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Slight Decline in Uninsured Children in PA

The number of uninsured children in Pennsylvania fell from 147,303 in 2013 to 139,000 in 2014, according to a new study released by the Pennsylvania Partnerships for Children and the Georgetown University Center for Children and Families.
Pennsylvania State MapThe decline was driven part by the expansion of the state’s Medicaid program, which was enabled by the federal Affordable Care Act. Pennsylvania’s Medicaid expansion began in early 2014.
Learn more about uninsured children in Pennsylvania in this Pittsburgh Post-Gazette article.

2015-11-03T06:00:46+00:00November 3rd, 2015|Uncategorized|Comments Off on Slight Decline in Uninsured Children in PA

GAO Questions Impact of Medicare Value-Based Purchasing Program

Medicare’s value-based purchasing program may not be having much of an impact on the quality of care hospitals provide, according to a new report by the U.S. Government Accountability Office.

According to a GAO summary of its report Hospital Value-Based Purchasing: Initial Results Show Modest Effects on Medicare Payments and No Apparent Change in Quality-of-Care Trends,

GAO’s analysis found no apparent shift in existing trends in hospitals’ performance on the quality measures included in the HVBP [note: hospital value-based purchasing] program during the program’s initial years.
gaoThe agency did note, however, that

…shifts in quality trends could emerge in the future as the HVBP program continues to evolve.

The study also evaluated how safety-net hospitals fare under the program.

GAO found that safety net hospitals, which provide a significant amount of care to the poor, consistently had lower median payment adjustments – that is, smaller bonuses or larger penalties – than hospitals overall in the program’s first three years. However, this gap narrowed over time.

For a closer look at the GAO study and what it means, see this Kaiser Health News report. Find the study itself here, on the GAO web site.
 

2015-10-08T06:00:16+00:00October 8th, 2015|Uncategorized|Comments Off on GAO Questions Impact of Medicare Value-Based Purchasing Program

Hospitals, Especially Safety-Net Hospitals, Struggle With Heart Failure Readmissions

For all the emphasis on reducing readmissions to hospitals, providers continue to struggle to prevent readmissions of patients suffering heart failure.
medical-563427__180Or so concludes a new study published in the Journal of Cardiac Failure.
According to the study, there has been only a slight reduction in readmissions rates for heart failure patients over the past four years.
In addition, Fierce Healthcare reports that

…2014 research revealed that safety-net hospitals and those with largely low-income patient populations are at particular risk for heart failure readmissions; patients from lower-income neighborhoods, researchers found, were nearly 17 percent more likely to be readmitted within six months of discharge.

This finding supports the Safety-Net Association of Pennsylvania’s long-time contention that the distinct challenges Pennsylvania’s safety-net hospitals face in serving their especially low-income, medically challenged communities speak to the need for public policy that reflects those special challenges. 
To learn more about this issue, see this Fierce Healthcare report.
 

2015-10-02T06:00:12+00:00October 2nd, 2015|Medicare, Uncategorized|Comments Off on Hospitals, Especially Safety-Net Hospitals, Struggle With Heart Failure Readmissions

PA to Push for Value-Based Purchasing of Care

The Secretary of Pennsylvania’s Department of Health has issued a call for greater use of value-based purchasing of health care services in the state.
department of healthAt a conference hosted by the Pittsburgh Business Group on Health, Secretary Karen Murphy invited insurers and employers to work together to pursue a value-based approach to the purchase of health care that would reduce the cost of care while improving the results of the care patients receive.
To support this initiative, Secretary Murphy has created a new innovation center in the state’s Health Department and appointed a deputy secretary to lead this effort.
Learn more about the state’s intentions in this Pittsburgh Business Times article.
 

2015-09-18T06:00:48+00:00September 18th, 2015|Uncategorized|Comments Off on PA to Push for Value-Based Purchasing of Care

PA Insurance Commissioner to Hold Hearing on Balance Billing

insurance deptPennsylvania Insurance Commissioner Teresa Miller will hold a public hearing next month to begin exploring the practice of balance billing.
According to a department news release, the hearing will

…be an opportunity to begin exploring options to make sure consumers are informed about their care and do not face these unexpected bills without recourse, as well as to identify some possible consumer-friendly solutions to the issue. Miller believes this hearing will be a substantive first step in tackling the issue of balance billing, and giving consumers more peace of mind and predictability in coverage.

The hearing will be held on October 1 in Harrisburg.
For more information about balance billing and the issues the Insurance Department hopes to begin addressing at this hearing, see this news release.
 

