Uncategorized Archives - Page 18 of 29 - Safety-Net Association of Pennsylvania

Providers Can’t Sue Over Low Medicaid Payments

Health care providers may not turn to the courts when they believe their state Medicaid program is not paying them enough for the services they deliver, the Supreme Court has decided.
Instead, they must seek help from the federal government, which makes the rules that govern Medicaid provider payments.
The Supreme Court decision overturns a lower court ruling in response to a suit by facilities in Idaho that provide residential services to the disabled claiming that the state was paying them less than it had agreed to pay. As a result, providers must now turn to the Centers for Medicare & Medicaid Services (CMS) if they believe they are not being paid fairly.
Learn more about the Supreme Court’s decision in this news story in The Hill.

PA Safety Net Admin2015-04-01T06:00:50+00:00April 1st, 2015|Uncategorized|Comments Off

PA Medicaid Transition Timetable

The Pennsylvania Department of Human Services has published a “HealthChoices Key Events and Milestones” table outlining the key steps in the state’s transition from the Healthy PA Medicaid expansion to the Wolf administration’s Medicaid expansion through the state’s existing HealthChoices program.
Listed on the timetable are the major steps in that transition and target dates for the completion of each.
Find that timetable here.

PA Safety Net Admin2015-03-27T06:00:46+00:00March 27th, 2015|Uncategorized|Comments Off

Safety-Net Hospitals Struggle With Medicare’s Value-Based Purchasing

Safety-net hospitals are more likely than others to fare poorly under Medicare’s value-based purchasing program.
Or so concludes a new study published in the journal Health Affairs.
Researchers examined the impact of the addition of patient mortality measures to the program in 2014, and according to the abstract of the new study,
We found that safety-net hospitals were more likely than other hospitals to be penalized under the VBP program as a result of their poorer performance on process and patient experience scores. In 2014, 63 percent of safety-net hospitals versus 51 percent of all other sample hospitals received payment rate reductions under the program.
See the new study “Safety-Net Hospitals More Likely Than Other Hospitals To Fare Poorly Under Medicare’s Value-Based Purchasing” here, on the Health Affairs web site.

PA Safety Net Admin2015-03-18T06:00:35+00:00March 18th, 2015|Uncategorized|Comments Off

Congress Mulls Another Medicare Doc Fix

With a March 31 deadline looming before Medicare payments to physicians are scheduled to decline more than 20 percent, it appears Congress may be considering permanent repeal of the underlying root of the problem rather than yet another short-term patch.
At the heart of the problem is the sustainable growth rate formula, or SGR, that determines how Medicare pays physicians. For years Congress has applied short-term solutions to the SGR problem and paid for those solutions with short-term spending cuts. Now it appears congressional leaders are contemplating a permanent repeal of the troublesome formula.
The cost of doing so is about $175 billion for ten years, and Congress reportedly is considering cuts in both benefits and provider payments.
Because many Pennsylvania safety-net hospitals own physician practices, this issue is very important to them.
The Wall Street Journal has taken a closer look at this matter, examining the issue, the stakes, and both the policy and the political challenges congressional negotiators now face. See its report here.

PA Safety Net Admin2015-03-17T06:00:59+00:00March 17th, 2015|Uncategorized|Comments Off

Congress to Consider Adding Risk Adjustment to Medicare Readmissions Program

A new bill introduced in Congress last week would require Medicare to consider the socio-economic status of the patients individual hospitals serve as part of its hospital readmissions reduction program.
The Establishing Beneficiary Equity in the Hospital Readmissions Program Act of 2015 was introduced as S. 688 in the Senate, sponsored by Senators Rob Portman (R-OH) and Joe Manchin (D-WV), and in the House by Representatives Jim Renacci (R-OH) and Eliot Engel (D-NY) as H.R. 1343.
Rep. Renacci introduced a similar measure last year. This year’s version has bipartisan sponsorship in both the House and Senate.
Since the launch of Medicare’s readmissions reduction program several years ago, a number of studies have suggested that the program is unfair to hospitals that serve especially large numbers of low-income patients. The new proposal seeks to address that unfairness.
Pennsylvania’s safety-net hospitals serve especially large numbers of low-income patients and have been especially vulnerable to the readmissions reduction program’s penalties.
To learn more about this proposal, see this news release announcing the bill. Find the bill itself here.

PA Safety Net Admin2015-03-16T06:00:53+00:00March 16th, 2015|Uncategorized|Comments Off

MedPAC Looks at Short-Stay Issues

The agency that advises Congress on Medicare payment issues is preparing to suggest changes in how Medicare approaches paying for short hospital stays.
At last week’s meeting of the Medicare Payment Advisory Commission (MedPAC), commissioners received a staff presentation on issues surrounding Medicare payments for short hospital stays and discussed possible recommendations for changes in how Medicare pays for those short hospital stays.
Among the possibilities discussed at the recent MedPAC meeting are revising how Medicare’s recovery audit contractors program (RAC audits) looks at short hospital stays; revising the three-day-stay requirement for Medicare to cover post-discharge skilled nursing care; penalizing hospitals found to have unusually large numbers of short stays; and shortening the time-frame during which individual cases are subject to RAC audits.
See the presentation made to MedPAC members here. Also, see this CQ HealthBeat report presented by the Commonwealth Fund on the MedPAC meeting at which this issue was discussed.

