New Members
The Safety-Net Association of Pennsylvania is pleased to welcome two new members: Mercy Fitzgerald Hospital (Darby, PA) and Mercy Philadelphia Hospital.
Welcome!
Where are the Uninsured?
A new interactive map from the New York Times enables readers to explore the entire country, county by county – including all 67 counties in Pennsylvania – and see how many of each county’s residents are uninsured, how many are publicly insured, and how many are privately insured.
Find the map here.
It’s Unanimous: All PA Non-General Acute-Care Hospitals Made Money in 2012
2012 was a very good year for non-general acute-care hospitals in Pennsylvania: every single one of them scored a positive operating margin.
The winners included 19 rehabilitation hospitals, 27 long-term acute-care hospitals, and 19 non-state-operated free-standing psychiatric hospitals, according to a new report from the Pennsylvania Health Care Cost Containment Council (PHC4).
Learn more about the performance of these providers in 2012 in this PHC4 news release and this PHC4 report.
CMS Seeks to Slow “Meaningful Use” Timetable
The federal government has proposed extending the deadlines for health care providers to demonstrate “meaningful use” of health information technology and receive supplemental Medicare and Medicaid payments to help pay for the acquisition and implementation of that technology.
As proposed by the Centers for Medicare & Medicaid Services (CMS), Stage 2 deadlines for demonstrating use of electronic health records, originally set for 2014, would be pushed back to 2016 and Stage 3 deadlines, currently in 2016, would begin in 2017 for qualified providers.
Funding for the supplemental payments comes through the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act.
Learn more about the program and why CMS is proposing a delay in this explanation on the CMS web site.
PA Seeks Federal OK for Medicaid Expansion
The Corbett administration is asking the federal government to authorize the expansion of the state’s Medicaid program to serve another 500,000 people.
Healthy Pennsylvania, the reform plan unveiled by the Corbett administration in September, calls for expanding eligibility for Medicaid as envisioned in the federal Affordable Care Act but providing coverage to newly eligible individuals through private insurers
Under the plan, most newly eligible recipients would select state-subsidized insurance through the federal health insurance marketplace and receive the same benefits as regular commercial customers.
Healthy Pennsylvania also calls for streamlined benefits packages, enrollee premiums, and a work search requirement.
The formal unveiling of the plan is linked to the state’s application to the federal government for a waiver from selected federal Medicaid requirements. While states routinely request such waivers, each waiver is subject to individual scrutiny and negotiation between the state and federal governments after a period of public comment at the state level.
To learn more about the Healthy Pennsylvania proposal, see this Philadelphia Inquirer article. The administration also has published a description of its proposed application for the federal waiver, including information about how interested parties may comment on the proposal, in the Pennsylvania Bulletin; that notice can be found here. The complete draft waiver application can be found here.
400,000 Fall Into PA Insurance Gap
400,000 Pennsylvanians currently fall into a gap between eligibility for the state’s Medicaid program and qualifying for health insurance subsidies through the state’s health insurance marketplace.
Under the Affordable Care Act, states were to expand eligibility for their Medicaid programs while the federal government would provide partial subsidies for low-income people who remained ineligible for Medicaid but were unlikely to be able to afford health insurance without such assistance.
But when the Supreme Court made Medicaid expansion optional for states, many people fell into a new insurance gap that was not anticipated when the 2010 reform law was written. Approximately half of the 50 states have expanded their Medicaid programs as the law expected, but in the half that did not, millions remain in this gap, earning too much money to qualify for Medicaid but not enough to be able to afford health insurance.
Among those millions are 400,000 Pennsylvanians because the commonwealth has not decided to move forward and expand its Medicaid program. Currently, state officials are exploring such expansion through a new “Healthy Pennsylvania” initiative and are negotiating possible terms for expansion with the federal government.
Learn more about Pennsylvania’s insurance gap, who is in it, why it exists, and why it is a candidate to disappear sometime in the future in this Philadelphia Inquirer article.
Some States Face Double Loss: No Medicaid Expansion Plus DSH Cut
When passed in 2010, the Affordable Care Act called for significant cuts in future Medicare disproportionate share hospital payments (Medicare DSH) based on the expectation that hospitals would have far fewer of the uninsured patients such payments helped subsidize. They would have fewer uninsured patients because of the reform law’s Medicaid expansion provisions and enhanced access to affordable health insurance.
But then the Supreme Court made Medicaid expansion optional instead of mandatory for states.
Today, 25 states have chosen either not to expand their Medicaid programs or have not decided what to do, but their hospitals still face the prospect of a future loss of Medicare DSH revenue without the full expected decline in the number of uninsured patients they serve.
Pennsylvania is one of those states that has not yet expanded its Medicaid program, although state officials are currently negotiating a possible expansion with the federal government; the Safety-Net Association of Pennsylvania (SNAP) supports such an expansion. In the meantime, the state’s safety-net hospitals continue to face the prospect of a future loss of Medicare DSH revenue.
The loss of such revenue would threaten any provider, but safety-net hospitals appear to be especially at risk, as the New York Times reports in the article “Cuts in Hospital Subsidies Threaten Safety-Net Care.” Learn about the challenges some hospitals and their low-income patients face as they await the loss of some Medicare DSH revenue without the expected increase in Medicaid patients in this Times article.
PA Facing Loss of Federal Medicaid Funds
Pennsylvania stands to lose $325 million in federal Medicaid matching funds next year.
The reduction comes as a result of a decline in the state’s federal medical assistance percentage (FMAP) of 1.7 percentage points that takes effect as of October 1, 2014.
Department of Public Welfare Secretary Beverly Mackereth is asking federal officials to review their calculation of the state’s matching rate.
Read about the anticipated loss of federal Medicaid funds and how it might affect recipient benefits and provider payments in this Philadelphia Inquirer article.
CMS Offers Guidance on Medicare “Two-Midnight Rule”
The Centers for Medicare & Medicaid Services (CMS) has published an FAQ to give providers guidance on the application of its so-called two-midnight rule governing when certain medical situations qualify for patient admission and when they should be classified as Medicare outpatient observation status. See that FAQ here.
PA Ambulatory Surgery Centers Grow in Numbers, Profitability
The number of ambulatory surgery centers in Pennsylvania grew in FY 2012, and along with that growth in numbers came a growth in profitability.
According to a new report by the Pennsylvania Health Care Cost Containment Council (PHC4), providers added 10 new facilities in FY 2012, raising the number to 281, and the average operating margin of the facilities rose from 24.94 percent to 25.83 percent.
For the latest data on ambulatory surgery centers in Pennsylvania, where they are, who they serve, how many procedures they perform, and who is paying for those procedures, find a PHC4 news release and the agency’s latest report here.