Health care reform Archives - Page 11 of 13 - Safety-Net Association of Pennsylvania

Implementation of Reform Act’s Medicaid Doc Pay Raise Uncertain

With the Affordable Care Act-mandated increase in Medicaid payments to primary care physicians now just a little more than two months away from taking effect, much remains unknown about how the increase will be implemented.
Under the 2010 reform law, payments to Medicaid primary care physicians will be increased to the same level as comparable Medicare payments, with the federal government picking up the entire $11 billion tab.
At this point, however, there are no regulations delineating how the increase will be achieved, leaving unanswered a number of questions, including what the new rates will be; how and when they will be paid; which physicians will receive them; and how physicians caring for Medicaid patients through managed care plans will receive their enhanced payments.
The purpose of the temporary, two-year increase is to attract more physicians to the care of Medicaid patients in time for the increased Medicaid eligibility that begins under the reform law in 2014.
Many physicians serving communities with large numbers of Medicaid patients, and those employed by Pennsylvania’s safety-net hospitals, are expected to benefit from this pay increase. Currently, Medicaid primary care physician payments in Pennsylvania are just 56 percent of comparable Medicare payments.
Learn more about the challenges of implementing this primary care physician Medicaid pay raise in this Kaiser Health News article.

PA Safety Net Admin2012-10-29T06:00:15+00:00October 29th, 2012|Health care reform, Pennsylvania Medicaid policy|Comments Off

Philadelphia Hospitals Hoping for Medicaid Expansion

Hospitals in the greater Philadelphia want the state to expand its Medicaid program as envisioned in the Affordable Care Act, the Philadelphia Business Journal reports.
According to a spokesman for the Delaware Valley Healthcare Council, Philadelphia-area hospitals are concerned that the state might not expand Medicaid eligibility. That expansion, mandated by the 2010 health care reform law, was made optional earlier this year by a Supreme Court decision.
Read more about why Philadelphia-area hospitals – many of which are safety-net hospitals – are eager for the state to embrace the reform law’s Medicaid eligibility expansion in this Philadelphia Business Journal article .

PA Safety Net Admin2012-10-22T06:00:32+00:00October 22nd, 2012|Health care reform, Pennsylvania Medicaid policy|Comments Off

Medicare DSH Cuts Loom for PA Safety-Net Hospitals

Safety-net hospitals across the country will soon lose important funding that helps them care for many of their low-income and uninsured patients: their Medicare disproportionate share hospital payments (Medicare DSH).
Come 2014, the Affordable Care Act mandates a significant cut in hospitals’ Medicare DSH payments. The underlying rationale for this cut is that once the health care reform law’s individual insurance mandate takes effect and states begin greatly expanding Medicaid eligibility (a reform law mandate made optional by this year’s Supreme Court decision), hospitals will have fewer such patients and less need for supplemental DSH funding.
But as a Kaiser Health News article points out, hospital officials are concerned that the funding will phase out before the expanded insurance phases in, leaving them with fewer resources to care for their low-income, still-uninsured patients.
Pennsylvania’s safety-net hospitals, which care for large numbers of low-income and uninsured patients, figure to suffer considerably under such circumstances.
Learn more about the phase-down of Medicare DSH payments and the challenges hospitals will face in its wake in this Kaiser Health News article .

PA Safety Net Admin2012-10-17T06:00:13+00:00October 17th, 2012|Health care reform|Comments Off

New Medicare Wrinkle May Hurt Safety-Net Hospitals

A new Medicare program that bases payments to hospitals in part on patient satisfaction with those hospitals could be especially harmful to the nation’s safety-net hospitals.
The Medicare value-based purchasing program, which took effect on October 1, will withhold one percent of all hospitals’ Medicare payments and then redistribute that money based on hospitals’ compliance with selected standards-of-care requirements and on the results of surveys of hospitalized Medicare patients. The withheld one percent will then be redistributed to hospitals that perform well based on these criteria. Beginning in 2017, two percent of hospitals’ Medicare payments will be withheld and eventually redistributed in this manner.
Learn more about the Medicare value-based purchasing program and how hospitals are preparing for the survey component of its payment adjustments in this Wall Street Journal article .

PA Safety Net Admin2012-10-16T06:00:55+00:00October 16th, 2012|Health care reform|Comments Off

PA Lags in Developing Health Insurance Exchange

Pennsylvania is unlikely to have a health insurance exchange (HIE) up and running when the individual insurance requirement mandated by the Affordable Care Act takes effect in 2014.
According to state insurance commissioner Michael Consedine, while Pennsylvania has laid considerable groundwork for developing its own exchange, its efforts have been hampered by lack of direction from the federal government on a number of key exchange-related issues. An August letter from Mr. Consedine to U.S. Health and Human Services Secretary Kathleen Sebelius has not yet been answered. In addition, the state legislature has not passed necessary enabling legislation.
If Pennsylvania does not establish its HIE by 2014, residents of the state will be served by an exchange established by the federal government. The state would still be free to establish its own exchange at a later date.
Read more about the situation in Pennsylvania today, what the state has done so far, and the obstacles to completing developing of the HIE in this Pittsburgh Post-Gazette report.

