Pennsylvania safety-net hospitals Archives - Page 10 of 20 - Safety-Net Association of Pennsylvania

Socio-Economic Factors Again Tied to Hospital Readmissions

Another study has linked socio-economic factors to increased hospital readmissions.
This latest study, published in the Journal for Healthcare Quality, found that

… meaningful risk-adjusted readmission rates can be tracked in a dynamic database. The clinical conditions responsible for the index admission were the strongest predictive factor of readmissions, but factors such as age and accompanying comorbid conditions were also important. Socioeconomic factors, such as race, income, and payer status, also showed strong statistical significance in predicting readmissions.

Conclusions: Payment models that are based on stratified comparisons might result in a more equitable payment system while at the same time providing transparency regarding disparities based on these factors. No model, yet available, discriminates potentially modifiable readmissions from those not subject to intervention highlighting the fact that the optimum readmission rate for any given condition is yet to be identified.

The study found that low-income patients are more likely to require readmission to the hospital than those with higher incomes and hospitals that serve higher proportions of low-income patients are more likely to incur Medicare penalties for readmissions than other hospitals.
These are the very patients served in especially large numbers by Pennsylvania’s private safety-net hospitals.
To learn more about the study, how it was conducted, and what it found, find the study “Patient Factors Predictive of Hospital Readmissions Within 30 Days” here, on the web site of the Journal for Healthcare Quality.

PA Safety Net Admin2016-03-25T06:00:42+00:00March 25th, 2016|Medicare, Pennsylvania safety-net hospitals|Comments Off

Hospitals Failing to Prevent Avoidable Readmissions

Hospitals continue to fail to prevent many avoidable readmissions, a new study in JAMA Internal Medicine has concluded.
Among the causes? Patients who shouldn’t have been admitted through the ER in the first place, post-discharge instructions written at too high a level for patients, failure of patients to keep follow-up appointments, and hospitals discharging patients too soon.
Two of those causes – hard-to-understand discharge instructions and difficulty keeping follow-up appointments – as problems that are especially prevalent within the kinds of communities served by Pennsylvania’s safety-net hospitals.
In all, the study of 12 academic medical centers concluded that 15 percent of readmissions were preventable, 12 percent were likely unpreventable, and there was about a 50 percent chance of preventing another 15 percent of readmissions.
For a look at the problems the study identified and its recommendations for addressing them, go here to see the JAMA Internal Medicine article “Preventability and Causes of Readmissions in a National Cohort of General Medicine Patients.”

PA Safety Net Admin2016-03-17T06:00:09+00:00March 17th, 2016|Uncategorized|Comments Off

DSH/340B Hospitals Have Lower Medicare Drug Costs

Medicare disproportionate share (Medicare DSH) hospitals that qualify for the federal 340B prescription drug discount program have lower Medicare Part B drug costs than other Medicare providers.
So concludes a new study performed for 340B Health, an association that represents more 1100 public and non-profit hospitals and health systems that participate in the 340B drug pricing program.
According to the organization 340B Health,

Medicare pays disproportionate share hospitals in the 340B drug discount program on average 13 percent less for separately payable drugs reimbursed through Medicare Part B. This is in comparison to what it pays other hospitals and physician practices in the Part B market. The study also shows that 340B DSH hospitals are treating more vulnerable patients than other providers in terms of race, age, disability, and dual eligibility.

The study also found that 340B-eligible hospitals are

Nearly four times as likely as non-340B providers to treat patients with end-stage renal disease
More than twice as likely to treat patients dually eligible for Medicare and Medicaid
More than twice as likely to treat patients who are disabled
More than twice as likely to treat Black, Hispanic, and North American Native patients

All of Pennsylvania’s safety-net hospitals are Medicare DSH hospitals and many participate in the 340B prescription drug pricing program as well.
For a closer look at the study and its findings, go here to see a 340B Health news release on the study and go here to see the study Analysis of Separately Billable Part B Drug Use Among 340B DSH Hospitals and Non-340B Providers.

