Uncategorized Archives - Page 9 of 29 - Safety-Net Association of Pennsylvania

PA Chosen for Behavioral Health Services Demo

Pennsylvania will be one of eight states to participate in a new federal two-year Certified Community Behavioral Health Clinic demonstration program.
samhsa According to the federal Substance Abuse and Mental Health Services Administration, the program is

…designed to improve behavioral health services in their communities. This demonstration is part of a comprehensive effort to integrate behavioral health with physical health care, increase consistent use of evidence-based practices, and improve access to high quality care for people with mental and substance use disorders.

A federal spokesperson explained that

The demonstration program will improve access to behavioral health services for Medicaid and CHIP beneficiaries, and will help individuals with mental and substance use disorders obtain the health care they need to maintain their health and well-being.

The program is authorized under Section 223 of the Protecting Access to Medicare Act of 2014. Last year the federal government awarded 24 states planning grants under the law. Nineteen of those states applied to participate in the program and eight, including Pennsylvania, were ultimately chosen.
As part of its application, Pennsylvania designated ten sites for program implementation:

Berks Counseling Center, Berks County
Cen Clear Child Services, Clearfield County
Cen Clear Punxsy, Jefferson County
Community Council Health Systems, Philadelphia County
NHS Human Services, Delaware County
Northeast Treatment Centers, Philadelphia County
Pittsburgh Mercy, Allegheny County
Resources for Human Development, Montgomery County
Safe Harbor Behavioral Health of UPMC Hamot, Erie County
The Guidance Center, McKean County

According to the state, the programs at these sites will:

enhance access to behavioral health services for Medicaid and CHIP beneficiaries,
help individuals with mental health and substance use disorders obtain the health care they need to maintain their health and well-being,
allow individuals to have access to a wide array of services at one location, and
remove the barriers that too often exist across physical and behavioral health systems.

Learn more about the demonstration from this news release from the U.S. Department of Health and Human Services. Learn more about Pennsylvania’s plans for its demonstration program from this news release from the state’s Department of Human Services.

PA Safety Net Admin2016-12-27T06:00:17+00:00December 27th, 2016|Pennsylvania Medicaid, Uncategorized|Comments Off

Feds Launch Medicare-Medicaid ACO Model

The Center for Medicare and Medicaid Innovation has announced a new Medicare-Medicaid Accountable Care Organization Model that it says

…is focused on improving quality of care and reducing costs for Medicare-Medicaid enrollees. The MMACO Model builds on the Medicare Shared Savings Program (Shared Savings Program), in which groups of providers take on accountability for the Medicare costs and quality of care for Medicare patients. Through the Model, CMS will partner with interested states to offer new and existing Shared Savings Program ACOs the opportunity to take on accountability for the Medicaid costs for their assigned Medicare-Medicaid enrollees.

cms In this new model, the Innovation Center

… seeks to encourage participation from safety-net providers in Alternative Payment Models. Medicare-Medicaid ACOs that qualify as “Safety-Net ACOs” will be eligible to receive pre-payment of Medicare shared savings to support the ACO’s investment in care coordination infrastructure.

The Innovation Center envisions pursuing such undertakings with six states, which will be chosen on a competitive basis.
Learn more about the Medicare-Medicaid Accountable Care Organization model here, on the Innovation Center’s web site.

PA Safety Net Admin2016-12-22T14:27:49+00:00December 22nd, 2016|Uncategorized|Comments Off

Uninsured Patients, Provider Taxes Hurt Adequacy of Medicaid Payments

While Medicaid payments now typically cover more than the cost of Medicaid services in many states, they do not cover the costs of caring for low-income patients after providers care for uninsured patients and pay Medicaid provider taxes, a new study has found.
According to a Health Affairs report,

After accounting for supplemental payments, we found that in 2011, disproportionate-share hospitals, on average, received gross Medicaid payments that totaled 108 percent of their costs for treating Medicaid patients but only 89 percent of their costs for Medicaid and uninsured patients combined. However, these payments were reduced by approximately 4–11 percent after we accounted for provider taxes and local government contributions that are used to help finance Medicaid payments.

