Uncategorized Archives - Page 19 of 29 - Safety-Net Association of Pennsylvania

Low-Income Patients Struggle With Diabetes Management

Low-income diabetics are more likely than others to struggle to manage their condition – even if they have health insurance.
According to a new study published in JAMA Internal Medicine, “Increasing access to care may be insufficient to improve the health of patients with diabetes mellitus and unmet basic needs.” The study defines those unmet needs as food insecurity, cost-related medication underuse, housing instability, and energy insecurity.
The study, “Material Needs Insecurities, Control of Diabetes Mellitus, and Use of Health Care Resources,” found that difficulty affording food led to more outpatient physician visits; trouble paying for medicine and underuse of medicine for that reason led to more emergency room visits and hospitalizations; and all of the material insecurities contributed to increased health care costs.
The study was based on observation of 400 patients served by community health centers in Massachusetts. It found that 19 percent of those patients had trouble affording food, 28 percent had difficulty paying for medicine, 11 percent struggled to pay for someplace to live, and 14 percent had a hard time paying their utility bills. Overall, nearly half had trouble managing their diabetes.
The study’s supports SNAP’s contention that low-income patients – patients served in disproportionate numbers by Pennsylvania’s safety-net hospitals – are fundamentally more challenging to treat than others and often lack the community and social supports needed to address their medical needs effectively.
Learn more about the study and its implications in this U.S. News & World Report article or find the study itself here, on the web site of JAMA Internal Medicine.

PA Safety Net Admin2015-01-08T06:00:45+00:00January 8th, 2015|Uncategorized|Comments Off

Access to Medicaid Services

A commentary in the New England Journal of Medicine by noted Medicaid expert and advocate Sara Rosenbaum examines the issues of access to Medicaid services, the effect of adequate (or inadequate) Medicaid reimbursement on that access, and the role the federal government and public policy can play in enhancing access to care for low-income Medicaid recipients.
Find that commentary here.

PA Safety Net Admin2014-12-31T06:00:33+00:00December 31st, 2014|Uncategorized|Comments Off

MedPAC Considers FY 2016 Pay Boost for Inpatient, Outpatient Payments

Medicare payments to hospitals for inpatient and outpatient care could rise 3.25 percent in the coming fiscal year.
At least that is what members of the Medicare Payment Advisory Commission (MedPAC) discussed recommending to Congress when they met last week in Washington.
During MedPAC’s two-day public meeting, members discussed recommending to Congress a 3.25 percent increase in Medicare inpatient and outpatient payments in FY 2016. They will vote on their recommendation at their next meeting.
A presentation to MedPAC members by their staff also offered a number of observations about Medicare services:

Demand for hospital services is stable.
With hospital occupancy down to 60 percent, it appears hospitals have excess capacity.
The quality of care hospitals provide is improving according to several metrics.
Hospital cost growth is down.
Hospitals’ Medicare margins are steady, although they remain negative, especially for outpatient services.
MedPAC should consider recommending policies to reduce or eliminate differences between payments to hospitals and doctors’ offices for selected outpatient services.

For a closer look at the Medicare inpatient and outpatient issues MedPAC examined at its December meeting, see the presentation on this subject here, on MedPAC’s web site.

PA Safety Net Admin2014-12-23T06:00:27+00:00December 23rd, 2014|Uncategorized|Comments Off

Unemployment Plays Major Role in Hospital Readmissions

A new study has found that employment status is the leading socioeconomic indicator of hospital readmissions for patients who have suffered heart attacks, heart failure, and pneumonia.
Using 2011 and 2012 data from the Centers for Medicare & Medicaid Services, researchers examined readmissions for these conditions based on nine factors that constitute what is known as the Community Needs Index: elderly poverty, single parent poverty, child poverty, lack of health insurance, minority, no high school, renting, unemployment, and limited English. Their analysis found that only employment status and lack of high school education were statistically significant predictors of hospital readmissions for the three conditions studied, with employment status more than three times as powerful an indicator as lack of high school education.
High unemployment is typically a major problem in the communities served by Pennsylvania safety-net hospitals.
Learn more about the study in this Fierce Healthcare report and see the study itself here.

PA Safety Net Admin2014-12-19T06:00:57+00:00December 19th, 2014|Uncategorized|Comments Off

Governor-Elect Sets Transition Teams

Pennsylvania Governor-elect Tom Wolf has announced the membership of his transition committees for human services (including Medicaid), health, and insurance.
Those committees and their members are:

Human Services

Chair Michael Rashid – Former CEO, AmeriHealth Caritas

Deb Beck – President, DASPOP

Joan Benso – President & CEO, PA Partnership for Children

Jeff Brown – President and CEO, Brown’s Super Stores, Inc.