PA Safety Net Admin2016-02-19T06:00:39+00:00February 19th, 2016|Medicare, Pennsylvania safety-net hospitals|Comments Off

MACPAC: Medicaid DSH Payments Not Always Reaching Targeted Providers

In many cases, Medicaid disproportionate share payments (Medicaid DSH) are being made to hospitals that do not necessarily serve especially large proportions of Medicaid and other low-income patients.
So concludes a new report from The Medicaid and CHIP Payment and Access Commission (MACPAC), is a non-partisan legislative branch agency that performs 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 issues affecting Medicaid and the State Children’s Health Insurance Program (CHIP).
According to a new MACPAC report,

Medicaid DSH payments provide substantial support to safety-net hospitals by helping to offset uncompensated care costs for Medicaid and uninsured patients. In 2014, Medicaid made a total of $18 billion in DSH payments ($8 billion in state funds and $10 billion in federal funds). About half of all U.S. hospitals receive such payments, with most going to hospitals that serve a particularly high share of Medicaid and other low-income patients, known as deemed DSH hospitals. But more than one-third of DSH payments are made to hospitals that do not meet this standard.

To remedy this problem, MACPAC recommends more and better data collection, noting that

The current variation in state DSH allotments stems from the variations that existed in state DSH spending in 1992.

Medicaid DSH has long been a subject of great interest to Pennsylvania’s safety-net hospitals because, serving so many Medicaid and low-income patients, they are the very providers for which Medicaid DSH payments have always been intended.
The MACPAC analysis Report to Congress on Medicaid Disproportionate Share Hospital Payments covers a broad range of Medicaid DSH-related issues. Find it here, on the MACPAC web site.

PA Safety Net Admin2016-02-08T06:00:14+00:00February 8th, 2016|Pennsylvania safety-net hospitals, Uncategorized|Comments Off

Report on Social Risk Factors in Medicare Payments

As Medicare continues to move toward making provider payments based on patient outcomes rather than services provided, the National Academies of Sciences, Engineering, and Medicine has issued a new report on the potential impact of socio-economic factors on those patient outcomes.
The report, commissioned by the U.S. Department of Health and Human Services, is based on a literature search and identifies five socio-economic risk factors that could affect Medicare patient outcomes and quality measures: socio-economic status; race, ethnicity, and cultural context; gender; social relationships; and residential and community context. HHS asked the Academies to look into this issue because of the growing perception that Medicare payment policies may be unfair to providers that care for especially large numbers of socio-economically disadvantaged Medicare patients. This is the very kind of challenge that Pennsylvania’s safety-net hospitals face because of the especially large numbers of low-income patients they serve.
The Academies report, Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors (2016), is the first of an expected five Academies reports on the subject. The second report will identify best practices in serving socio-economically disadvantaged communities; the third will seek to identify factors that are and are not within providers’ control; the fourth will present recommendations; and the fifth, expected in 2019, will summarize the first four.
Find the National Academies of Sciences, Engineering, and Medicine report Social Risk Factors in Medicare Payment: Identifying Social Risk Factors (2016) here, on the Academies’ web site.

PA Safety Net Admin2016-01-25T06:00:01+00:00January 25th, 2016|Medicare, Pennsylvania safety-net hospitals, Uncategorized|Comments Off

Dual Eligible Programs Show Mixed Results

The Affordable Care Act-inspired effort to find more effective ways to serve the so-called dual eligible population – mostly the disabled and low-income elderly covered by both Medicare and Medicaid – is not providing the kind of results policy-makers expected when they initiated new efforts to serve this high-cost population.
But not all of the news is bad.
On one hand, enrollment figures for those eligible to participate have not met expectations, with some of those eligible afraid they might lose their providers and some of those providers persuading their patients not to participate. In addition, some health plans that participated in the earliest efforts have withdrawn in the face of declining enrollment.
On the other hand, employing care managers to serve members has shown signs of reducing hospitalizations and Medicare costs and individuals who do participate have expressed satisfaction with the service they are receiving.
Programs that serve dually eligible individuals are of special interest to Pennsylvania safety-net hospitals because the communities they serve typically have especially large numbers of such residents.
For a closer look at the effort’s expectations, where it has succeeded, and where it has encountered challenges, see this Wall Street Journal article.

PA Safety Net Admin2015-12-30T06:00:59+00:00December 30th, 2015|Medicare, Pennsylvania Medicaid policy|Comments Off

Congress Forms New Medicaid Task Force

The U.S. House Energy & Commerce Committee has created a new task force “to strengthen and sustain the critical program for the nation’s most vulnerable citizens.”
According to a committee news release, the task force “…will examine the program to determine how to ensure the program is best serving the needs of those who rely on it.”
The task force’s work will undoubtedly be of interest to Pennsylvania safety-net hospitals, all of which care for unusually large numbers of Medicaid patients.
For further information about the new task force, its members, and its mission, see this House Energy & Commerce Committee news release.

