The Pennsylvania Health Law Project has published its latest newsletter.
Among the articles are stories about the preservation of the state’s Medical Assistance for Workers with Disabilities Program (MAWD); new funding for home- and community-based services for people with disabilities; a clarification of Children’s Health Insurance Program (CHIP) benefits; and more.
Find the newsletter here.
While the Affordable Care Act is enabling millions of Americans to obtain health insurance – many of them for the first time – many of the newly insured do not understand how their insurance works or how to use it to get the care they need.
Across the country, advocacy groups, insurers, hospitals, and clinics are encountering newly insured people struggling to translate their new health insurance into health care, and many are employing outreach and educational programs to teach people how to enjoy the benefits of their new coverage.
Learn more about the new challenges health care providers are encountering, and about how a group of organizations in Philadelphia is responding to that challenge, in this New York Times article.
A Pennsylvania program to help the elderly remain in their own homes instead of moving into nursing homes is struggling with backlogs.
The state’s Aging Waiver Program is a Medicaid program that enables those who meet certain medical and financial criteria to receive assistance in their own homes from nurses and home health aides rather than go into a nursing home.
Currently the program serves more than 32,000 people – nearly twice as many as it did six years ago – but applications are taking as long as two months to process. The biggest challenge is verifying financial eligibility, but the state recently added staff to help address the backlog.
Learn more about Pennsylvania’s Aging Waiver Program in this Pittsburgh Tribune-Review article.
‘’…there is an unquestionable imperative to assess and optimize the effectiveness of the public’s investment in GME (graduate medical education).”
So says the Institute of Medicine (IOM) in its new report Graduate Medical Education That Meets the Nation’s Health Needs.
The IOM also calls for “significant changes to GME financing and governance to address current deficiencies and better shape the physician workforce for the future.”
The report notes that government today, mostly through Medicare, plays the primary role in financing graduate medical education. It observes that while there is a common perception that the nation faces a shortage of physicians, simply increasing the number of residency slots that Medicare supports – a limit set in 1997 – without addressing geographic and specialty distribution issues will not solve the problem.
In the report, the IOM proposes six goals for improving GME financing.
To fulfill these goals, the report offers three specific recommendations:
Graduate medical education is an important issue for the Pennsylvania safety-net hospitals that also are teaching hospitals. The state’s Medicaid program is an important source of medical education funding for these hospitals as well.
To learn more about why the study was undertaken, what problems it sought to address, what the IOM learned, and what it proposed, follow this link to the IOM’s web site and the complete report as well as a report summary.
States are now financing more than a quarter of their share of Medicaid expenditures with money from sources other than state general funds, according to a new study by the Government Accountability Office (GAO).
According to the GAO, 26 percent of state share of Medicaid funding comes from taxes on health care providers, transfers from local governments and local government providers, and other sources. Such funding, the GAO noted, shifts additional Medicaid costs to the federal government.
Pennsylvania uses such funding mechanisms, including its gross receipts tax on Medicaid managed care organizations and state-wide and Philadelphia hospital assessments.
Exacerbating this problem, the GAO reports, is that the Centers for Medicare & Medicaid Services (CMS), which oversees Medicaid, does not assure that it receives complete and accurate data on funding sources from the states, leaving CMS without a complete understanding of how states are financing their Medicaid expenditures. In the report, the GAO recommends a stronger CMS effort to gather such data – a recommendation that CMS did not accept.
Learn more about the GAO study “States Increased Reliance on Funds From Health Care Providers and Local Governments Warrants Improved CMS Data Collection” by finding the complete report and a summary here, on the GAO web site.
The Corbett administration has reversed an earlier decision and decided to retain Pennsylvania’s Medical Assistance for Workers With Disabilities program, frequently referred to as “MAWD.”
MAWD provides low-cost health insurance to Pennsylvanians with disabilities who do not otherwise qualify for Medical Assistance because they work and have earnings.
The program, which serves about 34,000 people, costs the state $7 million a year. A Department of Public Welfare spokesman said preserving the program is consistent with the Corbett administration’s Healthy Pennsylvania initiative.
Learn more about MAWD here and about the decision to retain it in this Insurance Net News article.
The National Quality Forum (NQF) will perform a “robust trial” to assess the role and impact of sociodemographic factors on health care outcomes.
In a news release, the NQF announced that
Sociodemographic factors can be socioeconomic, e.g., income, education, and occupation, and demographic, e.g., race, ethnicity, and primary language. Growing evidence shows that sociodemographic factors may influence patient outcomes, which has implications for comparative performance measurement used in pay-for-performance programs.
Among the socioeconomic and sociodemographic factors the NQF will consider are income, education, and occupation, and demographic considerations such as race, ethnicity, and primary language.
With the Affordable Care Act requiring Medicare to adjust payments based on outcomes such as hospital readmissions, value-based purchasing requirements, hospital-acquired conditions, and more, reviews of the preliminary results of such programs have led some to question whether hospitals that serve especially large numbers of low-income patients – like Pennsylvania’s safety-net hospitals – may be especially and unfairly harmed by such programs.
Learn more about the NQF plan for a new study from this news release and find a link to further information about the planned study as well.
A new federal program seeks to encourage states to work faster to find ways to improve care and improve the health of their Medicaid patients and to reduce health care costs through payment and service delivery reforms.
The Center for Medicare & Medicaid Services’ (CMS) new Medicaid Innovation Accelerator Program is a collaboration between the Center for Medicaid and CHIP Services, the Center for Medicare and Medicaid Innovation, the Medicare-Medicaid Coordination Office, and other federal agencies and centers. According to a CMS fact sheet, the program
…aims to jumpstart innovation in key areas while supporting states in their efforts to improve health, improve health care, and lower costs. In consultation with states and stakeholders, the IAP will develop strategically targeted functions aimed at advancing delivery system and associated payment reforms, aligned with transformation efforts underway in Medicare and the commercial market.
The program will develop resources to support innovation through four key functions: identifying and advancing new models of care delivery and payment; data analytics; improving quality measurement; and state-to-state learning, rapid-cycle improvement, and federal evaluation.
Learn more about the launch of the Medicaid Innovation Accelerator Program from this CMS fact sheet and go here for a more detailed description of the program and a summary of the resources surrounding it.
The Robert Wood Johnson Foundation has launched a project to measure the impact of the Affordable Care Act on hospitals.
Working with 24 state hospital associations, the foundation’s Hospital ACA Monitoring Project will collect quarterly hospital data on admissions, emergency room visits, and selected diagnoses and procedures. The project will collect data from different types of hospitals with different payer mixes.
According to the foundation, the project “is designed to shed light on some of the effects of health reform on hospitals and provide extremely timely data to researchers, policymakers and hospital leaders.”
Learn more about the Robert Wood Johnson Foundation’s Hospital ACA Monitoring Project from this notice on the foundation’s web site.
Physician groups and other health care organizations are asking Congress to continue the increase in Medicaid payments that primary care providers have been receiving for nearly two years.
The pay raise, mandated by the Affordable Care Act, was instituted to help induce more primary care providers to serve Medicaid patients in anticipation of the reform law’s significant expansion of Medicaid eligibility. That pay raise, which brings Medicaid rates up to the level of Medicare rates and is paid for entirely by the federal government, expires at the end of 2014.
Now, primary care physicians have written to the leaders of the Senate Finance Committee and the House Energy and Commerce Committee asking them to extend the raises and add ob/gyns to providers eligible for the enhanced payments.
See their letter here.