Uncategorized Archives - Page 13 of 29 - Safety-Net Association of Pennsylvania

SNAP Comments on Balance Billing Proposal

The Safety-Net Association of Pennsylvania has submitted comments to the Pennsylvania Insurance Department addressing that department’s proposed Balance Billing Protection Act.
While supporting the concept of addressing the problem of surprise balance billing for insurance-covered medical services, SNAP encouraged the Insurance Department to consider the potential market-influenced conditions that may be leading to balance billing; to foster greater transparency and better communication between consumers, insurers, and providers; to avoid any methodology for resolving reimbursement disputes that favors insurers over providers; and to require hospitals to participate in reimbursement dispute resolution only when hospitals are part of that dispute and not when they are only the site at which the disputed services were delivered.
SNAP also encouraged the Insurance Department to involve the state’s Department of Health in addressing this issue; to seek greater public input; and to look to balance billing efforts elsewhere for guidance.
Find the Pennsylvania Insurance Department’s proposed Balance Billing Protection Act here and read SNAP’s comments on that proposal here.

PA Safety Net Admin2016-03-01T11:06:30+00:00March 1st, 2016|Uncategorized|Comments Off

New Look at Preventive Care

The organization America’s Health Rankings issued a new report documenting the use of preventive health care services across the country.
The organization’s “Spotlight: Prevention”

…takes an in-depth look at the status of clinical disease prevention across the country and the inequities within subpopulations. The aim of this spotlight is to drive awareness and understanding about the roles of key clinical preventive services and interventions—Access to Health Care, Immunizations, and Chronic Disease Prevention—in improving the health of individuals and our communities.

The report takes a state-by-state look the use of preventive services in the country today.
Find an introduction to “Spotlight: Prevention” go here and go here for a look at the status of prevention efforts in Pennsylvania based on such factors as patient age, gender, race, education, and income.

PA Safety Net Admin2016-02-29T06:00:45+00:00February 29th, 2016|Uncategorized|Comments Off

Hospitals Not Using Observation Status to Avoid Readmissions Penalties

Hospitals are not moving returning patients to observation status to avoid incurring financial penalties under Medicare’s hospital readmissions reduction program, according to new study published in the New England Journal of Medicine.
Since that program’s inception, more than 3300 hospitals have reduced the rate at which they readmit Medicare patients within 30 days of their discharge from the hospital. A moderate increase in the classification of Medicare patients in observation status led some critics to suggest that observation status was being used to avoid penalties for readmissions.
The study disagrees, concluding that

…we found a change in the rate of readmissions coincident with the enactment of the ACA, which suggested that the Hospital Readmissions Reduction Program may have had a broad effect on care, especially for targeted conditions. In the long-term follow-up period, readmission rates continued to fall for targeted and nontargeted conditions, but at a slower rate. We did not see large changes in the trends of observation-service use associated with the passage of the ACA, and hospitals with greater reductions in readmission rates were no more likely to increase their observation-service use than other hospitals.

For a closer look at the study, the methodology employed, and its conclusions, go here to see the New England Journal of Medicine article “Readmissions, Observation, and the Hospital Readmissions Reduction Program.” In addition, the U.S. Department of Health and Human Services features a commentary about the study on its blog. Go here to see that commentary, titled “Reducing Avoidable Hospital Readmissions to Create a Better, Safer Health Care System.”

PA Safety Net Admin2016-02-26T06:00:17+00:00February 26th, 2016|Health care reform, Medicare, Uncategorized|Comments Off

Do Return ER Visits Yield Better Outcomes?

Patients who visit hospital emergency rooms for care, return home, and then return to the ER within 30 days have better outcomes than those who are admitted to the hospital from the ER.
And their care costs less as well.
This according to a new study published in the Journal of the American Medical Association.
What does this mean?
According to the study’s abstract,

These findings suggest that hospital admissions associated with return visits to the ED may not adequately capture deficits in the quality of care delivered during an ED visit.

To learn more about the study and its surprising findings, see this Fierce Healthcare article or go here for a link to the JAMA article “In-Hospital Outcomes and Costs Among Patients Hospitalized During a Return Visit to the Emergency Department.”

PA Safety Net Admin2016-02-25T06:00:57+00:00February 25th, 2016|Uncategorized|Comments Off

Medicaid Implications of the President’s FY 2017 Proposed Budget

The National Association of Medicaid Directors has published a detailed memo outlining how President Obama’s proposed FY 2017 would affect Medicaid.
See that memo here.