PA Safety Net Admin2015-03-11T06:00:18+00:00March 11th, 2015|Uncategorized|Comments Off

MACPAC Looks at Medicaid, CHIP Issues

The Medicaid and CHIP Payment and Access Commission (MACPAC), the independent, non-partisan federal agency that advises Congress on the Medicaid and CHIP programs, met in Washington, D.C. recently to examine a number of issues under its purview.
During two days of meetings, MACPAC heard staff presentations on the status of Medicaid expansion, sites of care for the delivery of Medicaid services, Medicaid eligibility and enrollment issues, Medicaid behavioral health populations, and more.
See these and other presentations here, on MACPAC ‘s web site.

PA Safety Net Admin2015-03-09T06:00:49+00:00March 9th, 2015|Uncategorized|Comments Off

Insurance Expansion Won’t Hurt Access to Primary Care, Study Finds

Fears that significant increases in the numbers of Americans with health insurance as a result of Affordable Care Act policies would overwhelm the health care system and lead to access to care problems are unfounded, according to a new Commonwealth Fund report.
According to the new report “How Will the Affordable Care Act Affect the Use of Health Care Services?”, the country’s current supply of primary care providers is more than adequate to meet any demand for primary care services. The study found that

… primary care providers will see, on average, 1.34 additional office visits per week, accounting for a 3.8 percent increase in visits nationally. Hospital outpatient departments will see, on average, 1.2 to 11.0 additional visits per week, or an average increase of about 2.6 percent nationally.

The study concludes that

It is critical that the expansion of health insurance coverage leads to improved access to care for those who were previously uninsured and does not limit access for those who already have coverage. Our results suggest that the current supply of primary care physicians and physicians in most specialties is sufficient to ensure this result will hold.

While the study’s findings appear encouraging, its methodology involved examining the supply of physicians and the expected increase in the demand for care only on a state-by-state basis and did not attempt to differentiate supply and demand in individual areas within states. Consequently, it did not specifically evaluate the prospects for access to care in medically underserved parts of Pennsylvania, including communities served by the state’s private safety-net hospitals. Such places have long had difficulty attracting primary care physicians (and specialists) because large numbers of their residents are uninsured or insured by Medicaid, which pays physicians poorly for their services, thereby discouraging doctors from establishing practices in such communities.
For a closer look at the study’s methodology and findings, see the research brief here, on the Commonwealth Fund’s web site.

PA Safety Net Admin2015-03-02T06:00:34+00:00March 2nd, 2015|Uncategorized|Comments Off

“Super-Utilizers” Costing PA Millions, Report Shows

“Super-utilizers” – people who visit hospital emergency rooms often and are admitted to hospital beds with unusual frequency – are costing the health care system millions of dollars a year.
According to a new report from the Pennsylvania Health Care Cost Containment Council (PHC4), super-utilizers – people admitted to the hospital at least five times in a year – while just three percent of hospital patients in FY 2014, accounted for 17 percent of the state’s Medicaid expenditures for inpatient care ($216 million) and 14 percent of Medicare inpatient expenditures ($545 million). In all, 18 percent of Medicaid hospital admissions in Pennsylvania in FY 2014 were for super-utilizers.
PHC4 identified the three leading reasons for these admissions as heart failure, septicemia, and mental health disorders.
Learn more about super-utilizers and their impact on hospital admissions and health care spending in the PHC4 report, which can be found here.

PA Safety Net Admin2015-02-20T11:06:56+00:00February 20th, 2015|Uncategorized|Comments Off

Medicare Giveth and Medicare Taketh Away

With a growing number of Medicare programs basing portions of future reimbursement on meeting specific performance metrics, hospitals are finding that they need a scorecard to keep track of their successes and failures.
Medicare’s value-based purchasing program, for example, is rewarding 1700 hospitals this year for their performance under the program. Another 1360 hospitals are being penalized under the program.
But among those 1700 winners, fewer than 800 will see their bonuses because their losses under Medicare’s hospital readmissions reduction program and health care-associated infection program exceed their value-based purchasing winnings.
Overall, the average bonus for large hospitals for the three programs combined is nearly $213,000 while the average penalty for such hospitals is approximately $1.2 million. For hospitals with 200 or fewer beds, the average bonus is about $32,000 and the average penalty approximately $131,000.
Pennsylvania’s hospitals were divided evenly among winners and losers: of 147 hospitals assessed as part of these programs, half received bonuses and half were penalized.
Not included in the totals are the six percent of hospitals that face new penalties for failing to make enough progress in their transition to electronic health records.
For a closer look at how hospitals are faring under Medicare’s various performance-based program, as well as how hospitals in other states fared, see this Kaiser Health News story.

PA Safety Net Admin2015-01-29T06:00:37+00:00January 29th, 2015|Uncategorized|Comments Off

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