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PA Insurance Exchange Rates to Rise in 2020

Insurance premiums will rise on Pennsylvania’s new health insurance exchange in 2020, the Wolf administration has announced.

2020 will mark the first year Pennsylvania operates its own health insurance exchange under the Affordable Care Act.  Previously, Pennsylvanians shopped for health insurance on the federal health insurance exchange.

Pennsylvania State MapPennsylvania rates will rise an average of four percent for individual plans and 9.7 percent for small groups, the state Insurance Department has announced.  All insurers that offered plans in 2019 will do so again in 2020 and the exchange will include a new insurer and increased choice in some of the state’s 67 counties.  Beginning in 2020, residents of only six counties will have only a single insurer offering individual plans.

Learn more from this Wolf administration news release.

2019-10-18T06:00:04+00:00October 18th, 2019|Uncategorized|Comments Off on PA Insurance Exchange Rates to Rise in 2020

Overdose Deaths Down in PA

Overdose deaths in Pennsylvania fell 18 percent from 2017 to 2018, according to a news release issued by Governor Wolf’s office.

The decline results, according to the news release, from a combination of prevention, rescue, and treatment.  These and efforts, including the distribution of free naloxone, a drug that helps rescue those who have overdosed on some drugs, have been funded in part by a grant from the U.S. Substance Abuse and Mental Health Services Administration and Pennsylvania’s own Substance Use Disorder Loan Repayment Program, which assists health care professionals who work in the behavioral health field with the cost of their education.

At the same time, however, overdose deaths in Pennsylvania from stimulants such as cocaine and methamphetamines continue to rise.

Learn more about the decline in overdose deaths in Pennsylvania and how it has come about from a news release from the governor’s office and the Johnstown Tribune-Democrat article “State OD deaths dropped 18 percent in 2018; stimulant deaths rose.”

2019-08-15T06:00:30+00:00August 15th, 2019|Uncategorized|Comments Off on Overdose Deaths Down in PA

PHC4 Reports on Common Procedures

The Pennsylvania Health Care Cost Containment Council has published a new report detailing hospital performance on four common surgical procedures:  knee replacement, hip replacement, spinal fusion, and coronary artery bypass graft.

The report details individual hospital performance on these procedures, including in-hospital mortality, complications, and extended post-operative length of stay.  In addition, it breaks down hospital performance for all of these measures and all of these procedures based on patient age, income, gender, geographic location, and race and ethnicity.

The PHC4 report also reveals how many of these procedures individual hospitals performed and how much they charged for their services.

Learn more in the new PHC4 publication Common Procedures Report.

2019-08-13T06:00:07+00:00August 13th, 2019|Uncategorized|Comments Off on PHC4 Reports on Common Procedures

Study Finds Surprise in Sources of Medicaid, CHIP Growth

While enrollment in Medicaid and CHIP has been greatest among low-income families working full-time for small businesses, growth in Medicaid and CHIP enrollment among low-income families employed full-time by big businesses has been rising faster in recent years.

According to a new study published in the journal Health Affairs, Medicaid and CHIP enrollment among low-income families employed full-time by large companies rose from 45 percent to 69 percent between 2008 and 2016.  The driving force behind this growing reliance on public insurance appears to be the shift of health insurance costs from companies to employees:  employee share of health insurance premiums rose 57 percent during that same period, leaving many families unable to afford even employer-subsidized health insurance.

Learn more about the growing Medicaid and CHIP participation rates among different economic groups in the Health Affairs report “Growth Of Public Coverage Among Working Families In The Private Sector.”

2019-07-09T06:00:56+00:00July 9th, 2019|Uncategorized|Comments Off on Study Finds Surprise in Sources of Medicaid, CHIP Growth

Opioid Prescriptions Down in PA

Pennsylvania doctors are writing fewer prescriptions for opioids, according to a new analysis by the American Medical Association.

According to the AMA, prescriptions for opioids declined 40 percent in the state between 2013 and 2018 – one of the largest declines in the country.

