Pennsylvania safety-net hospitals Archives - Page 12 of 20 - Safety-Net Association of Pennsylvania

Congress Mulls Another Medicare Doc Fix

With a March 31 deadline looming before Medicare payments to physicians are scheduled to decline more than 20 percent, it appears Congress may be considering permanent repeal of the underlying root of the problem rather than yet another short-term patch.
At the heart of the problem is the sustainable growth rate formula, or SGR, that determines how Medicare pays physicians. For years Congress has applied short-term solutions to the SGR problem and paid for those solutions with short-term spending cuts. Now it appears congressional leaders are contemplating a permanent repeal of the troublesome formula.
The cost of doing so is about $175 billion for ten years, and Congress reportedly is considering cuts in both benefits and provider payments.
Because many Pennsylvania safety-net hospitals own physician practices, this issue is very important to them.
The Wall Street Journal has taken a closer look at this matter, examining the issue, the stakes, and both the policy and the political challenges congressional negotiators now face. See its report here.

PA Safety Net Admin2015-03-17T06:00:59+00:00March 17th, 2015|Uncategorized|Comments Off

Congress to Consider Adding Risk Adjustment to Medicare Readmissions Program

A new bill introduced in Congress last week would require Medicare to consider the socio-economic status of the patients individual hospitals serve as part of its hospital readmissions reduction program.
The Establishing Beneficiary Equity in the Hospital Readmissions Program Act of 2015 was introduced as S. 688 in the Senate, sponsored by Senators Rob Portman (R-OH) and Joe Manchin (D-WV), and in the House by Representatives Jim Renacci (R-OH) and Eliot Engel (D-NY) as H.R. 1343.
Rep. Renacci introduced a similar measure last year. This year’s version has bipartisan sponsorship in both the House and Senate.
Since the launch of Medicare’s readmissions reduction program several years ago, a number of studies have suggested that the program is unfair to hospitals that serve especially large numbers of low-income patients. The new proposal seeks to address that unfairness.
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 this proposal, see this news release announcing the bill. Find the bill itself here.

PA Safety Net Admin2015-03-16T06:00:53+00:00March 16th, 2015|Uncategorized|Comments Off

SNAP Looks to the Future

With the inauguration of a new governor and the start of a new legislative session, the Safety-Net Association of Pennsylvania (SNAP) has prepared a series of four papers for leaders of the new Wolf administration and legislative and committee leaders and staff.
The fourth of those papers, released this week, addresses the importance of innovation in addressing the challenges safety-net hospitals face in leading the way to serving Pennsylvania’s growing Medicaid population.
The paper describes the new demands being made of hospitals by insurers, government, and others; tools through which to pursue innovation; the goals of future innovation; and the role that SNAP and safety-net hospitals must play in that innovation.
The first paper, “What is SNAP?”, was an introduction to the Safety-Net Association of Pennsylvania: what safety-net hospitals are, where they are located, whom they serve, and how they differ from other acute-care hospitals in the state.
The second paper, “The Challenges Pennsylvania Safety-Net Hospitals Face,” describes the special role safety-net hospitals play in serving low-income and medically vulnerable Pennsylvanians and the emerging challenges they face in fulfilling this vital role.
The third paper, “Transitioning Medicaid: Principles for Changing Course on Medicaid Expansion,” presents eight principles SNAP believes state officials should follow if they choose to abandon the Healthy Pennsylvania model of Medicaid expansion in favor of a more traditional approach to expanding the state’s Medicaid expansion.
Find all four SNAP papers here.

PA Safety Net Admin2015-02-12T10:43:14+00:00February 12th, 2015|Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off

Millions Live in ACA Coverage Gap

Nearly four million people who were supposed to be helped to health insurance through the Affordable Care Act remain uninsured today because they earn too much to qualify for Medicaid and not enough to qualify for the reform law’s health insurance subsidies.
When the law was passed in 2010, it was supposed to provide Medicaid coverage for those earning up to 138 percent of the federal poverty level and offer subsidies to other low-income earners. But when the Supreme Court made the reform law’s mandatory Medicaid expansion optional for states and some states chose not to expand their Medicaid programs, nearly four million people found themselves wedged between eligibility for Medicaid and eligibility for subsidies, with no help forthcoming.
Among the four million, more than half work at least part-time and two-thirds reside in a household with at least one wage-earner. Most work for small companies that are not required to provide health insurance for their employees and many earn the minimum wage. Many are single adults.
The coverage gap has been a problem in Pennsylvania, which until recently did not expand its Medicaid program. As a result, many people who fell into this gap turned to the state’s safety-net hospitals when they needed care but had no health insurance.
The Washington Post has taken a look at the challenges these low-income and often medically vulnerable people face living in states that have chosen not expanded their Medicaid programs. See its report here.