Mark Bullock – Senior VP, Mercy Health System

Adam Devlin – Co-Founder, New Vitae Wellness and Recovery

John Elliott – Chairman and Senior Shareholder, Elliott Greenleaf

Liz Healey – Member, Pittsburgh School Board; Executive Director, The PEAL Center

Dorothy Mann – Former CEO, The Family Planning Council of SEPA

Sam Milkes – Executive Director, PLAN, Inc.

Ross Nese – President, Grane Healthcare

Mark Painter – Former State Legislator

Tony Payton, Jr. – Former State Legislator

Peri Jude Radecic – Chief Executive Officer, Disability Rights Network Pennsylvania

Jay Spector – CEO, JEVS Human Services

Sari Stevens – Executive Director, Planned Parenthood PA

John Tague – Principal, JT Consulting Services

Richard Vague – Managing Partner, Gabriel Investments; Chairman, Woods Foundation

Health

Co-Chair Dr. Karen Hacker – Director, Allegheny County Health Department

Co-Chair Dr. Rachel Levine – Professor of pediatrics and psychiatry, Penn State College of Medicine

Bruce Bartels – Former President, WellSpan Health

Frank Cervone – Executive Director, Support Center for Child Advocates

Karen Feinstein – President, Jewish Healthcare Foundation

Peter Grollman – Sr. VP, Children’s Hospital of Philadelphia

Larry Kaiser – CEO, Temple University Health System

Chuck Kritko – Former District Executive Director, Department of Health, Commonwealth of Pennsylvania

Larry Light – Executive Director, PA Med Society

Herbert Long – Board member, Temple University Hospital and the Philadelphia Nursing Home

Bruce Melgary – Former Executive Director, Lenfest Foundation

Carolyn Rogers – Executive Director, Healthy Philadelphia

Stuart Shapiro – President & CEO, PA Health Care Association

Jane Shull – Executive Director, Philadelphia FIGHT

David Simon – Current Chairman, Pa E-Health Board; Former Chief Counsel, Jefferson Health System; Former Chief Counsel, Pa. Dept. of Insurance

Evon Sutton – Business Agent, Local 48 of AFSCME District Council 33

Susan Taylor – Dermatologist

Ann Torregrossa – Director, PA Health Funders Collaborative

Insurance

Chair TJ Rooney – Former State Representative; served on Rules, Consumer Affairs, and Insurance Committees

Pat Brier – Attorney, Myers Brier & Kelly

Patrick Casey – Attorney, Elliot Greenleaf

Christopher Drumm – Senior Vice President, Government and External Affairs, AmeriHealth Caritas Pennsylvania

Jo Ann Lawer – Director, Government Affairs and Grants, Lancaster General Health

Gerald Lawerence – Partner, Lowey Dannenberg Cohen & Hart, PC

Sam Marshall – President & CEO, Insurance Federation of Pennsylvania

Silas Russell – Government Affairs and Legislative Director, SEIU Healthcare Pennsylvania

David Senoff – Attorney, Caroselli Beachler McTiernan & Conboy

Martin (Lenny) Torrence – Owner & Agent, Nationwide Insurance

PA Safety Net Admin2014-12-18T06:00:09+00:00December 18th, 2014|Uncategorized|Comments Off

SNAP Seeks State Help With Unpaid Claims

The Safety-Net Association of Pennsylvania (SNAP) is seeking the state Department of Human Services’ assistance with millions in unpaid Medicaid fee-for-service claims.
According to SNAP, the state’s Place of Services Review and Utilization Review processes are not addressing fee-for-services claims in a timely manner, leaving safety-net hospitals with large, long-overdue receivables. Eight SNAP members alone currently await payments of more than $30 million, and in many cases, some of those unpaid claims are more than a year old.
SNAP is seeking a meeting with state officials to discuss the problem and possible solutions.
See SNAP’s letter to the Department of Human Services (“SNAP Seeks State Help With Unpaid Claims Problem”).

