Their analysis found that only employment status and lack of high school education were statistically significant predictors of hospital readmissions for the three conditions studied, with employment status more than three times as powerful an indicator as lack of high school education.
High unemployment is typically a major problem in the communities served by Pennsylvania safety-net hospitals.
Learn more about the study in this Fierce Healthcare report and see the study itself here.

PA Safety Net Admin2014-12-19T06:00:57+00:00December 19th, 2014|Uncategorized|Comments Off

Governor-Elect Sets Transition Teams

Pennsylvania Governor-elect Tom Wolf has announced the membership of his transition committees for human services (including Medicaid), health, and insurance.
Those committees and their members are:

Human Services

Chair Michael Rashid – Former CEO, AmeriHealth Caritas

Deb Beck – President, DASPOP

Joan Benso – President & CEO, PA Partnership for Children

Jeff Brown – President and CEO, Brown’s Super Stores, Inc.

Mark Bullock – Senior VP, Mercy Health System

Adam Devlin – Co-Founder, New Vitae Wellness and Recovery

John Elliott – Chairman and Senior Shareholder, Elliott Greenleaf

Liz Healey – Member, Pittsburgh School Board; Executive Director, The PEAL Center

Dorothy Mann – Former CEO, The Family Planning Council of SEPA

Sam Milkes – Executive Director, PLAN, Inc.

Ross Nese – President, Grane Healthcare

Mark Painter – Former State Legislator

Tony Payton, Jr. – Former State Legislator

Peri Jude Radecic – Chief Executive Officer, Disability Rights Network Pennsylvania

Jay Spector – CEO, JEVS Human Services

Sari Stevens – Executive Director, Planned Parenthood PA

John Tague – Principal, JT Consulting Services

Richard Vague – Managing Partner, Gabriel Investments; Chairman, Woods Foundation

Health

Co-Chair Dr. Karen Hacker – Director, Allegheny County Health Department

Co-Chair Dr. Rachel Levine – Professor of pediatrics and psychiatry, Penn State College of Medicine

Bruce Bartels – Former President, WellSpan Health

Frank Cervone – Executive Director, Support Center for Child Advocates

Karen Feinstein – President, Jewish Healthcare Foundation

Peter Grollman – Sr. VP, Children’s Hospital of Philadelphia

Larry Kaiser – CEO, Temple University Health System

Chuck Kritko – Former District Executive Director, Department of Health, Commonwealth of Pennsylvania

Larry Light – Executive Director, PA Med Society

Herbert Long – Board member, Temple University Hospital and the Philadelphia Nursing Home

Bruce Melgary – Former Executive Director, Lenfest Foundation

Carolyn Rogers – Executive Director, Healthy Philadelphia

Stuart Shapiro – President & CEO, PA Health Care Association

Jane Shull – Executive Director, Philadelphia FIGHT

David Simon – Current Chairman, Pa E-Health Board; Former Chief Counsel, Jefferson Health System; Former Chief Counsel, Pa. Dept. of Insurance

Evon Sutton – Business Agent, Local 48 of AFSCME District Council 33

Susan Taylor – Dermatologist

Ann Torregrossa – Director, PA Health Funders Collaborative

Insurance

Chair TJ Rooney – Former State Representative; served on Rules, Consumer Affairs, and Insurance Committees

Pat Brier – Attorney, Myers Brier & Kelly

Patrick Casey – Attorney, Elliot Greenleaf

Christopher Drumm – Senior Vice President, Government and External Affairs, AmeriHealth Caritas Pennsylvania

Jo Ann Lawer – Director, Government Affairs and Grants, Lancaster General Health

Gerald Lawerence – Partner, Lowey Dannenberg Cohen & Hart, PC

Sam Marshall – President & CEO, Insurance Federation of Pennsylvania

Silas Russell – Government Affairs and Legislative Director, SEIU Healthcare Pennsylvania

David Senoff – Attorney, Caroselli Beachler McTiernan & Conboy

Martin (Lenny) Torrence – Owner & Agent, Nationwide Insurance

PA Safety Net Admin2014-12-18T06:00:09+00:00December 18th, 2014|Uncategorized|Comments Off

PA Medicaid Primary Care Fees to Plummet

Payments to Pennsylvania primary care physicians who serve Medicaid patients will fall 52.4 percent after the first of the year, when the Affordable Care Act’s two-year increase in those payments ends.
The temporary fee increase was included in the Affordable Care Act to encourage more primary care physicians to serve Medicaid patients in anticipation of the significant growth of Medicaid as a result of the reform law’s Medicaid expansion. Under that law, Medicaid primary care fees were raised to the level of Medicare primary care rates for two years. Nation-wide, the average Medicaid primary care fee will fall 42.8 percent.
So far, 15 states plan to use their own money to prevent the dramatic reduction of Medicaid primary care payments. Pennsylvania is not among them.
The cut will be especially damaging to the state’s safety-net hospitals because they serve so many more Medicaid patients than the typical hospital and expect to serve even more such patients when the state’s Medicaid program expands beginning on January 1.
Learn more about the upcoming Medicaid payment cut in the new Urban Institute report Reversing the Medicaid Fee Bump: How Much Could Medicaid Physician Fees for Primary Care Fall in 2015?, which you can find here, on the Urban Institute’s web site.

