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House Committee to Hold 340B Hearing

The House Energy and Commerce Committee’s oversight subcommittee will hold a hearing on Wednesday about the 340B Drug Pricing Program.
At the hearing, titled “Examining How Covered Entities Utilize the 340B Drug Pricing Program,” the subcommittee hopes

…to hear directly from entities participating in the program to get a better understanding of how the program is used, including how much money is saved, the types of drugs purchased and prescribed within the program, how entities track their savings, and how those savings are used to improve patient care.

All Pennsylvania safety-net hospitals participate in the 340B program.
Learn more about the hearing and the witness list from the subcommittee’s news release on the subject.

PA Safety Net Admin2017-10-09T06:00:52+00:00October 9th, 2017|Uncategorized|Comments Off

Suit Claims Low Medicaid Rates are Discriminatory

A lawsuit filed in state courts in California argues that the state’s low Medicaid payments amount to discrimination against the state’s large Hispanic Medicaid population.
California pays among the lowest rates in the country to physicians, making health care inaccessible for some, and the suit maintains that this is a civil rights issue in which low rates amount to discrimination.
The suit is based on state anti-discrimination and equal protection laws, and many other states have similar laws on the books. Observers question whether the low rates constitute discrimination against the suit’s Hispanic plaintiffs because the low rates affect the state’s entire Medicaid population, but health advocates around the country will be watching the suit’s progress closely as they consider whether it offers a model for how they, too, might seek redress over the low Medicaid payments that are common in so many states – payments typically much lower than those paid by Medicare.
Pennsylvania safety-net hospitals will be following this lawsuit closely.
For a closer look at the lawsuit, the situation in California, the suit’s legal implications, and how others view it, see this Stateline article.

PA Safety Net Admin2017-10-05T06:00:43+00:00October 5th, 2017|Uncategorized|Comments Off

PA Drug Monitoring Program Showing Results

Pennsylvanians are having a harder time inappropriately obtaining prescriptions for opioids and other dangerous prescription drugs because of continued implementation of the state’s prescription drug monitoring program.
Under the program, introduced last year, anyone who can prescribe Schedule II-V class drugs must query a state database before doing so and report any prescriptions they write by the end of the next business day.
The idea is to prevent people from going from doctor and doctor and pharmacy to pharmacy seeking prescriptions for dangerous drugs, and it appears to be working. The state’s Department of Health reports that the number of people who visited five or more doctors to obtain prosecutions for drugs covered by the program fell 86 percent in a year and the practice of visiting ten or more doctors in search of such drugs disappeared entirely.
Learn more about Pennsylvania’s prescription drug monitoring program, how it works, and whether it is working in this Erie Times-News article.

PA Safety Net Admin2017-10-03T06:00:57+00:00October 3rd, 2017|Uncategorized|Comments Off

U.S. House Committee Looks at 340B

Are hospitals using the savings generated by their participation in the section 340B prescription drug discount program to help their low-income and uninsured patients?
That’s what the U.S. House Energy and Commerce Committee’s Health Subcommittee is asking.
Earlier this year the committee requested such information from the Health Services and Resources Administration, which runs the 340B program, and now it’s asking hospitals as well.
Specifically, the subcommittee sent five-page letters to 19 providers that participate in the 340B program asking them about:

the quantity of 340B-purchased drugs they dispense to Medicare beneficiaries, Medicaid beneficiaries, and those with private insurance
the quantity of 340B-purchased drugs they dispense to uninsured patients
their savings from the 340B program and how they calculate those savings
how much charity care they provide
how they use 340B savings to serve vulnerable populations

The letters address many other 340B-related issues as well.
Most Pennsylvania safety-net hospitals participate in the 340B program and view it as a critical tool in their ability to meet the needs of their many low-income patients.
Learn more about the Health Subcommittee’s letter by reading this news release describing this initiative and go here to view the letters the subcommittee sent to selected 340B providers.

PA Safety Net Admin2017-09-22T06:00:05+00:00September 22nd, 2017|Uncategorized|Comments Off

Overutilization of ERs May Not be as Great as Perceived

Far fewer hospital emergency room visits are for medical problems better addressed in other settings, according to a new study.
In a review of six years worth of data encompassing 424 million ER visits, researchers found that only 3.3 percent of those visits were truly “avoidable,” with the avoidable visits mostly involving problems ERs are not equipped to address, such as dental and mental health issues.
This finding flies in the face of the conventional wisdom that people turn too quickly to hospital ERs for routine medical problems or use ERs because they lack access to more appropriate care.
Learn more about the study and its findings in this Fierce Healthcare article or go here for a link to the study “Avoidable emergency department visits: a starting point,” which was published in the International Journal for Quality in Health Care.