In a news release, the Pennsylvania Medical Society attributed the decline in part to physician education and in part to the state’s prescription drug monitoring programs.

Learn more from the Central Pennsylvania Business Journal article “Pa. physicians writing fewer opioid prescriptions” and from a news release from the Pennsylvania Medical Society.

2019-06-11T06:00:52+00:00June 11th, 2019|Uncategorized|Comments Off on Opioid Prescriptions Down in PA

Legislature to Examine Mental Health Provider Shortage

Pennsylvania’s apparent shortage of mental health providers will be the subject of study by the Pennsylvania Joint State Government Commission, a bipartisan arm of the state’s General Assembly.

The resolution to conduct the study was approved unanimously by the state House, and according to a news release from state representative Jeanne McNeill, who sponsored the resolution,

The study will work to identify factors behind the state shortages, make projections on the number of mental health care providers in Pennsylvania in the future, make recommendations on how to solve the disparity in the number of mental health care providers in rural counties compared to urban and suburban counties and any other solutions needed to stop and reverse the mental health care provider shortage.

Learn more about the mental health provider shortage and the legislature’s search for solutions to that problem in the Central Penn Business Journal article “Panel to study mental health care shortage in PA” and from Representative O’Neill’s news release.

2019-06-07T06:00:34+00:00June 7th, 2019|Uncategorized|Comments Off on Legislature to Examine Mental Health Provider Shortage

PHC4 Reports on PA Hospital Financial Performance

Pennsylvania hospitals’ financial performance in 2018 was mixed, according to a new analysis by the Pennsylvania Health Care Cost Containment Council.

According to PHC4,

  • uncompensated care declined two percent
  • total margins fell 0.05 percentage points
  • operating margins declined 0.39 percentage points
  • net patient revenue rose 3.9 percent
  • discharges fell 1.2 percent
  • inpatient days fell 0.3 percent

Learn more about the 2018 financial performance of acute-care hospitals in Pennsylvania, including data for every such hospital in the state and measures such as payer mix, in the PHC4 report Financial Analysis 2018:  General Acute Care Hospitals

2019-05-23T06:00:24+00:00May 23rd, 2019|Uncategorized|Comments Off on PHC4 Reports on PA Hospital Financial Performance

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C.

The following is MACPAC’s own summary of the sessions.

The Commission wrapped up its work on the June 2019 Report to Congress on Medicaid and CHIP at the April meeting, with sessions reviewing four of the report’s five draft chapters on Thursday morning, and votes on potential recommendations later in the afternoon.

First on Thursday’s agenda was a draft June chapter on Medicaid prescription drug policy, which contained draft recommendations to provide states with a grace period to determine Medicaid drug coverage and raise the cap on rebates. The Commission then revisited hospital payment policy, with a draft chapter and recommendation on how to treat third-party payment in the definition of Medicaid shortfall when determining disproportionate share hospital payments. Next, commissioners considered two recommendations proposed as part of a June chapter on improving the effectiveness of Medicaid program integrity. The final morning session addressed the Commission’s proposed recommendation on therapeutic foster care.

The Commission returned from lunch for two presentations discussing preliminary findings of forthcoming congressionally mandated reports. The first afternoon session presented initial findings from a MACPAC review of state Medicaid utilization management policies related to medication-assisted treatment, to be issued in October. The session immediately following presented preliminary findings for a January 2020 study on Medicaid standards for institutions for mental diseases. Both reports are required as part of the SUPPORT for Patients and Communities Act (P.L. 115-271). Votes on June 2019 recommendations closed out the day.

Friday’s sessions opened with a review of the fifth draft chapter slated for June, on Medicaid in Puerto Rico. The second session of the morning reviewed a proposed rule issued by the Centers for Medicare & Medicaid Services in March to promote interoperability in federal health care programs. The April meeting closed with a review of evaluations of integrated care for dually eligible beneficiaries.