PA Safety Net Admin2014-12-17T06:00:15+00:00December 17th, 2014|Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

SNAP Seeks State Help With Unpaid Claims

The Safety-Net Association of Pennsylvania (SNAP) is seeking the state Department of Human Services’ assistance with millions in unpaid Medicaid fee-for-service claims.
According to SNAP, the state’s Place of Services Review and Utilization Review processes are not addressing fee-for-services claims in a timely manner, leaving safety-net hospitals with large, long-overdue receivables. Eight SNAP members alone currently await payments of more than $30 million, and in many cases, some of those unpaid claims are more than a year old.
SNAP is seeking a meeting with state officials to discuss the problem and possible solutions.
See SNAP’s letter to the Department of Human Services (“SNAP Seeks State Help With Unpaid Claims Problem”).

PA Safety Net Admin2014-12-16T06:00:45+00:00December 16th, 2014|Uncategorized|Comments Off

Access to Primary Care a Medicaid Problem, HHS OIG Says

Many of the primary care providers that participate in Medicaid managed care programs are inaccessible to those plans’ members, according to a new report by the U.S. Department of Health and Human Services’ Office of the Inspector General (OIG).
As states’ Medicaid rolls grow and they direct more of their Medicaid beneficiaries into managed care plans, those beneficiaries may be encountering difficulty converting their access to health insurance into access to health care.
According to the OIG report Access to Care: Provider Availability in Medicaid Managed Care,

We found that slightly more than half of providers could not offer appointments to enrollees. Notably, 35 percent could not be found at the location listed by the plan, and another 8 percent were at the location but said that they were not participating in the plan. An additional 8 percent were not accepting new patients. Among the providers who offered appointments, the median wait time was 2 weeks. However, over a quarter had wait times of more than 1 month, and 10 percent had wait times longer than 2 months. Finally, primary care providers were less likely to offer an appointment than specialists; however, specialists tended to have longer wait times.

In response to these problems, the OIG recommended that the Centers for Medicare & Medicaid Services (CMS) work with states to

… (1) assess the number of providers offering appointments and improve the accuracy of plan information, (2) ensure that plans’ networks are adequate and meet the needs of their Medicaid managed care enrollees, and (3) ensure that plans are complying with existing State standards and assess whether additional standards are needed.

Pennsylvania’s safety-net hospitals will need to monitor this situation closely in the coming months as the state’s Medicaid expansion begins, bringing as many as 600,000 new beneficiaries into the program.
See the complete OIG report here.

PA Safety Net Admin2014-12-15T06:00:51+00:00December 15th, 2014|Healthy PA, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

Residents of Disadvantaged Neighborhoods More Likely to Require Readmission

Medicare beneficiaries living in the most disadvantaged neighborhoods are more likely than others to require readmission to the hospital for problems associated with congestive heart failure, pneumonia, or myocardial infarction.
This is one of the findings in a new Annals of Internal Medicine study titled “Neighborhood Socioeconomic Disadvantage and 30-Day Rehospitalization: A Retrospective Cohort Study.”
The study, based on data from 2004 through 2009, compared Medicare readmission rates in different geographic areas using what is called a validated area deprivation index that measures relative socioeconomic disadvantage to identify the most disadvantaged areas. Researchers concluded that

The 30-day rehospitalization rate did not vary significantly across the least disadvantaged 85% of neighborhoods, which had an average rehospitalization rate of 21%. However, within the most disadvantaged 15% of neighborhoods, rehospitalization rates increased from 22% to 27% with worsening ADI.

These findings document the special challenges Pennsylvania’s private safety-net hospitals face in serving some of the most disadvantaged communities in the state.
Find the study here, on the web site of the Annals of Internal Medicine.

PA Safety Net Admin2014-12-12T06:00:34+00:00December 12th, 2014|Uncategorized|Comments Off

Hospitals Worry About Underpayments as Medicaid Expands in PA

The Healthy Pennsylvania Medicaid expansion will bring Medicaid payments that often fall below hospital costs, potentially causing problems for hospitals that serve especially large numbers of new Medicaid beneficiaries.
While hospitals acknowledge that in some cases they will, under the program, start receiving payments for care they otherwise might have provided without any reimbursement at all, they note that the payments they expect from Healthy PA private insurers will fail to cover the cost of the care they provide in many cases.
The problem is especially acute when it comes to payment for outpatient services, which may cover only about 30 percent of the cost of outpatient care.
Because they serve so many Medicaid patients, this situation is likely to pose an especially great challenge for Pennsylvania’s safety-net hospitals.
For a look at the challenges hospitals expect under the Healthy PA Medicaid expansion and the effect it may have on their bottom line, see this Pittsburgh Tribune-Review story.

PA Safety Net Admin2014-12-11T06:00:55+00:00December 11th, 2014|Healthy PA, Pennsylvania Medicaid policy|Comments Off

Pennsylvania Health Law Project Newsletter

Among the articles in the November newsletter are a piece on how some immigrants currently covered by the state’s General Assistance program may be able to retain their coverage under Healthy Pennsylvania and another on differences in how the state’s Medicaid expansion population will obtain behavioral health services from private option plans participating in that expansion.
Find the November newsletter here.

PA Safety Net Admin2014-12-10T06:00:45+00:00December 10th, 2014|Healthy PA, Pennsylvania Medicaid policy|Comments Off

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