PA Safety Net Admin2017-09-06T17:11:15+00:00September 6th, 2017|Uncategorized|Comments Off

Leave 340B Alone, CMS Advisory Group Says

The Centers for Medicare & Medicaid Services should not significantly reduce Medicare payments for some prescription drugs.
Or so says one of CMS’s own advisory panels.
The agency’s Advisory Panel on Outpatient Prospective Payment reached this conclusion after listening to testimony from hospital industry stakeholders who told of the savings the federal government’s 340B prescription drug discount program produces and how those savings enable hospitals in low-income areas to help low-income patients who would not otherwise be able to afford their drugs and help improve access to care for low-income patients with very limited health care options.
The panel’s recommendation came just a month after CMS proposed reducing Medicare reimbursement for 340B drugs from its current level, average sales price plus six percent, to average sales price less 22.5 percent..
Critics of the program maintain that it is abused by hospitals, which are not required to reinvest their 340B savings in health care for the poor. Program supporters maintain that hospitals do use those savings for this very purpose.
Most Pennsylvania safety-net hospitals participate in the 340B program and consider it an essential part of their overall effort to serve the many low-income residents of the communities they serve.
CMS called for the change in the 340B program in a proposed regulation published in July. Interested parties have until September 11 to comment on the proposal.
Learn more about this issue and the CMS advisory panel’s recommendation in this Fierce Healthcare article.

PA Safety Net Admin2017-09-01T06:00:36+00:00September 1st, 2017|Medicare, Pennsylvania safety-net hospitals, Uncategorized|Comments Off

SNAP Writes to House Ways and Means Committee About Medicaid DSH Audits

The federal government should give states the option of monitoring Medicaid disproportionate share payments (Medicaid DSH) to hospitals through prospective DSH limit calculations rather than through retroactive DSH audits.

SNAP recently shared this view with the House Ways and Means Committee’s Health Subcommittee in response to that subcommittee’s request for suggestions from stakeholders on ways to improve the delivery of Medicare services and eliminate statutory and regulatory obstacles to more effective care delivery.

According to SNAP, retroactive DSH audits are cumbersome, burdensome, and expensive, give rise to many disputes and appeals, and in the end yield results very similar to much simpler prospective DSH limit calculations performed by the very state governments that distribute Medicaid DSH funds.

See SNAP’s comments to the Ways and Means Committee here.

PA Safety Net Admin2017-08-29T17:00:02+00:00August 29th, 2017|Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania, Uncategorized|Comments Off

Congress Looks at 340B Program

Last week the House Energy and Commerce Committee took a look at the 340B prescription drug discount program, which requires pharmaceutical companies to sell discounted drugs for outpatient use to hospitals that care for especially large numbers of low-income patients.
The previous week, the Centers for Medicare & Medicaid Services issued a proposed Medicare regulation calling for significant reductions in Medicare payments for such drugs.
The hearing touched on the CMS proposal to reduce Medicare payments for 340B drugs, the high prices of prescription drugs, the 340B program’s growth over the years, the possibility that the program is being abused by hospitals and clinics, and more.

The 340B program is an essential tool in the efforts of Pennsylvania safety-net hospitals to help the many low-income residents of the communities they serve.

Learn more about the hearing and the issues raised during it this Kaiser Health News report.

PA Safety Net Admin2017-07-25T06:00:27+00:00July 25th, 2017|Medicare, Pennsylvania safety-net hospitals, Uncategorized|Comments Off

PHC4 Looks at “Super-Utilizers”

The Pennsylvania Health Care Cost Containment Council has released a new research brief on so-called super-utilizers: a small portion of the population that consumes an inordinate amount of health care. Super-utilizers are defined as individuals with five or more hospital admissions a year.
According to the PHC4 report,

Three percent of hospitalized patients accounted for 10 percent of hospital payments, or $1.25 billion, in 2016.
Super-utilizers accounted for three percent of hospitalized patients, 10 percent of hospital payments, 12 percent of hospital admissions, and 15 percent of hospital days.
46 percent of that care was paid for by Medicare, 19 percent by Medicaid, and 19 percent was for dually eligible patients.
The top three reasons for admissions among super-utilizers were sepsis, heart failure, and mental health disorders.
Diabetes and alcohol and substance abuse disorders were among the leading causes of admission for Medicaid patients.
The highest rates of super-utilizers were among blacks, low-income individuals, and older people.

The PHC4 report breaks down super-utilizers by county and shows the reasons for super-utilizers’ hospital admissions. Its side-by-side comparison of 2012 and 2016 shows a decline in super-utilizer admissions to hospitals, perhaps because of efforts by hospitals to reduce admissions and avoid Medicare penalties for avoidable hospital readmissions.
Go here to find the PHC4 report Pennsylvania’s “Super-Utilizers” of Hospital Care.

PA Safety Net Admin2017-06-21T11:29:59+00:00June 21st, 2017|Uncategorized|Comments Off

New Report on PA Hospital Financial Performance

The Pennsylvania Health Care Cost Containment Council has published its annual report detailing the financial health of acute-care hospitals in the state.
According to the report, hospital net patient revenue increased in FY 2016, accounts receivable are being paid faster, operating and total margins rose, and uncompensated care declined.
The report describes hospital financial performance and utilization state-wide and by region and also presents FY 2016 margin, uncompensated care, and Medicare and Medicaid share data for every acute-care hospital in the state.
Go here to find the PHC4 report Financial Analysis 2016: General Acute Care Hospitals.

PA Safety Net Admin2017-05-10T11:23:09+00:00May 10th, 2017|Uncategorized|Comments Off

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