PA Safety Net Admin2015-11-18T06:00:34+00:00November 18th, 2015|Uncategorized|Comments Off

CMS Proposal Would Mandate Hospital Discharge Planning

Hospitals that participate in Medicare and Medicaid would be required to develop discharge plans for all inpatients and many outpatients under a new regulation proposed by the Centers for Medicare & Medicaid Services (CMS).
According to a CMS news release,

…hospitals, including inpatient rehabilitation facilities and long-term care hospitals, critical access hospitals, and home health agencies would be required to develop a discharge plan based on the goals, preferences, and needs of each applicable patient . Under the proposed rule, hospitals and critical access hospitals would be required to develop a discharge plan within 24 hours of admission or registration and complete a discharge plan before the patient is discharged home or transferred to another facility. This would apply to all inpatients and certain types of outpatients, including patients receiving observation services, patients who are undergoing surgery or other same-day procedures where anesthesia or moderate sedation is used, and emergency department patients who have been identified by a practitioner as needing a discharge plan. In addition, hospitals, critical access hospitals, and home health agencies would have to —

Provide discharge instructions to patients who are discharged home (proposed for hospitals and critical access hospitals only);
Have a medication reconciliation process with the goal of improving patient safety by enhancing medication management (proposed for hospitals and critical access hospitals only);
For patients who are transferred to another facility, send specific medical information to the receiving facility; and
Establish a post-discharge follow-up process (proposed for hospitals and critical access hospitals only).

The proposed regulation stresses the preferences and goals of patients in the development of their discharge plans, including the selection of post-acute-care providers to which they may be discharged or the home health providers that may serve them when they return home.
Significantly, from the perspective of Pennsylvania’s safety-net hospitals, the proposed regulation calls for hospitals to consider the socio-economic status of the patients for whom they are planning – although no requirements are associated with that status.
Interested parties have until January 3 to submit comments to CMS on the proposed regulation.
To learn more about what CMS is proposing and what it hopes to accomplish, see this CMS news release. Find the proposed regulation itself here.

PA Safety Net Admin2015-11-02T06:00:15+00:00November 2nd, 2015|Medicare|Comments Off

Better Medicaid Data Needed, Governors Say

States need better data to meet the needs of Medicaid recipients with complex medical needs, according to the National Governors Association (NGA).
One of the biggest costs in state Medicaid programs is “super-utilizers”: patients who consume a significant amount of health care services. Although relatively few in number, these patients account for a significant proportion of state Medicaid expenditures.
The group’s conclusion is based on the NGA Center for Best Practices’ experience working with seven states to find better ways to meet the needs of these patients with better but less-expensive care.
According to the report,

Before state leaders can begin to address their super-utilizer populations, they first need to understand who those patients are, how they use the health care system, and how the state might adapt its system to meet patient needs.

To do this, state Medicaid programs need more and better data so they can

understand the characteristics of complex populations
identify and target specific patients
ensure effective management and evaluation

Pennsylvania’s safety-net hospitals routinely serve significant numbers of such patients.
To learn more about the NGA’s recommendation and how it reached it, go here to see its report Using Data to Better Serve the Most Complex Patients: Highlights from NGA’s Intensive Work with Seven States.

PA Safety Net Admin2015-10-01T06:00:52+00:00October 1st, 2015|Pennsylvania Medicaid policy|Comments Off

Medicare Readmissions Program Unfair to Safety-Net Hospitals, Study Finds

Medicare’s readmissions reduction program penalizes hospitals based largely on the patients they serve rather than their performance serving them, a new study has concluded.
According to the report “Patient Characteristics and Differences in Hospital Readmission Rates,” published in the journal JAMA Internal Medicine,

Patient characteristics not included in Medicare’s current risk-adjustment methods explained much of the difference in readmission risk between patients admitted to hospitals with higher vs lower readmission rates. Hospitals with high readmission rates may be penalized to a large extent based on the patients they serve.

Among those two dozen socio-economic factors: patient income, education, and ability to bathe, dress, and feed themselves.
The study found, for example, that the worst-performing hospitals under Medicare’s hospital readmissions reduction program have 50 percent more patients with less than a high school education than the program’s best performers.
Pennsylvania’s safety-net hospitals serve especially large numbers of low-income patients and have been especially vulnerable to the readmissions reduction program’s penalties.
To learn more about the study, see this Washington Post story. To find the study itself, go here, to the web site of JAMA Internal Medicine.

PA Safety Net Admin2015-09-22T06:00:25+00:00September 22nd, 2015|Medicare|Comments Off

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