Uncategorized Archives - Page 14 of 29 - Safety-Net Association of Pennsylvania

Report on Social Risk Factors in Medicare Payments

As Medicare continues to move toward making provider payments based on patient outcomes rather than services provided, the National Academies of Sciences, Engineering, and Medicine has issued a new report on the potential impact of socio-economic factors on those patient outcomes.
The report, commissioned by the U.S. Department of Health and Human Services, is based on a literature search and identifies five socio-economic risk factors that could affect Medicare patient outcomes and quality measures: socio-economic status; race, ethnicity, and cultural context; gender; social relationships; and residential and community context. HHS asked the Academies to look into this issue because of the growing perception that Medicare payment policies may be unfair to providers that care for especially large numbers of socio-economically disadvantaged Medicare patients. This is the very kind of challenge that Pennsylvania’s safety-net hospitals face because of the especially large numbers of low-income patients they serve.
The Academies report, Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors (2016), is the first of an expected five Academies reports on the subject. The second report will identify best practices in serving socio-economically disadvantaged communities; the third will seek to identify factors that are and are not within providers’ control; the fourth will present recommendations; and the fifth, expected in 2019, will summarize the first four.
Find the National Academies of Sciences, Engineering, and Medicine report Social Risk Factors in Medicare Payment: Identifying Social Risk Factors (2016) here, on the Academies’ web site.

PA Safety Net Admin2016-01-25T06:00:01+00:00January 25th, 2016|Medicare, Pennsylvania safety-net hospitals, Uncategorized|Comments Off

CMS Demonstration to Tie Medical, Service Needs

A new federal demonstration program will attempt to help low-income Medicare and Medicaid recipients gain access to services that ultimately will improve their health.
The Accountable Health Communities project, developed by the Center for Medicare and Medicaid Innovation and launched by the Centers for Medicare & Medicaid Services (CMS), is a $157 million demonstration program that
… aims to identify and address beneficiaries’ health-related social needs in at least the following core areas:

Housing instability and quality,
Food insecurity,
Utility needs,
Interpersonal violence, and
Transportation needs beyond medical transportation.

The federal government intends to provide grants of up to $4.5 million to as many of 44 projects that pursue better ways to identify selected patients’ non-medical needs and connect those patients with available services in their communities. The grant funding will pay for the programs, not the services themselves, and will be evaluated to determine their impact on the health of program participants and the health care services utilization of those participants in light of the program’s central objectives of testing whether addressing the targeted needs will improve participants’ health and reduce their health care utilization.
For further information about the Accountable Health Community project, see this Kaiser Health News report; this CMS news release; this CMS fact sheet; and “Accountable Health Communities — Addressing Social Needs through Medicare and Medicaid,” a New England Journal of Medicine article that describes the program, its goals, and its underlying rationale.

PA Safety Net Admin2016-01-07T06:00:43+00:00January 7th, 2016|Uncategorized|Comments Off

PHC4 Reports on Hospital Performance

The Pennsylvania Health Care Cost Containment Council (PHC4) has issued a report that offers a wide range of statistics describing the performance and quality of care provided by the state’s acute-care hospitals.
The report presents regional and hospital-by-hospital mortality and readmission rates for a wide variety of medical conditions, doing so on a regional basis.
It also tallies the volume of hospital patients according to medical conditions and describes who is paying for the different types of care hospitals are providing.
Go here to see the PHC4 report Hospital Performance Report: 2014 Data.

PA Safety Net Admin2015-12-18T06:00:37+00:00December 18th, 2015|Uncategorized|Comments Off

Source Materials on Medicaid

The National Association of Medicaid Directors recently held its 2015 fall conference. The following are presentations made at the conference by state and federal Medicaid officials, consultants, foundation officials, associations, non-profit groups, and others.

PA Safety Net Admin2015-12-02T06:00:54+00:00December 2nd, 2015|Uncategorized|Comments Off

Financial Performance Mixed for PA Non-General Acute-Care Hospitals

Pennsylvania’s non-general acute-care hospitals are generally in good financial health, although their financial performance varied in FY 2014.
According to a new report published by the Pennsylvania Health Care Cost Containment Council, in FY 2014

psychiatric hospital operating margins rose from 8.29 percent to 9.87 percent
long-term acute care hospital operating margins fell from 5.77 percent to 5.24 percent
rehab hospital operating margins decreased from 12.93 percent to 12.74 percent
specialty hospital operating margins more than doubled, from 5.25 percent to 11.38 percent

For a closer look at the financial performance of non-general acute-care hospitals, find links to the report Non-General Acute Care Hospitals – Volume Three here, on the web site of the Pennsylvania Health Care Cost Containment Council.

