Pennsylvania safety-net hospitals Archives - Page 9 of 14 - Safety-Net Association of Pennsylvania

Temporarily Gone But Not Forgotten

While last week’s withdrawal of the American Health Care Act at least temporarily halted talk of immediate repeal and replacement of the Affordable Care Act, at least one aspect of that proposed legislation, often discussed in the past, is sure to arise in the future as well: replacing the current manner in which the federal government matches state Medicaid funding with Medicaid per capita limits or Medicaid block grants.
In a new issue brief, the Kaiser Family Foundation examines how a switch to per capita limits or block grants might affect low-income seniors served by both Medicare and Medicaid. Among the issues the brief addresses are:

why such a switch would matter to low-income seniors at all
how it might change federal funding of Medicaid for low-income seniors
how states might react in ways that would affect low-income seniors
how it might affect the providers who serve low-income seniors
how such an approach might vary from state to state

Any move to Medicaid per capita limits or block grants could have serious implications for Pennsylvania safety-net hospitals and the communities they serve because these hospitals serve so many dually eligible Medicare/Medicaid patients.
Learn more about a possible change in how the federal government pays for its share of the Medicaid program that will surely find its way into future health policy discussions and debates in the Kaiser Family Foundation issue brief “What Could a Medicaid Per Capita Cap Mean for Low-Income People on Medicare?”

PA Safety Net Admin2017-03-31T06:00:22+00:00March 31st, 2017|Federal Medicaid issues, Medicare, Pennsylvania safety-net hospitals|Comments Off

MACPAC Meets, Discusses Medicaid Issues

Members of the non-partisan legislative branch agency that advises Congress, the Secretary of Health and Human Services, and the states on Medicaid and Children’s Health Insurance Program matters met in Washington recently to discuss a number of issues.
On the agenda of the Medicaid and CHIP Payment and Access Commission were the following issues:

state Medicaid flexibility
state Medicaid responses to fiscal pressures
a study requested by Congress on mandatory and optional benefits and populations
current Medicaid parallels to per capita financing options
illustrations of state-level effects of per capita cap design elements
high-cost hepatitis C drugs
the role of section 1915(b) waivers in Medicaid managed care

Because Pennsylvania safety-net hospitals serve so many Medicaid and CHIP participants, MACPAC’s deliberations are especially important and relevant to them.
Go here for a link to overviews of these issues and the presentations offered at the MACPAC meeting.

PA Safety Net Admin2017-03-23T06:00:24+00:00March 23rd, 2017|Federal Medicaid issues, Pennsylvania safety-net hospitals, Uncategorized|Comments Off

Changing Medicaid

House Chamber of the State House With policy-makers in Washington considering some changes, and possibly major changes, in the state/federal Medicaid partnership, the Health Affairs Blog has taken a look at some of the options those policy-makers might consider.
Among them are:

giving states greater flexibility in the design and implementation of their own Medicaid programs
requiring cost-sharing by some or all beneficiaries, such as through premiums and co-payments
limiting benefits
employing incentives to encourage healthy behaviors

The article also considers the manner in which individuals enroll in Medicaid and how that has evolved over the years.
Because Pennsylvania’s safety-net hospitals care for so many low-income and Medicaid patients, they could be affected by any major federal Medicaid policy changes far more than the typical Pennsylvania hospital.
Learn more about some of the options Congress will have as it looks at possible Medicaid reform in the Health Affairs Blog article “The Future Of Medicaid: When Improving Upon The Wheel, Start With Something Round,” which can be found here.

PA Safety Net Admin2017-02-16T06:00:00+00:00February 16th, 2017|Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

Serving High-Need, High-Cost Medicare Patients

With Medicare beneficiaries who have four or more chronic conditions accounting for 90 percent of Medicare hospital readmissions and 74 percent of Medicare costs (both 2010 figures), policy-makers are constantly looking for better ways to serve such individuals.
Academic research suggests that these beneficiaries need a variety of non-medical social interventions and supports, most of which are not covered by Medicare.
With this in mind, the Bipartisan Policy Center has prepared a review of current regulatory, payment, and other barriers that prevent providers and insurers from meeting some of the non-medical needs of high-need, high-cost patients that result in such high health care costs and hospital readmissions rates.
Many of these high-need, high-cost patients live in low-income communities served by private urban safety-net hospitals, making this a subject of particular interest to NAUH and its members
Many of these high-need, high-cost patients live in low-income communities served by Pennsylvania’s safety-net hospitals, making this a subject of particular interest to SNAP and its members.
Among the care models this review considers are Medicare Advantage plans, Medicare Advantage Dual-Eligible Special Needs Plans, Medicare Shared Savings Program Accountable Care Organizations, Next Generation ACOs, Comprehensive Primary Care Plus Model Participants, and Programs for All-Inclusive Care for the Elderly (PACE).
Find this all in the Bipartisan Policy Center report Challenges and Opportunities in Caring for High-Need, High-Cost Medicare Patients, which is available here.

