Pennsylvania safety-net hospitals Archives - Page 11 of 20 - Safety-Net Association of Pennsylvania

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

Report on Public Health and Health Care

The Institute of Medicine (IOM) has published a report summarizing its February workshop that explored the relationship between public health and health care.
According to the IOM, the workshop

… was designed to discuss and describe the elements of successful collaboration between health care and public health organizations and professionals; reflect on the five principles of primary care–public health integration (which can be applied more broadly to the health care–public health relationship): shared goals, community engagement, aligned leadership, sustainability, and data and analysis; and explore the “elephants in the room” when public health and health care interact: what are the key challenges and obstacles and what are some potential solutions, including strengths both sides bring to the table. The workshop presentations reflected on collaboration in four contexts: payment reform, the Million Hearts initiative, hospital – public health collaboration, and asthma control.

Because of the nature of the communities they serve and the work they do, Pennsylvania safety-net hospitals are often important parts of public health efforts throughout the commonwealth.
Find the IOM report Collaboration between Health Care and Public Health: Workshop Summary here.

PA Safety Net Admin2015-07-01T06:00:05+00:00July 1st, 2015|Uncategorized|Comments Off

Feds Propose New Medicaid Managed Care Regs

The Centers for Medicare & Medicaid Services (CMS) has proposed its first major changes in regulations governing Medicaid managed care in more than a decade.
In a 653-page draft regulation published on Monday, CMS proposes imposing a medical-loss ratio on Medicaid managed care plans; establishing new standards for adequate provider networks; partially lifting the ban on payments to institutions for mental diseases; pursuing greater transparency in rate-setting; and new quality initiatives that mirror those of Medicare and the federal marketplace.
In addition, the proposed regulation calls for new marketing guidelines for Medicaid managed care plans, improved access to information for Medicaid beneficiaries, and new program integrity measures. It also proposes better aligning the governance of CHIP with Medicaid, new requirements for managed long-term services and supports, and new tools for fostering delivery system reform at the state level.
With virtually all Medicaid recipients in Pennsylvania now enrolled in managed care plans, this regulation will be significant for the state’s safety-net hospitals.
Interested parties have until July 27 to submit comments to CMS about the proposals.
To learn more about this major regulatory proposal, see this Kaiser Health News article; find the regulation here; and see this CMS fact sheet on the draft regulation.

PA Safety Net Admin2015-05-28T06:00:35+00:00May 28th, 2015|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

Post-Mortem on the Medicaid Primary Care Fee Bump

The Affordable Care Act required state Medicaid programs to raise their fees for primary care services to the same level as Medicare rates, with the federal government shouldering the full cost of the difference. The rationale for the increase was that with millions of additional Americans expected to enroll in Medicaid in the coming years, a rate increase would encourage more primary care physicians to serve Medicaid patients because historically, many choose not to do so because of what they believe to be inadequate payments.
That two-year Medicaid primary care fee bump ended on December 31, 2014. Sixteen states and the District of Columbia felt the increase was beneficial enough to extend it using their own resources. Pennsylvania is not among the states that continued paying the enhanced rates.
The question of whether the fee increase accomplished its objective and is worth re-establishing remains unanswered. The brief nature of the experiment – only two years – and the delays many states experienced before they started paying the enhanced rates left little time for meaningful research. One quantitative analysis suggests the rate increase helped, there have been several more qualitative approaches to research, and some studies remain under way.
Because they care for so many more Medicaid patients than the typical hospital, the adequacy of Medicaid payments has long been of special concern to Pennsylvania safety-net hospitals.
For a closer look at the Affordable Care Act’s Medicaid primary care fee bump, how it worked, its impact, and its future, see the new health policy brief “Medicaid Primary Care Parity” here, on the web site of the journal Health Affairs.

PA Safety Net Admin2015-05-15T06:00:54+00:00May 15th, 2015|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

New 340B Rules Expected Soon

The federal Health Resources and Services Administration (HRSA) is expected to release new rules governing its section 340B prescription drug discount pricing program in the near future.
The new rules have long been in development and were in the verge of being published late last year when the agency decided to try another approach to addressing some of the program’s problems, but now, new draft guidelines are being reviewed by the White House Office of Management and Budget (OMB) in anticipation of being published soon in the Federal Register.
The 340B program, which provides discounts on prescription drugs to hospitals and others that serve large numbers of low-income patients, has encountered controversy in recent years with providers complaining about the lack of transparency in drug manufacturers’ prices and the manufacturers claiming that the program’s benefits are being extended to some patients who do not qualify for the assistance.
The 340B program is a vital resource for most Pennsylvania safety-net hospitals.
To learn more about the program and what might be expected when the new rules are proposed, see this CQ HealthBeat article presented by the Commonwealth Fund.

PA Safety Net Admin2015-05-13T06:00:39+00:00May 13th, 2015|Pennsylvania safety-net hospitals|Comments Off

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