PA Safety Net Admin2016-02-24T06:00:59+00:00February 24th, 2016|Uncategorized|Comments Off

Cutting ER Visits: Harder Than Expected

The first two years of major expansion of access to health insurance under the Affordable Care Act did not produce the significant reduction in hospital ER visits that many expected.
Or so reports a new study from the Centers for Disease Control and Prevention.
According to the CDC, even though eight million people gained health insurance under the health reform law in 2013 and 2014, ER visit rates changed little.
Still, the CDC survey found some progress: visits among Medicaid patients and the uninsured fell slightly, although Medicaid patents still frequent hospital ERs more than the privately insured.
Among those who did visit the ER, many said their primary care practice was not open at the time or that the ER was the only provider to which they felt they had access to care. In addition, many who made ER return visits reported doing so because of local government reductions of behavior health services options.
Because they are located in low-income communities, Pennsylvania safety-net hospitals typically have far more ER visits than the average hospital.
Learn more about changing rates of ER visits during the first years under the Affordable Care Act in this Fierce Healthcare article or go here to see the CDC report Reasons for Emergency Room Use Among U.S. Adults Aged 18–64: National Health Interview Survey, 2013 and 2014.

PA Safety Net Admin2016-02-23T06:00:12+00:00February 23rd, 2016|Pennsylvania safety-net hospitals, Uncategorized|Comments Off

GAO Suggests Changes in Federal Medicaid Funding Formula

The U.S. Government Accountability Office has recommended changes in how the federal government matches state Medicaid funding for its share of overall Medicaid spending.
In testimony submitted to the House Energy and Commerce Committee’s Health Subcommittee, GAO reminded Congress that in the past

…GAO has examined multiple concerns regarding how the FMAP [federal medical assistance formula] allocates funds among states, including during times of economic downturn, and has suggested improvements.

In particular, the GAO is concerned about how the FMAP formula’s use of per capita income in targeting federal Medicaid matching funds may not accurate reflect economic conditions at the state level, especially during economic downturns, and fail to respond to states’ individual needs during those downturns.
In response to these concerns, the GAO suggested

…that Congress could consider an FMAP formula that targets variable state Medicaid needs and provides automatic, timely, and temporary assistance in response to national economic downturns.

For a closer look at what the GAO investigated, what it concluded, and what it recommended to Congress, go here to see the GAO report Medicaid: Changes to Funding Formula Could Improve Allocation of Funds to States.

PA Safety Net Admin2016-02-18T06:00:32+00:00February 18th, 2016|Uncategorized|Comments Off

Wolf Administration Weighs Addressing Balance Billing

The Wolf administration is floating a proposal that would end medical balance billing in situations in which out-of-network providers are involved in the delivery of care patients receive from providers they believe to be in their health insurer’s provider network.
Such situations typically arise when patients receive inpatient care at hospitals they know to be within their insurer’s provider network but some of the professionals involved in providing that care are not part of that network.
The results can be large bills for services their insurers do not cover.
The Pennsylvania Insurance Department has published draft legislation to address such balance billing and is seeking public comment on the proposal. See that draft legislation here.

PA Safety Net Admin2016-02-18T06:00:29+00:00February 18th, 2016|Uncategorized|Comments Off

MACPAC: Medicaid DSH Payments Not Always Reaching Targeted Providers

In many cases, Medicaid disproportionate share payments (Medicaid DSH) are being made to hospitals that do not necessarily serve especially large proportions of Medicaid and other low-income patients.
So concludes a new report from The Medicaid and CHIP Payment and Access Commission (MACPAC), is a non-partisan legislative branch agency that performs policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on issues affecting Medicaid and the State Children’s Health Insurance Program (CHIP).
According to a new MACPAC report,

Medicaid DSH payments provide substantial support to safety-net hospitals by helping to offset uncompensated care costs for Medicaid and uninsured patients. In 2014, Medicaid made a total of $18 billion in DSH payments ($8 billion in state funds and $10 billion in federal funds). About half of all U.S. hospitals receive such payments, with most going to hospitals that serve a particularly high share of Medicaid and other low-income patients, known as deemed DSH hospitals. But more than one-third of DSH payments are made to hospitals that do not meet this standard.

To remedy this problem, MACPAC recommends more and better data collection, noting that

The current variation in state DSH allotments stems from the variations that existed in state DSH spending in 1992.

Medicaid DSH has long been a subject of great interest to Pennsylvania’s safety-net hospitals because, serving so many Medicaid and low-income patients, they are the very providers for which Medicaid DSH payments have always been intended.
The MACPAC analysis Report to Congress on Medicaid Disproportionate Share Hospital Payments covers a broad range of Medicaid DSH-related issues. Find it here, on the MACPAC web site.

PA Safety Net Admin2016-02-08T06:00:14+00:00February 8th, 2016|Pennsylvania safety-net hospitals, Uncategorized|Comments Off

New Medicaid Regulation Clarifies Access to Home Health Services

Under a new regulation unveiled by the Centers for Medicare & Medicaid Services, physicians and other authorized providers now must document their face-to-face encounters with patients when they are authorizing home health services but those encounters can be conducted through telehealth.
This approach, already part of the Medicare program, applies only to Medicaid fee-for-service patients and not to those served by managed care plans.
In addition, the rule regulates how recently providers must have their encounters with patients when prescribing home health services and provides those services in settings other than the home.
For a closer look at the new regulation, see this Fierce Healthcare article and this CMS fact sheet.

PA Safety Net Admin2016-02-04T06:00:48+00:00February 4th, 2016|Uncategorized|Comments Off

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