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

CMS to Examine How States Set Medicaid Managed Care Rates

The Centers for Medicare & Medicaid Services (CMS) is launching an initiative to explore how states set the rates they pay managed care organizations to serve Medicaid patients.
The initiative consists of two parts: first, CMS is examining the adequacy of the process states employ to set their rates – a process that affects the adequacy of the rates themselves; and second, it is drafting updated Medicaid managed care regulations.
Because Pennsylvania safety-net hospitals serve so many Medicaid patients, this effort could have a future impact on the payments they receive for serving these patients.
Learn more about this new undertaking in this Kaiser Health News report.

PA Safety Net Admin2014-05-29T06:00:25+00:00May 29th, 2014|Pennsylvania Medicaid policy|Comments Off

Hospitals Reconsidering Charity Care Policies?

In the wake of Affordable Care Act policies that enhance access to health insurance, hospitals around the country are beginning to take a second look at their charity care policies.
Some are charging co-pays to uninsured patients; others are moving the line at which they provide free or subsidized care.
Such practices are not occurring in great numbers and do not yet constitute a trend, but they do reflect a growing concern among hospitals that some of their uninsured patients have options they are choosing not to exercise.
The New York Times has taken a look at a few hospitals that have reconsidered their long-time charity care policies. Read its report here.

PA Safety Net Admin2014-05-27T10:23:53+00:00May 27th, 2014|Affordable Care Act|Comments Off

PHC4 Issues Report on Hospital Financial Performance

The Pennsylvania Health Care Cost Containment Council (PHC4) has issued its annual report on the financial performance of the state’s acute-care hospitals.
Among the highlights:

The state-wide average operating margin of hospitals fell from 5.73 percent in FY 2012 to 4.69 percent in FY 2013.
Uncompensated care rose 5.41 percent, to more than $1 billion, and up from an average of 2.72 percent of hospital net patient revenue in FY 2012 to 2.81 percent in FY 2013.
35 percent of hospitals reported negative operating margins.
22 percent reported negative operating margins over the latest three-year period.

Find the complete PHC4 report here.

PA Safety Net Admin2014-05-22T09:20:26+00:00May 22nd, 2014|Uncategorized|Comments Off

No Observation Rate Yet for PA Medicaid

The Pennsylvania Department of Public Welfare has published a notice in the Pennsylvania Bulletin continuing its current payment methodology under the state’s Medicaid program but noting that it still has not developed an observation rate for the program.
Last year the state indicated that it wanted to establish such an observation rate, but it has not yet done so. The new notice states that

The Department also announced its intent to establish an observation rate for hospital cases for which an inpatient admission is not medically necessary, but medical observation of a patient is required. The Department received multiple public comments concerning an intended observation rate. At this time, the Department plans to develop a payment policy and rates for observation services and will provide an opportunity for public comment in a future notice of intent.

At the time the state expressed an interest in developing an observation rate, the Safety-Net Association of Pennsylvania wrote to the Department of Public Welfare expressing support for the concept. Read SNAP’s letter here.
Find the entire Pennsylvania Bulletin notice here.

PA Safety Net Admin2014-05-19T06:00:51+00:00May 19th, 2014|Pennsylvania Bulletin, Pennsylvania Medicaid policy|Comments Off

Safety-Net Hospital Finances Falling Behind Other Hospitals

While most hospitals have recovered from the worst of the recession, safety-net hospitals that were already weak before the recession now find a growing financial gap between themselves and other hospitals.
So reports the new study “Hospital Financial Performance in the Recent Recession and Implications for Institutions That Remain Financially Weak,” which was published in the May edition of Health Affairs.
According to a news release about the study,

About 28 percent of the safety-net hospitals were financially weak in 2006. While their financial performance dipped in 2008, these institutions rebounded by 2011. However, the financial gap between the safety-net hospitals and the non-safety-net hospitals continues to widen in terms of their total profit.

The release also notes the implications of this financial struggle:

On the one hand, financially weak and safety-net hospitals continue to keep their doors open. On the other hand, these institutions remain in precarious financial positions that could compromise their ability to invest in innovations or quality improvement activities that may provide value for patients.

Learn more about the study in this news release or find the study itself here, on the web site of the publication Health Affairs.

PA Safety Net Admin2014-05-14T06:00:04+00:00May 14th, 2014|Uncategorized|Comments Off

PA Seeks Insurer Bids for Medicaid Expansion

In anticipation of the possibility of receiving approval from the federal government to expand its Medicaid program, the Corbett administration is soliciting bids from insurers interested in serving the state’s Medicaid expansion population.
The market for those insurers: approximately 600,000 people who would become eligible for Medicaid and free to choose from among eligible insurers.
The Corbett administration has taken a sometimes-controversial approach to Medicaid expansion, seeking to underwrite premiums to private insurers for those newly eligible for Medicaid coverage. For months the administration has been negotiating the terms of its proposed Healthy Pennsylvania Medicaid expansion plan with the federal government, and the decision to seek bids in anticipation of a possible January 1, 2015 launch of Medicaid expansion is viewed as a sign that those negotiations are going well.
Read about this latest development in Pennsylvania’s bid to expand its Medicaid program through a private market option in this Philadelphia Inquirer article. Find the state’s request for applications for insurers interested in serving the Medicaid expansion population here.