PA Safety Net Admin2017-02-13T06:00:02+00:00February 13th, 2017|Medicare, Pennsylvania safety-net hospitals|Comments Off

Academies Completes Work on Social Risk Factors in Health Care

Completing its assignment from the U.S. Department of Health and Human Services, the Health and Medicine Division of the National Academies of Science, Engineering, and Medicine has published its fifth and final report on social risk factors that affect health outcomes for Medicare beneficiaries and how to account for those risk factors in Medicare payments.
Among other things, the report notes that

Although VBP [value-based purchasing] programs have catalyzed health care providers and plans to address social risk factors in health care delivery through their focus on improving health care outcomes and controlling costs, the role of social risk factors in producing health care outcomes is generally not reflected in payment under current VBP design. This misalignment has led to concerns that trends toward VBP could harm socially at-risk populations: Providers disproportionately serving socially at-risk populations are more likely to score poorly on performance/quality rankings, more likely to be penalized financially, and less likely to receive bonus payments under VBP. VBP may be taking resources from the organizations that need them the most.

The risk factors the Academies considered were socioeconomic position; race, ethnicity, and cultural context; gender; social relationships; and residential and community context.
The Academies’ fifth and final report brings together its first four efforts.

The first report, Accounting for Social Risk Factors in Medicare Payment Programs: Identifying Social Risk Factors, presented a conceptual framework and the results of a literature search linking social risk factors to health-related measures.
The second report, System Practices for the Care of Socially At-Risk Populations, explored six patient-centered systems practices that show potential for improving care for socially at-risk communities.
The third report, Accounting for Social Risk Factors in Medicare Payment: Criteria, Factors, and Methods, offered guidance on social risk factors might be incorporated into future Medicare payment systems.
The fourth report, Accounting for Social Risk Factors in Medicare Payment: Data, offered data strategies and solutions for collecting data to measure social risk factors that might be addressed in future Medicare payment systems.

The fifth and final report, Accounting for Social Risk Factors in Medicare Payment, offers additional thoughts and recommendations for next steps.
The subject of socio-economic risk adjustment is of interest to Pennsylvania safety-net hospitals because so many of the patients they serve present with such risk factors.
Find the new report here.

PA Safety Net Admin2017-01-13T06:00:16+00:00January 13th, 2017|Medicare, Pennsylvania safety-net hospitals, Uncategorized|Comments Off

Weighing the Impact of ACA Repeal

How might repeal of the Affordable Care Act affect the financial health of different kinds of hospitals?
The New York Times recently took a look at how the 2010 reform law’s repeal would affect two Pennsylvania health systems: the Temple University Health System, led by a heavily Medicaid-dependent safety-net hospital located in one of the poorest communities in the country; and Main Line Health, a non-profit organization with several hospitals all located in affluent communities.
See what the Times found here.

PA Safety Net Admin2017-01-10T06:00:03+00:00January 10th, 2017|Affordable Care Act, Pennsylvania safety-net hospitals|Comments Off

New Study: Social Risk Factors Affect Provider Performance and Patient Outcomes

Medicare patients with social risk factors fare worse than others in programs that measure quality and the providers that serve them also perform worse than others on quality measures.
This news comes from a new report presented to Congress by the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Planning Evaluation.
The report, mandated by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, focused on nine Medicare payment programs:

the hospital readmissions reduction program
the hospital value-based purchasing program
the hospital acquired condition reduction program
the Medicare Advantage (Part C) quality star rating program
the Medicare shared savings program
the physician value-based payment modifier program
the end-stage renal disease quality incentive program
the skilled nursing facility value-based purchasing program
the home health value-based purchasing program

APSE concluded that:

Beneficiaries with social risk factors had worse outcomes on many quality measures, regardless of the providers they saw, and dual enrollment status was the most powerful predictor of poor outcomes.
Providers that disproportionately served beneficiaries with social risk factors tended to have worse performance on quality measures, even after accounting for their beneficiary mix. Under all five value-based purchasing programs in which penalties are currently assessed, these providers experienced somewhat higher penalties than did providers serving fewer beneficiaries with social risk factors.

