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

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

Medicare Proposes Addressing Health Disparities

The Centers for Medicare & Medicaid Services (CMS) has unveiled its first plan to reduce health disparities among Medicare beneficiaries.
The plan, produced by CMS’s Office of Minority Health and titled “The CMS Equity Plan for Improving Quality in Medicare,” will seek to improve care for

…Medicare populations that experience disproportionately high burdens of disease, lower quality of care, and barriers to accessing care. These include racial and ethnic minorities, sexual and gender minorities, people with disabilities, and those living in rural areas.

This is the very population served in disproportionate numbers by many of Pennsylvania’s private safety-net hospitals.
The program will focus on six priorities:

expanding the collection, reporting, and analysis of standardized data
evaluating disparity impacts and integrating equity solutions across Medicare programs
developing and dissemination promising approaches to reducing health disparities
increasing the ability of the health care workforce to meet the needs of vulnerable populations
improving communication and language access for individuals with limited English proficiency and persons with disabilities
increasing physical accessibility of health care facilities

To learn more about The CMS Equity Plan for Improving Quality in Medicare, see this CMS news release.

PA Safety Net Admin2015-09-15T06:00:58+00:00September 15th, 2015|Medicare, Pennsylvania safety-net hospitals|Comments Off

Socio-Economic Status Affects Health, Study Shows

A new study by California state public health officials has concluded that demographic factors have a major influence on individuals’ health.
Among the factors specifically cited in the study are education, employment status, gender identity, race and ethnicity, income, and sexual orientation.
In Portrait of Promise: The California Statewide Plan to Promote Health and Mental Health Equity, the California Department of Public Health’s Office of Health Equity identifies and describes the socio-economic factors that influence health status and proposes interventions for overcoming those challenges.
SNAP has long pointed to such challenges as one of the chief distinctions between Pennsylvania’s safety-net hospitals and other hospitals in the state.
See the California report here.

PA Safety Net Admin2015-09-08T06:00:44+00:00September 8th, 2015|Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania, Uncategorized|Comments Off

GAO Looks at Behavioral Health Options

Access to behavioral health services can be a challenge for low-income adults, so the U.S. Government Accountability Office (GAO) recently looked into those challenges.
In a new report, the GAO examined how many low-income adults have behavioral health problems, where they can go to receive the care they need – including whether there are differences in those options depending on whether the state in which the reside has expanded its Medicaid program – how Medicaid expansion states are providing coverage for behavioral health for newly eligible beneficiaries, and how obtaining Medicaid coverage affects the ability of such individuals to get the care they seek.
Access to behavioral health care can be an especially major challenge in the low-income communities typically served by Pennsylvania’s safety-net hospitals.
Read about the GAO’s findings in the report Options for Low-Income Adults to Receive Treatment in Selected States, which you can find here.

PA Safety Net Admin2015-07-24T06:00:04+00:00July 24th, 2015|Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

Graduate Medical Education: Boon or Bane for Hospitals’ Bottom Line?

Do hospitals make money on graduate medical education? Do they lose money subsidizing positions above and beyond the funding they receive for completing the training of the next generation of doctors? Are there other benefits hospitals reap from medical education training programs – and are those benefits worth the cost?
This is an important question for the many Pennsylvania safety-net hospitals that also are teaching hospitals.
Crain’s Detroit Business has taken a look at some of the surprisingly complex considerations that go into answering what seem like very simple questions. Go here for its report “Hospitals say they subsidize graduate medical education, but cost-benefit unknown.”

PA Safety Net Admin2015-07-23T06:00:32+00:00July 23rd, 2015|Medicare|Comments Off

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