PA Safety Net Admin2012-10-15T10:42:06+00:00October 15th, 2012|Health care reform|Comments Off

PA Goes Slow on Health Exchanges

Pennsylvania is not engaging in extensive planning on the development of key components of the Affordable Care Act and will not do so until it receives additional information from the federal government.
So explained state Insurance Commissioner Michael Consedine in an August letter to U.S. Health and Human Services Secretary Kathleen Sebelius. Mr. Consedine reinforced this message in a statement he submitted to the U.S. House Ways and Means Committee on September 12.
According to Mr. Consedine, Pennsylvania lacks the information it needs on two important aspects of the 2010 health care reform law: the creation of health insurance exchanges and the development of the essential benefits packages that insurers will be required to offer Pennsylvanians.
Read more about the state’s position on this issue in this Central Penn Business Journal article. In addition, read Mr. Consedine’s letter to Secretary Sebelius here and his statement to the House Ways and Means Committee here .

PA Safety Net Admin2012-09-24T06:00:47+00:00September 24th, 2012|Health care reform|Comments Off

Physician Reluctance Threatens Medicaid Expansion in PA

If Pennsylvania moves ahead and expands Medicaid eligibility as envisioned in the Affordable Care Act, the ability of newly enrolled recipients to obtain medical care may be jeopardized by the reluctance of some physicians to take on more Medicaid patients.
According to a recent article in the journal Health Affairs, 68 percent of the state’s doctors are currently accepting new Medicaid patients. Those who are not cite low reimbursement rates and already-high patient loads among the reasons they are not accepting new Medicaid patients.
Pennsylvania Governor Tom Corbett has not revealed whether he intends to expand Medicaid eligibility in the state and is not expected to do so until after the November election. The mandatory Medicaid expansion, part of the 2010 health care reform law, was ruled unconstitutional by the U.S. Supreme Court, leaving expansion decisions to the individual states.
The Pennsylvania Department of Health says that 94 percent of rural doctors and 84 percent of the state’s urban doctors currently care for Medicaid patients.
Read more about the situation in Pennsylvania today and its implications for Medicaid expansion in this Pittsburgh Post-Gazette article .

PA Safety Net Admin2012-09-11T06:00:28+00:00September 11th, 2012|Health care reform, Pennsylvania Medicaid policy|Comments Off

“Medicaid Works,” Foundation Declares

Medicaid improves access to care and saves lives and deserves to be expanded in the manner envisioned in the Affordable Care Act, according to a new blog entry on the web site of the health care-focused Commonwealth Fund.
According to the blog commentary, Medicaid “fulfills the two main purposes of health insurance – ensuring access to needed care and providing adequate financial protection from burdensome medical expenses.” It also cites research that “confirms that expanding Medicaid not only improves access to care and financial protection of vulnerable individuals and families, but actually saves lives.”
In addition, the blog suggests that Medicaid recipients have only slightly greater cost-related access-to-care problems than individuals with private insurance.
The Safety-Net Association of Pennsylvania (SNAP) and the state’s private safety-net hospitals have eagerly anticipated the expansion of Medicaid eligibility mandated by the Affordable Care Act. In the wake of the Supreme Court decision ruling the expansion mandate unconstitutional, these safety-net hospitals now await for Governor Corbett’s decision on whether Pennsylvania will move ahead with that Medicaid expansion.
The title of this commentary is “Medicaid Works: Public Program Continues to Provide Access to Care and Financial Protection for Society’s Most Vulnerable,” and it can be found here , on the Commonwealth Fund’s web site.

PA Safety Net Admin2012-08-29T06:00:13+00:00August 29th, 2012|Health care reform, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy, Safety-Net Association of Pennsylvania, Uncategorized|Comments Off

New Medicare Readmissions Policy to Hit Safety-Net Hospitals Hardest

A new Medicare reimbursement policy that will penalize hospitals financially for readmitting patients within 30 days of discharge will have a disproportionate impact on hospitals that care for large numbers of low-income patients.
According to an analysis by Kaiser Health News, hospitals that treat significant numbers of low-income patients – those eligible for Medicare disproportionate share (DSH) payments – are more likely to be penalized by Medicare than other hospitals. Those that serve the most poor patients are twice as likely to suffer the maximum Medicare penalty as those that care for the fewest low-income patients.
The penalties apply to patients readmitted after suffering pneumonia, heart attacks, and heart failure.
The new Medicare readmissions reduction program poses a particular challenge for Pennsylvania’s safety-net hospitals, such as those that belong to the Safety-Net Association of Pennsylvania (SNAP), because so many of their patients have additional medical problems and often have difficulties following post-discharge instructions and getting and paying for follow-up care.
Read more about the new Medicare reimbursement program and the Kaiser analysis in this Kaiser Health News report Hospital building .

PA Safety Net Admin2012-08-24T06:00:45+00:00August 24th, 2012|Health care reform, Safety-Net Association of Pennsylvania|Comments Off

DPW Secretary Shares Views on Medicaid Program

In an extensive interview with the Central Penn Business Journal, Pennsylvania Department of Public Welfare Secretary Gary Alexander shared his views on the state’s Medicaid program, the changes he would like to see, and the challenges the state faces in the immediate future.
Among the issues Alexander addressed are his desire to have greater flexibility to operate the state’s Medical Assistance program; the state’s prospects for expanding Medicaid eligibility as called for in the Affordable Care Act; his concern that greater access will increase rather than decrease uncompensated care and emergency room use; his interest in greater transparency for health care costs and quality; and his fight against fraud, waste, and abuse.
Read the complete Central Penn Business Journal interview with Secretary Alexander here .