Uncategorized Archives - Page 10 of 29 - Safety-Net Association of Pennsylvania

Hospital Group Models Risk-Adjusted Medicare Readmissions

The Missouri Hospital Association has published data that demonstrates that risk-adjusting Medicare readmissions based on social determinants of health reduces the readmission rates of hospitals that care for large numbers of low-income patients.
The data, modeling, and risk adjustment methodology, developed by the association based on data from Missouri hospitals, published on the association’s “Focus on Hospitals” web site, and described in an article on the NEJM Catalyst web site, showed that

SDS [note: sociodemographic status)-enriched models yielded significant relative reductions in the range of risk-standardized readmission ratios for each of…6 outcomes…Overall, SDS enrichment best improved the 30-day readmission assessments of hospitals that served higher concentrations of Medicaid patients and higher-poverty communities.

The lack of risk adjustment for socioeconomic risk factors has been a controversial aspect of Medicare’s hospital readmissions reduction, with a growing body of research suggesting that without such risk adjustment, the program is unfair to hospitals that care for especially large numbers of low-income patients- hospitals like Pennsylvania’s private safety-net hospitals.
Learn more about the work done by the Missouri Hospital Association, and its implications, in its report Risk Adjustment for Sociodemographic Status in 30-Day Hospital Readmissions and this description of and commentary on the association’s research on the NEJM Catalyst web site.

PA Safety Net Admin2016-09-07T06:00:05+00:00September 7th, 2016|Medicare, Uncategorized|Comments Off

Amid Rising Improper Medicaid Payments, CMS Offers Help

With improper Medicaid payments nearly twice as high as they were just a few years ago, the Centers for Medicare & Medicaid Services is reaching out to state Medicaid programs with suggestions for how to reduce those improper payments.
The problem?
According to CMS,

States are facing greater challenges keeping pace with stricter enrollment requirements, tracking providers who have been excluded from other States’ or Federal health care programs, and generally adapting to changing regulations for qualifications of certain provider types.

In a new e-alert, CMS identifies factors that contribute to improper payments – things like ineligible and excluded providers, provider identity theft, medical services not provided, phantom or invalid provider addresses and ID numbers, and more. For each factor it identifies in the new e-alert CMS suggests solutions and directs interested parties to resources that can help them with those solutions.
To learn more about the extent of improper Medicaid payments and their recent increase, what has contributed to that rise, and possible solutions go here to see the CMS e-alert “Medicaid Improper Payments.”

PA Safety Net Admin2016-09-06T06:00:22+00:00September 6th, 2016|Uncategorized|Comments Off

NIH Launches Research on Health Disparities in Disadvantaged Communities

The National Institutes of Health is launching a new Transdisciplinary Collaboratives Centers for Health Disparities Research on Chronic Disease Prevention program that seeks to respond to

…the need for more robust, ecological approaches to address chronic diseases among racial and ethnic minority groups, under-served rural populations, people of less privileged socio-economic status, along with groups subject to discrimination who have poorer health outcomes often attributed to being socially disadvantaged. Two centers will focus their research efforts on development, implementation, and dissemination of community-based, multilevel interventions to combat chronic diseases such as heart disease, cancer and diabetes.

Anticipated funding over the first five years of the program is approximately $20 million.
In announcing the program, the NIH noted that

Heart disease, stroke, cancer, diabetes, and arthritis are among the most common, costly and preventable of all health problems. Many of these conditions disproportionately affect health disparity populations and in advanced stages can lead to significant limitations in activities of daily living.

These are the very health challenges that Pennsylvania’s safety-net hospitals tackle regularly – and far more often than the typical community hospital.
To learn more about what the program seeks to accomplish and the health challenges it anticipates addressing, see this NIH news release.

PA Safety Net Admin2016-09-02T06:00:16+00:00September 2nd, 2016|Uncategorized|Comments Off

PA Launches Prescription Drug Monitoring Program

Pennsylvania’s Department of Health has launched its much-anticipated prescription drug monitoring program.
Previously operated by the state’s office of the attorney general but assigned to the state’s Health Department through 2014 legislation, the program requires those authorized to prescribe controlled substance prescription drugs to collect and submit information to the PDMP each time they do so within 72 hours. That information is then stored in a database that is available to health care professionals to help them identify patients who may have problems with controlled substances or may even be going from provider to provider to gain additional prescriptions.
department of health The state Health Department has created a web site for the program that includes FAQs about how the PDMP works for those who prescribe and dispense controlled substances. Visit that web site here.

PA Safety Net Admin2016-08-31T06:00:46+00:00August 31st, 2016|Uncategorized|Comments Off

PA Ratchets Up Battle Against Opioid Abuse

The Commonwealth of Pennsylvania will create 25 new Opioid Use Disorder Centers of Excellence, joining 20 similar centers established last year.
According to a news release from the office of Pennsylania Governor Tom Wolf,

The additional COEs announced today will serve at least 5,600 additional individuals. The COEs are a central, efficient hub around which treatment revolves. These centers will have navigators to assist people with opioid-related substance use disorders through the medical system, and ensure they receive behavioral and physical health care, as well as any evidence-based medication-assisted treatment needed.

wolf The centers are funded in part by state behavioral health funds, in part by state Medicaid funds, and in part by federal Medicaid matching funds.
Learn more about the Centers of Excellence approach to combating opioid abuse and find a list of the new centers in this Wolf administration news release.