PA Safety Net Admin2014-12-16T06:00:45+00:00December 16th, 2014|Uncategorized|Comments Off

Residents of Disadvantaged Neighborhoods More Likely to Require Readmission

Medicare beneficiaries living in the most disadvantaged neighborhoods are more likely than others to require readmission to the hospital for problems associated with congestive heart failure, pneumonia, or myocardial infarction.
This is one of the findings in a new Annals of Internal Medicine study titled “Neighborhood Socioeconomic Disadvantage and 30-Day Rehospitalization: A Retrospective Cohort Study.”
The study, based on data from 2004 through 2009, compared Medicare readmission rates in different geographic areas using what is called a validated area deprivation index that measures relative socioeconomic disadvantage to identify the most disadvantaged areas. Researchers concluded that

The 30-day rehospitalization rate did not vary significantly across the least disadvantaged 85% of neighborhoods, which had an average rehospitalization rate of 21%. However, within the most disadvantaged 15% of neighborhoods, rehospitalization rates increased from 22% to 27% with worsening ADI.

These findings document the special challenges Pennsylvania’s private safety-net hospitals face in serving some of the most disadvantaged communities in the state.
Find the study here, on the web site of the Annals of Internal Medicine.

PA Safety Net Admin2014-12-12T06:00:34+00:00December 12th, 2014|Uncategorized|Comments Off

Homelessness and Safety-Net Hospitals

Homeless people with serious medical problems are more likely than others to be readmitted to hospitals – and especially, to safety-net hospitals – during their convalescence from illnesses and injuries.
This is one of the conclusions in the recently published Journal of Community Health Nursing article “Assessing the Needs for a Medical Respite: Perceptions of Service Providers and Homeless Persons.”
According the study, homeless people lack safe places to convalesce. Shelters do not suffice, the study found, because they are not open around the clock and lack staff qualified to support recovery. The homeless also report that their drugs are often stolen in shelters and they are vulnerable to infections while staying in them.
As a result, many of these patients end up being readmitted to the safety-net hospitals that originally treated them – often, for extended periods of time. Among others, this poses a real challenge for Pennsylvania safety-net hospitals because they serve so many more homeless patients than the typical hospital.
In more than 70 cities across the country, respite care facilities have been established to serve the homeless recovering from serious injuries and illnesses.
Learn more about the challenges facing homeless patients and the role safety-net hospitals play in addressing those challenges in this Dallas Morning News story and find the Journal of Community Health Nursing article here.

PA Safety Net Admin2014-12-09T06:00:10+00:00December 9th, 2014|Uncategorized|Comments Off

Feds Release Medicaid DSH “Uninsured” Definition

The Centers for Medicare & Medicaid Services (CMS) has published a new regulation that defines “uninsured” for the purpose of calculating the limit for how much individual hospitals may receive in Medicaid disproportionate share hospital payments (Medicaid DSH).
Under federal law, Medicaid DSH payments to hospitals cannot exceed the uncompensated costs of the services those hospitals provide to Medicaid recipients and the uninsured. In calculating hospital-specific limits, according to the new regulation,

… the calculation of uncompensated care for purposes of the hospital-specific DSH limit will include the cost of each service furnished to an individual by that hospital for which the individual had no health insurance or other source of third party coverage.

This regulation is important to Pennsylvania safety-net hospitals because they receive Medicaid DSH payments and serve more uninsured patients than the typical hospital.
Find the complete regulation here, in the Federal Register.

PA Safety Net Admin2014-12-08T06:00:42+00:00December 8th, 2014|Uncategorized|Comments Off

Administration Delays Major 340B Program Regulation

The U.S. Department of Health and Human Services has decided against releasing a long-awaited regulation that was expected to bring sweeping changes to the federal government’s 340B Drug Pricing Program.
The 340B program requires drug manufacturers to sell drugs at a discount to hospitals and other providers that serve especially large proportions of low-income patients. While providers believe the program enables them to serve more vulnerable patients at a reasonable cost, drug companies have argued that the federal government has expanded the program to include more providers and more drugs than the program originally envisioned.
A spokesman for the federal Health Resources and Services administration told Bloomberg BNA that the release has been delayed until next year and that the agency

…plans to issue a proposed guidance for notice and comment that will address key policy issues raised by various stakeholders committed to the integrity of the 340B program. HRSA is also planning to issue proposed regulations where the statute provides explicit rulemaking authority, pertaining to civil monetary penalties for manufacturers, calculation of the 340B ceiling price, and administrative dispute resolution.

Because they serve so many low-income patients and typically participate in the 340B program, Pennsylvania’s private safety-net hospitals have a great deal of interest in any attempt by the federal government to alter the scope or regulation of the program.

To learn more about the delay in the anticipated 340B regulation, see this Bloomberg BNA article.

PA Safety Net Admin2014-11-24T06:00:26+00:00November 24th, 2014|Uncategorized|Comments Off

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