PA Safety Net Admin2015-11-24T06:00:17+00:00November 24th, 2015|Uncategorized|Comments Off

Latest Edition of Health Law PA News

The Pennsylvania Health Law Project has released the latest edition of its newsletter. The November 2015 edition includes new Children’s Health Insurance Program (CHIP) benefits, Pennsylvania Medicaid’s new specialty pharmacy drug program, and Pennsylvania’s receipt of a federal planning grant for certified community behavioral health clinics.
Find the latest Health Law PA News here.

PA Safety Net Admin2015-11-23T06:00:47+00:00November 23rd, 2015|Pennsylvania Medicaid policy, Uncategorized|Comments Off

Congress Forms New Medicaid Task Force

The U.S. House Energy & Commerce Committee has created a new task force “to strengthen and sustain the critical program for the nation’s most vulnerable citizens.”
According to a committee news release, the task force “…will examine the program to determine how to ensure the program is best serving the needs of those who rely on it.”
The task force’s work will undoubtedly be of interest to Pennsylvania safety-net hospitals, all of which care for unusually large numbers of Medicaid patients.
For further information about the new task force, its members, and its mission, see this House Energy & Commerce Committee news release.

PA Safety Net Admin2015-11-18T06:00:34+00:00November 18th, 2015|Uncategorized|Comments Off

Study Looks at Social Determinants of Health

A new issue brief from the Kaiser Family Foundation looks at the social determinants of health and health outcomes.
The issue brief “Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity” reports that

Social determinants have a significant impact on health outcomes. Social determinants of health are “the structural determinants and conditions in which people are born, grow, live, work and age.” They include factors like socioeconomic status, education, the physical environment, employment, and social support networks, as well as access to health care (Figure 2). Based on a meta-analysis of nearly 50 studies, researchers found that social factors, including education, racial segregation, social supports, and poverty accounted for over a third of total deaths in the United States in a year. In the United States, the likelihood of premature death increases as income goes down. Similarly, lower education levels are directly correlated with lower income, higher likelihood of smoking, and shorter life expectancy. Children born to parents who have not completed high school are more likely to live in an environment that poses barriers to health. Their neighborhoods are more likely to be unsafe, have exposed garbage or litter, and have poor or dilapidated housing and vandalism. They also are less likely to have sidewalks, parks or playgrounds, recreation centers, or a library.

The issue brief also looks at different steps that are being pursued to address such challenges through the State Innovation Models Initiative (SIM), state Medicaid programs, community health centers, health insurers, local groups, and more.
The Safety-Net Association of Pennsylvania (SNAP) has long maintained that the patients it serves are fundamentally more challenging to treat than those served by the typical community hospital because of the very factors identified in this study.
To learn more, find the Kaiser Foundation issue brief here.

PA Safety Net Admin2015-11-17T06:00:21+00:00November 17th, 2015|Safety-Net Association of Pennsylvania, Uncategorized|Comments Off

Report on Hospital Performance in PA

The Pennsylvania Health Care Quality Alliance has released its annual report on the performance of the state’s hospitals.
The group compared hospital performance over time on 16 process measures: three heart attack measures, two heart failure measures, three pneumonia measures, six surgical care measures, and one prevention measure. It found that hospital performance in the state improved during the July 2013 to June 2014 over previous years and that those improvements mirrored similar improvements nationally. Overall, the group found that the performance of Pennsylvania’s hospitals on these measures was better than average nationally.
The alliance also evaluated patient satisfaction with Pennsylvania hospitals as quantified by hospital consumer assessment of healthcare providers and systems (HCAHPS) measures. It found modestly improved performance that generally mirrored national trends.
Finally, alliance reported on the delivery of care in hospital emergency rooms and found modestly improved performance that was very similar to hospitals’ performance nation-wide.
The Pennsylvania Health Care Quality Alliance is a voluntary group of health care organizations working together to improve the quality of health care in Pennsylvania. It report State of the State: Hospital Performance in Pennsylvania, October 2015, can be found here, on the organization’s web site.

PA Safety Net Admin2015-11-16T06:00:08+00:00November 16th, 2015|Uncategorized|Comments Off

CMS Requires States to Monitor Medicaid Access

A new federal regulation requires states to monitor access to Medicaid-covered services.
According to a new regulation issued by the Centers for Medicare & Medicaid Services (CMS), states must submit to CMS plans for monitoring Medicaid beneficiary access to care in five service areas: primary care, physician specialists, behavioral care; pre- and post-natal care; and home health services.
State monitoring plans must address the extent to which Medicaid is meeting beneficiaries’ needs; the availability of care; changes in service utilization; and comparisons between Medicaid rates and rates paid by other public and private payers.
Interested parties have 60 days to submit comments to CMS about the new regulation.
For a closer look at the regulation, see this CMS fact sheet and the regulation itself here, in the Federal Register.

PA Safety Net Admin2015-11-12T12:09:56+00:00November 12th, 2015|Uncategorized|Comments Off

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