Because they are all disproportionate share hospitals, this is especially a challenge for Pennsylvania’s urban safety-net hospitals.
To learn more, go here to see the Health Affairs analysis “For Disproportionate-Share Hospitals, Taxes And Fees Curtail Medicaid Payments.”

PA Safety Net Admin2016-12-20T06:00:49+00:00December 20th, 2016|Pennsylvania safety-net hospitals, Uncategorized|Comments Off

Financial Performance Strong at PA Non-General Acute Hospitals

For non-general acute-care hospitals in Pennsylvania, FY 2015 was generally a good year.
Long-term acute-care hospitals saw their average operating margins rise from 5.24 percent to 8.04 percent.
Operating margins for rehabilitation hospitals rose from 12.7 percent to 12.87 percent.
phc4 And while operating margins for psychiatric and specialty hospitals declined, they still remain generally strong at 8.81 percent and 7.78 percent, respectfully.
Learn more about the financial performance of non-acute-care hospitals in Pennsylvania in Financial Analysis 2015: An Annual Report on the Financial Health of Pennsylvania Non-GAC Hospitals, a new report from the Pennsylvania Health Care Cost Containment Council.

PA Safety Net Admin2016-11-28T06:00:44+00:00November 28th, 2016|Uncategorized|Comments Off

PA Hospitals Reducing Readmissions, Mortality

Pennsylvania hospitals have seen a state-wide decrease in their mortality and readmission rates, according to new data released by the Pennsylvania Health Care Cost Containment Commission.
phc4 According to the new numbers, which cover hospital performance from January 1 through September 30 of 2015, hospital mortality rates fell for ten of the 16 conditions PHC4 tracks while readmissions fell for nine of the 13 conditions for which the agency collects data.
PHC4 estimates that this improved performance saved 3900 lives and avoided 2700 hospital readmissions.
For a closer look at the data PHC4 collected, the conditions it tracked, and a hospital-by-hospital, region-by-region, and state-wide look at hospital performance go here, to the PHC4 web site, to find a summary of the report, the news release that accompanied its publication, and three separate reports with all of the numbers and findings.

PA Safety Net Admin2016-10-21T06:00:42+00:00October 21st, 2016|Uncategorized|Comments Off

MACPAC Meets

The federal agency responsible for advising Congress on Medicaid and Children’s Health Insurance Program payment and access issues met last week in Washington, D.C.
According to the Medicaid and CHIP Payment and Access Commission,

The initial sessions of MACPAC’s September 2016 Commission meeting focused on hospital payment policy, first discussing MACPAC’s new work to develop an index of Medicaid inpatient payments across states and relative to Medicare, and later looking at how Affordable Care Act coverage expansions have affected hospitals serving a disproportionate share of low-income patients, including those with Medicaid coverage. The Commission then reviewed state policies for covering and paying for services in residential care settings, part of the drive to rebalance long-term services and supports from institutions to the community.

A briefing on MACPAC’s recent roundtable on improving service delivery to Medicaid beneficiaries with serious mental illness kicked off the afternoon sessions, followed by a discussion of Medicaid financing and its relationship to provider payment policies. At the final session of the day, the Commission reviewed the possible elements of a package of recommendations on children’s coverage and the future of CHIP.

The following are the presentation materials referenced during the meeting:

MACPAC’s deliberations often have implications for Pennsylvania safety-net hospitals.

PA Safety Net Admin2016-09-23T06:00:11+00:00September 23rd, 2016|Uncategorized|Comments Off

Medicare Readmissions Down Almost Everywhere

Hospitals in 49 of the 50 states have reduced their Medicare readmissions since the federal health care program introduced its readmissions reduction program in 2010.
Only hospitals in Vermont have failed to cut readmissions.
Nationally, readmissions fell more than five percent in 43 states and more than ten percent in 11 states. Overall, readmissions fell 100,000 in 2015 alone compared to 2010 and have fallen 565,000 since 2010.
As the program ages more medical conditions are being subjected to the readmissions reduction program’s requirements. In the coming year, the Centers for Medicare & Medicaid Services estimates it will penalize 2500 hospitals $538 million for failing to reduce their readmissions.
Learn more about CMS’s efforts to reduce readmissions among Medicare patients in this entry on the CMS Blog.