Among the solutions suggested in the report for addressing these problems are:

adjusting quality and resource use measures
adjusting payments
addressing the underlying issues

The report also suggests that HHS’s strategy for accounting for social risk in Medicare’s value-based purchasing programs should consist of the following three steps:

measure and report quality for beneficiaries with social risk factors
set high, fair quality standards for all beneficiaries
reward and support better outcomes for beneficiaries with social risk factors

And in carrying out these steps, the report recommends that HHS

provide specific payment adjustments to reward achievement and/or improvement for beneficiaries with social risk factors, and
where feasible, provide targeted support for providers who disproportionately serve them.

Medicare beneficiaries who present with socio-economic risk factors are served by Pennsylvania safety-net hospitals in especially large numbers.
Learn more about the problems APSE found and its proposals for dealing with those problems by reading Report to Congress: Social Risk Factors and Performance Under Medicare’s Value-Based Purchasing Programs.

PA Safety Net Admin2016-12-30T06:00:20+00:00December 30th, 2016|Medicare, Pennsylvania safety-net hospitals|Comments Off

Medicare Program Biased Against Selected Hospitals

Medicare’s hospital-acquired conditions program unfairly penalizes large, large urban, and teaching hospitals, according to a new study.
According to “Complication Rates, Hospital Size, and Bias in the CMS Hospital-Acquired Condition Reduction Program,” published recently in the American Journal of Medical Quality, the hospital-acquired conditions program, which last year penalized nearly 800 hospitals, disproportionately penalizes large, large urban, and teaching hospitals because its threshold for identifying poor-performing hospitals is too broad, it relies on results that in many cases are not statistically different, and it fails to recognize when hospital performance improves.
To correct these biases, the study’s authors recommend adding risk-adjustment components, such as hospital size, to identify poor performers.
Many of Pennsylvania’s safety-net hospitals are large and have teaching programs.
Learn more about the study, its findings, and its recommendation in this Fierce Healthcare article or go here to read the study on the web site of the American Journal of Medical Quality.

PA Safety Net Admin2016-12-29T06:00:36+00:00December 29th, 2016|Medicare, Pennsylvania safety-net hospitals|Comments Off

Improving Social Conditions May Improve Health

A new study has found that interventions that address patient problems such as difficulty affording food, housing, and medicine may lead to better health for those patients.
According to a new study published in JAMA Internal Medicine, when the group Health Leads screened patients for unmet basic needs and helped address those needs, those patients showed significant improvement in blood pressure and cholesterol levels.
While not conclusive – the interventions did not improve blood glucose levels – the study suggests that the kinds of patients served by Pennsylvania safety-net hospitals, who often turn to such hospitals for care with significant socio-economic risk factors, would benefit from a broader array of services than hospitals alone typically provide.
Learn more by going here to view the JAMA Internal Medicine report “Addressing Unmet Basic Resource Needs as Part of Chronic Cardiometabolic Disease Management.”

PA Safety Net Admin2016-12-21T06:00:30+00:00December 21st, 2016|Pennsylvania safety-net hospitals|Comments Off

Uninsured Patients, Provider Taxes Hurt Adequacy of Medicaid Payments

While Medicaid payments now typically cover more than the cost of Medicaid services in many states, they do not cover the costs of caring for low-income patients after providers care for uninsured patients and pay Medicaid provider taxes, a new study has found.
According to a Health Affairs report,

After accounting for supplemental payments, we found that in 2011, disproportionate-share hospitals, on average, received gross Medicaid payments that totaled 108 percent of their costs for treating Medicaid patients but only 89 percent of their costs for Medicaid and uninsured patients combined. However, these payments were reduced by approximately 4–11 percent after we accounted for provider taxes and local government contributions that are used to help finance Medicaid payments.

Because they are all disproportionate share hospitals, this is especially a challenge for Pennsylvania’s urban safety-net hospitals.
To learn more, go here to see the Health Affairs analysis “For Disproportionate-Share Hospitals, Taxes And Fees Curtail Medicaid Payments.”