Supporting the discussion were the following presentations:

  1. Review of Draft Chapter for June Report and Recommendations on Prescription Drug Policy: Grace Period and Cap on Rebates
  2. Review of Draft Chapter for June Report and Proposed Medicaid Shortfall Recommendation
  3. Review of Draft Chapter on Improving the Effectiveness of Medicaid Program Integrity and Recommendations
  4. Review of Recommendation for June Report Chapter on Therapeutic Foster Care
  5. Preliminary Findings from Congressionally Mandated Study on Medication-Assisted Treatment Utilization Management Policies
  6. Preliminary Findings on Congressionally Mandated Study on Institutions for Mental Diseases
  7. Review of Draft June Report Chapter on Medicaid in Puerto Rico
  8. Review of Proposed Rule to Promote Interoperability in Federal Health Care Programs
  9. Evaluating Integrated Care: Review of Results from Literature

Because Pennsylvania safety-net hospitals serve so many Medicaid patients, MACPAC’s deliberations are especially relevant to them because its recommendations often find their way into future Medicaid and CHIP policies.

MACPAC is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department  of Health and Human Services, and the states on a wide variety of issues affecting Medicaid and the State Children’s Health Insurance Program.  Find its web site here.

 

2019-04-17T06:00:32+00:00April 17th, 2019|Uncategorized|Comments Off on MACPAC Meets

PA to Experiment with Global Budgets for Rural Areas

Pennsylvania plans to launch an experiment in which participating health insurers will fund global budgets to care for residents served by selected rural hospitals.

The program seeks to preserve access to care in rural parts of the state by stabilizing the financial health of struggling rural hospitals.

According to a Pennsylvania Department of Health news release,

The Rural Health Model is an alternative payment model, transitioning hospitals from a fee-for-service model to a global budget payment. Instead of hospitals getting paid when someone visits the hospital, they will receive a predictable amount of money. Payment for the global budget will include multiple-payers, including private and public insurers.

The global budgeting project is a joint venture of the state’s Department of Human Services, Department of Health, Insurance Department, the Pennsylvania Office for Rural Health, the federal Center for Medicare and Medicaid Innovation, and the participating hospitals and health insurers.

The five hospitals that will participate in the model’s launch are Barnes-Kasson County Hospital, Endless Mountain Health Systems, Geisinger Jersey Shore Hospital, UPMC Kane, and Wayne Memorial Hospital.  The five participating insurers are Gateway Health Plan, Geisinger Health Plan, Highmark Blue Cross and Blue Shield, UPMC, and the state’s Medicaid program.  The state hopes to bring additional hospitals and additional insurers into the program in the future.

The federal government’s Center for Medicare and Medicaid Innovation is investing $25 million over five years to fund a rural health redesign center to support the project’s launch.

The project is needed, according to the state, because “Nearly half of all rural hospitals in Pennsylvania are operating with negative margins and are at-risk of closure.”

Learn more about this initiative from this Pennsylvania Department of Health news release.

 

2019-03-08T06:00:58+00:00March 8th, 2019|Uncategorized|Comments Off on PA to Experiment with Global Budgets for Rural Areas

Health Care Lobbying Rose in 2018

Hospitals and health systems spent $99.7 million lobbying in Washington, D.C. last year, just barely more than in 2017 but much less than in 2009, when the focus of health care lobbying was the Affordable Care Act, then just a proposal and not a law.

The issues on which they spent the most money lobbying were the 340B program, site-neutral Medicare payments for outpatient services, safety-net hospitals, Medicare-for-all proposals, and Medicaid funding.

Learn more about what hospitals spent their lobbying money on, who were the biggest lobbying spenders, and where industry groups figure in the overall spending in the Healthcare Dive article “Hospital lobbying in 2018 — by the numbers.”

2019-02-20T06:00:09+00:00February 20th, 2019|Uncategorized|Comments Off on Health Care Lobbying Rose in 2018
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