PA Safety Net Admin2016-09-22T06:00:36+00:00September 22nd, 2016|Medicare, Uncategorized|Comments Off

New ACO Model Targets Social Determinants of Health

The federal government is altering a previously announced accountable care organization model to help it target the social determinants of health of the patients it serves.
The Accountable Health Communities model, launched by the Centers for Medicare & Medicaid Services and the Center for Medicare and Medicaid Innovation in January, has been modified to target “community-dwelling Medicare and Medicaid beneficiaries with unmet health-related social needs.”
According to a CMS fact sheet,

The foundation of the Accountable Health Communities Model is universal, comprehensive screening for health-related social needs of community-dwelling Medicare, Medicaid, and dual-eligible beneficiaries accessing health care at participating clinical delivery sites. The model aims to identify and address beneficiaries’ health-related social needs in at least the following core areas:

Housing instability and quality,
Food insecurity,
Utility needs,
Interpersonal violence, and
Transportation needs beyond medical transportation.

Addressing the health-related associated with social determinants of health has long been one of the major challenges Pennsylvania’s safety-net hospitals face.
CMS anticipated participating ACOs serving their members through annual screenings of needs, increased dissemination of information about how to address health-related social needs, and appropriate referrals to community resources to meet those needs.
Among the organizations invited to apply to participate are community-based groups, health care organizations, hospitals and health systems, institutions of higher education, and government entities. In recognition of the need for a more patient-focused approach than CMS proposed in January, the number of members participating ACOs must serve has been reduced the potential award amount has been raised.
To learn more about the Accountable Health Communities model, why it has been modified, what it hopes to accomplish, and how it will operate, see this CMS fact sheet.

PA Safety Net Admin2016-09-19T09:40:14+00:00September 19th, 2016|Uncategorized|Comments Off

CMS Posts Tentative List of Essential Community Providers

The Centers for Medicare & Medicaid Services has posted on its web site a draft list of essential community providers for 2018.
To qualify as essential community providers, organizations must serve predominantly low-income, medically underserved patients. Qualified health plans must contract with at least 30 percent of the essential community providers in their markets and must offer contracts in good faith to at least one such provider in each of six categories, including federally qualified health centers, hospitals, and family planning providers.
Providers that believe they have mistakenly been excluded from the list may petition for inclusion.
Find the draft list here.

PA Safety Net Admin2016-09-08T06:00:07+00:00September 8th, 2016|Uncategorized|Comments Off

Hospital Group Models Risk-Adjusted Medicare Readmissions

The Missouri Hospital Association has published data that demonstrates that risk-adjusting Medicare readmissions based on social determinants of health reduces the readmission rates of hospitals that care for large numbers of low-income patients.
The data, modeling, and risk adjustment methodology, developed by the association based on data from Missouri hospitals, published on the association’s “Focus on Hospitals” web site, and described in an article on the NEJM Catalyst web site, showed that

SDS [note: sociodemographic status)-enriched models yielded significant relative reductions in the range of risk-standardized readmission ratios for each of…6 outcomes…Overall, SDS enrichment best improved the 30-day readmission assessments of hospitals that served higher concentrations of Medicaid patients and higher-poverty communities.

The lack of risk adjustment for socioeconomic risk factors has been a controversial aspect of Medicare’s hospital readmissions reduction, with a growing body of research suggesting that without such risk adjustment, the program is unfair to hospitals that care for especially large numbers of low-income patients- hospitals like Pennsylvania’s private safety-net hospitals.
Learn more about the work done by the Missouri Hospital Association, and its implications, in its report Risk Adjustment for Sociodemographic Status in 30-Day Hospital Readmissions and this description of and commentary on the association’s research on the NEJM Catalyst web site.

PA Safety Net Admin2016-09-07T06:00:05+00:00September 7th, 2016|Medicare, Uncategorized|Comments Off

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