2015-09-14T06:00:37+00:00September 14th, 2015|Uncategorized|Comments Off on PA Insurance Commissioner to Hold Hearing on Balance Billing

Newspaper Profiles DHS Secretary

ted dallasThe Pittsburgh Post-Gazette has published a profile of Pennsylvania Department of Human Services Secretary Ted Dallas. His department and its Office of Medical Assistance Programs administers the state’s Medicaid program.
Find that profile here.

2015-09-10T06:00:52+00:00September 10th, 2015|Uncategorized|Comments Off on Newspaper Profiles DHS Secretary

Socio-Economic Status Affects Health, Study Shows

A new study by California state public health officials has concluded that demographic factors have a major influence on individuals’ health.
Among the factors specifically cited in the study are education, employment status, gender identity, race and ethnicity, income, and sexual orientation.
medical-563427__180In Portrait of Promise: The California Statewide Plan to Promote Health and Mental Health Equity, the California Department of Public Health’s Office of Health Equity identifies and describes the socio-economic factors that influence health status and proposes interventions for overcoming those challenges.
SNAP has long pointed to such challenges as one of the chief distinctions between Pennsylvania’s safety-net hospitals and other hospitals in the state.
See the California report here.

2015-09-08T06:00:44+00:00September 8th, 2015|Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania, Uncategorized|Comments Off on Socio-Economic Status Affects Health, Study Shows

Feds Issue Proposed Guidance for 340B Program

The federal Health Resources and Services Administration (HRSA) has issued proposed guidelines governing its section 340B Drug Pricing Program.
The 340B program, which requires pharmaceutical companies to provide discounted drugs for qualified providers to dispense to low-income patients, has become controversial in recent years amid a significant increase in the number of eligible providers and allegations by the pharmaceutical companies that the drugs are not being used for their intended purpose.
FederalRegisterThe proposed guidance released by HRSA seeks to clarify a number of the concerns that have been raised about the program. Among other considerations, these guidelines address entities that may participate in the program; patient eligibility requirements; and audits, records, and compliance.
For a closer look at the proposed guidelines, see this article in Becker’s Hospital Review. Find the 90-page guidance document itself here, in the Federal Register. Interested parties have until October 27 to submit written comments to HRSA about the proposed guidance.

2015-09-03T06:00:15+00:00September 3rd, 2015|Uncategorized|Comments Off on Feds Issue Proposed Guidance for 340B Program

CMS Proposes New Medicaid Substance Abuse Initiatives

The Centers for Medicare & Medicaid Services (CMS) has announced a new initiative designed to improve how states identify and serve Medicaid beneficiaries with substances use disorders (SUD).
According to a recent notice sent by CMS to state Medicaid directors, the agency is proposing

… an opportunity to allow states embarking on broad and deep system transformations in the area of SUD to pursue 1115 demonstrations to improve the care and outcomes for individuals with SUD. This new initiative would be available to states that are developing comprehensive strategies to ensure a full continuum of services, focusing greater attention to integration efforts with primary care and mental health treatment, and working to deliver services that are considered promising practices or have fidelity to evidence-based models consistent with industry standards. In addition, we seek to support states that are interested in developing new payment mechanisms and performance quality initiatives…

The aim of this initiative is to enable states that are pursuing significant delivery system transformation efforts in the area of SUD to better identify individuals with an SUD in the Medicaid population, increase access to care for these individuals, increase provider capacity, to deliver effective treatments for SUD, and use quality metrics to evaluate the success of these interventions.

The notice outlines the specific goals of the initiative, the reforms CMS seeks, examples of the kinds of changes it envisions, the results it expects to see, and the process for pursuing section 1115 waivers to launch such initiatives.
For a more detailed look at what CMS is attempting to achieve and how it envisions states working to achieve it, see the letter “New Service Delivery Opportunities for Individuals with a Substance Use Disorder” sent by CMS to the nation’s Medicaid directors.

2015-07-30T06:00:07+00:00July 30th, 2015|Uncategorized|Comments Off on CMS Proposes New Medicaid Substance Abuse Initiatives

Unleashing Nurse Practitioners Could Save PA Billions, Report Says

A new report suggests that enabling nurse practitioners to practice without collaborating physicians could save Pennsylvanians $6.4 billion in health care costs over the next ten years.
In addition, nurse practitioners are more likely than physicians to serve in rural and medically underserved areas and would provide primary care at a time when the state is facing a predicted shortfall in primary care physicians.
Group of healthcare workersTwenty-one states already permit nurse practitioners to practice without a collaborating physician.
The study, “Value of Full Practice Authority in Pennsylvania,” was performed by law students at the Duke University School of Law and underwritten by the Pennsylvania Coalition of Nurse Practitioners.  Find the study here.

2015-07-20T06:00:29+00:00July 20th, 2015|Uncategorized|Comments Off on Unleashing Nurse Practitioners Could Save PA Billions, Report Says
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