PA Safety Net Admin2016-08-30T13:08:35+00:00August 30th, 2016|Uncategorized|Comments Off

Price Transparency Report Released by PA Department of Health

The Pennsylvania Department of Health has published a report it commissioned on the state of health care price transparency in the commonwealth.
Health Benefits Claim Form The report, prepared by the organization Catalyst for Payment Reform, seeks to

… evaluate the level and robustness of health care price transparency in the Commonwealth of Pennsylvania today and the opportunities to enhance it going forward. The report reviews and assesses the legal and regulatory landscape related to price transparency; identifies and compares the best practices of other states that are leading the country in enhancing price transparency; summarizes results from a CPR-conducted evaluation of consumer-facing transparency tools offered by health insurance plans; identifies gaps in price and quality transparency in the state; and lastly, provides actionable recommendations for furthering price transparency to the Commonwealth based on our research, as well as CPR’s expertise in this area.

Find the report here, in the “innovation” section of the web site of Pennsylvania’s Department of Health.

PA Safety Net Admin2016-08-24T06:00:23+00:00August 24th, 2016|Uncategorized|Comments Off

Docs Less Likely to Participate in ACOs in Disadvantaged Communities

A new study has found that physicians who practice in areas with higher proportions of low-income, uninsured, less-educated, disabled, and African-American residents are less likely than others to participate in accountable care organizations.
If ACOs ultimately are found to improve health care quality while better managing costs, their benefits might be limited in such communities, thereby exacerbating health care disparities. If this trend holds true in Pennsylvania, it could be harmful to many of the communities served by the state’s safety-net hospitals.
To learn more, go here to see the Health Affairs report “Physicians’ Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More Affluent Communities.”

PA Safety Net Admin2016-08-23T10:41:08+00:00August 23rd, 2016|Pennsylvania safety-net hospitals, Uncategorized|Comments Off

Medicare Readmissions Penalties Rise

Medicare will impose more than $500 million in penalties in FY 2017 on hospitals that readmit too many Medicare patients within 30 days of their discharge from the hospital.
The penalties, part of Medicare’s hospital readmissions reduction program, represent a 20 percent increase over the penalties the program levied in FY 2016.
Under the program, most (but not all) hospitals are evaluated on their performance with patients with six medical conditions: heart attacks, heart failure, chronic lung disease, hip and knee replacement, and the need for coronary bypass surgery. The maximum penalty is three percent of hospitals’ Medicare payments and the average penalty in FY 2017 will be 0.73 percent – up from 0.61 percent in FY 2016.
The program is widely credited with driving a national reduction in the number of Medicare patients readmitted to the hospital within 30 days of discharge, although as the program’s FY 2017 penalties suggest, reducing those readmissions is proving a considerable challenge for some hospitals.
Ever since the program’s introduction, critics have maintained that hospitals that serve large numbers of low-income patients are treated unfairly by the program. Such patients, a growing body of research has found, are more difficult to treat and more likely to lack the financial, social, and family supports needed to recover from illnesses and injuries without requiring a return to the hospital. Pennsylvania’s safety-net hospitals serve especially large numbers of such patients.
Learn more about how the readmissions reduction program works and how it will treating hospitals in FY 2017 in this Kaiser Health News report.

PA Safety Net Admin2016-08-11T06:00:36+00:00August 11th, 2016|Uncategorized|Comments Off

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its July 2016 newsletter.
phlp Included in this edition are stories about the unexpected rebidding of HealthChoices contracts for Medicaid-covered physical health services; passage of the state’s fiscal year 2017 budget; access for Medicaid beneficiaries to drugs to treat hepatitis C; the creation by the state legislature of a task force to explore barriers to access to treatment for substance abuse; and more.
Find the newsletter here.

PA Safety Net Admin2016-08-04T06:00:10+00:00August 4th, 2016|Uncategorized|Comments Off

Report to CMS on Risk Adjustment of Medicare Payments

The National Academies of Sciences, Engineering, and Medicine has issued its latest report to the Centers for Medicare & Medicaid Services on how to adjust Medicare payments to hospitals based on the socio-economic risk factors hospitals’ patients pose.
At the request of CMS, the Academies created an expert committee to

…identify criteria for selecting social risk factors, specific social risk fascinators Medicare could use, and methods of accounting for those factors in Medicare quality measurement and payment applications.

The committee created for this purpose viewed its goal to be

…to guide the selection of social risk factors that could be accounted for in VBP [value-based purchasing] so that providers or health plans are rewarded for delivering quality care and value, independent of whether they serve patients with relatively low or high levels of social risk factors.

Now, the committee has issued its third report to CMS, and in that report it offers three overarching considerations and five criteria to determine “whether a social risk factor should be accounted for in performance indicators used in Medicare VBP programs.” They are:

The social risk factor is related to the outcome.

The social risk factor has a conceptual relationship with the outcome of interest.
The social risk factor has an empirical association with the outcome of interest.

The social risk factor precedes care quality and is not a consequence of the quality of care.

The social risk factor is present at the start of care.
The social risk factor is not modifiable through provider actions.

The social risk factor is not something the provider can manipulate.

The social risk factor is resistant to manipulation or gaming.

Medicare’s readmissions reduction program and other value-based purchasing programs create special challenges for providers like Pennsylvania’s safety-net hospitals that serve especially large numbers of low-income patients.
To learn more about what the committee proposed and why it proposed it, see this news release describing its work, this summary of its work, and the full report, titled Accounting for Social Risk Factors in Medicare Payment Criteria, Factors, and Methods.

PA Safety Net Admin2016-07-20T06:00:58+00:00July 20th, 2016|Medicare, Pennsylvania safety-net hospitals, Uncategorized|Comments Off

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