PA Safety Net Admin2014-05-09T06:00:34+00:00May 9th, 2014|Affordable Care Act, Health care reform, Healthy PA, Pennsylvania Medicaid policy|Comments Off

Study Points to Risk of DSH Cuts

A new study suggests that future cuts in Medicare disproportionate share (Medicare DSH) and Medicaid DSH payments could pose problems for hospitals that serve large numbers of uninsured patients.
According to a new report in the journal Health Affairs,

Such cuts in government funding of uncompensated care could pose challenges to some providers, particularly in states that have not adopted the Medicaid expansion or where implementation of health care reform is proceeding slowly.

Medicare DSH and Medicaid DSH payments help underwrite the uncompensated care hospitals provide to their uninsured patients. These payments are a vital source of revenue for Pennsylvania’s safety-net hospitals and Pennsylvania is among the states that have not yet adopted Medicaid expansion.
Even after Affordable Care Act reforms take effect, 25 to 30 million Americans are expected to remain uninsured. Medicare DSH payments are expected to decline $22.1 billion between now and 2019 and Medicaid DSH payments, temporarily delayed by two separate actions of Congress, are expected to decline $17.1 billion through 2020.
Learn more about the Health Affairs study in this Washington Post article and find the study itself here, on the web site of Health Affairs.

PA Safety Net Admin2014-05-07T06:00:01+00:00May 7th, 2014|Affordable Care Act, Health care reform, Pennsylvania Medicaid policy|Comments Off

Report Questions Fairness of Medicare Quality and Incentive Programs

A draft technical report by the National Quality Forum has called into question the fairness of Affordable Care Act Medicare programs that seek to provide financial incentives to hospitals that meet selected quality care standards and penalize those that fail to meet those standards.
According to the report, which was commissioned by the Obama administration, these programs unfairly penalize hospitals that care for especially large numbers of low-income seniors – hospitals like those that belong to the Safety-Net Association of Pennsylvania.
The report notes, according to the New York Times, that

Low-income people may be unable to afford needed medications or transportation to doctor’s offices and clinics, the panel said. If they have low levels of formal education or literacy, they may have difficulty understanding or following written instructions for home care and the use of medications. In addition, the clinics and hospitals they use may lack the resources and high tech equipment needed to diagnose and treat illnesses.

Among the programs cited for this problem are Medicare’s value-based purchasing program and its hospital readmissions reduction program.
Read more about the programs’ challenges, as well as the views of those who believe the programs are working as intended and should not be adjusted, in this New York Times article. Go here, to the National Quality Forum’s web site, for a direct link to the study, titled “Risk Adjustment for Socioeconomic Status or Other Sociodemographic Factors.”

PA Safety Net Admin2014-04-28T10:41:20+00:00April 28th, 2014|Affordable Care Act, Safety-Net Association of Pennsylvania|Comments Off

Medicaid Enrollment Up in PA

Pennsylvania’s Medicaid enrollment has risen by 18,000 since October 1 even though the state did not expand its eligibility criteria as authorized by the Affordable Care Act.
Instead, the enrollment increase is being attributed to what is commonly called “the woodwork effect:” people who were unaware that they already were eligible for Medicaid, were led to explore their insurance options by all of the attention the Affordable Care Act has received in recent months, and subsequently learned that they were eligible for Medicaid.
For a closer look at the woodwork effect, how it has affected Medicaid enrollment in Pennsylvania and elsewhere, and the enrollment increase’s financial implications for the state, see this Pittsburgh Post-Gazette article.

PA Safety Net Admin2014-04-23T06:00:08+00:00April 23rd, 2014|Affordable Care Act, Health care reform|Comments Off

Mackereth Explains Healthy PA Rationale

Last week, Pennsylvania Department of Public Welfare Secretary Beverly Mackereth met with the editorial board of the York Daily Record to talk about Healthy Pennsylvania, the Corbett administration’s proposal to expand the state’s Medicaid program using private insurers instead of an expansion of the state’s existing Medicaid program.
Among other things, Mackereth described why the administration chose to move in the direction it ultimately went.
Read a summary of that discussion here, on the web site of the York Daily Record.

PA Safety Net Admin2014-04-21T11:41:18+00:00April 21st, 2014|Healthy PA, Pennsylvania Medicaid policy|Comments Off

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