PA Safety Net Admin2015-01-26T06:00:19+00:00January 26th, 2015|Affordable Care Act, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

The Challenges Facing Pennsylvania’s Safety-Net Hospitals

With the arrival of a new governor and the start of a new legislative session, the Safety-Net Association of Pennsylvania (SNAP) has prepared a series of four papers for leaders of the new Wolf administration and legislative and committee leaders and staff.
The second of those four papers describes the major health care and health policy challenges safety-net hospitals face. Those challenges include:

the distinct patients safety-net hospitals serve
inadequate payments for Medicaid services
the large numbers of uninsured and underinsured patients safety-net hospitals serve
threats to vital state Medicaid supplemental payments, such as Medicaid disproportionate share payments (Medicaid DSH
continuing change and reform in the health care system, including the delivery of care and how safety-net hospitals are paid for their services

The first paper, “What is SNAP?”, was an introduction to the Safety-Net Association of Pennsylvania: what safety-net hospitals are, where they are located, whom they serve, and how they differ from other acute-care hospitals in the state.
Find both SNAP papers here.

PA Safety Net Admin2015-01-23T06:00:07+00:00January 23rd, 2015|Safety-Net Association of Pennsylvania|Comments Off

Will High Court Help Pave the Way to Higher Medicaid Payments?

In a case that could have nation-wide implications for health care providers, the U.S. Supreme Court will hear an appeal of a lower court decision that ordered the state of Idaho to raise Medicaid payments to providers serving the developmentally disabled because the state’s payments were too low.
While litigants in some states have used the courts in recent years to seek redress for what they believed were inadequate Medicaid payments, Supreme Court action on that matter could have national implications: if the court supports the state of Idaho’s appeal of the order to raise fees it could limit the use of litigation in the future as a means of increasing payments and improving access to care for the Medicaid population. If, on the other hand, the court rejects the Idaho appeal, it could potentially open the door to more such litigation, especially in states with Medicaid payments that do not even cover the cost of services providers deliver.
The outcome of this case will be of special interest to Pennsylvania’s safety-net hospitals because the state still underpays hospitals for much of the care they provide to their Medicaid patients.
To learn more about the Idaho case, similar litigation elsewhere, and the implications of the case about to go before the Supreme Court, see this Kaiser Health News report.

PA Safety Net Admin2015-01-14T06:00:35+00:00January 14th, 2015|Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

Unemployment Plays Major Role in Hospital Readmissions

A new study has found that employment status is the leading socioeconomic indicator of hospital readmissions for patients who have suffered heart attacks, heart failure, and pneumonia.
Using 2011 and 2012 data from the Centers for Medicare & Medicaid Services, researchers examined readmissions for these conditions based on nine factors that constitute what is known as the Community Needs Index: elderly poverty, single parent poverty, child poverty, lack of health insurance, minority, no high school, renting, unemployment, and limited English. Their analysis found that only employment status and lack of high school education were statistically significant predictors of hospital readmissions for the three conditions studied, with employment status more than three times as powerful an indicator as lack of high school education.
High unemployment is typically a major problem in the communities served by Pennsylvania safety-net hospitals.
Learn more about the study in this Fierce Healthcare report and see the study itself here.

PA Safety Net Admin2014-12-19T06:00:57+00:00December 19th, 2014|Uncategorized|Comments Off

PA Medicaid Primary Care Fees to Plummet

Payments to Pennsylvania primary care physicians who serve Medicaid patients will fall 52.4 percent after the first of the year, when the Affordable Care Act’s two-year increase in those payments ends.
The temporary fee increase was included in the Affordable Care Act to encourage more primary care physicians to serve Medicaid patients in anticipation of the significant growth of Medicaid as a result of the reform law’s Medicaid expansion. Under that law, Medicaid primary care fees were raised to the level of Medicare primary care rates for two years. Nation-wide, the average Medicaid primary care fee will fall 42.8 percent.
So far, 15 states plan to use their own money to prevent the dramatic reduction of Medicaid primary care payments. Pennsylvania is not among them.
The cut will be especially damaging to the state’s safety-net hospitals because they serve so many more Medicaid patients than the typical hospital and expect to serve even more such patients when the state’s Medicaid program expands beginning on January 1.
Learn more about the upcoming Medicaid payment cut in the new Urban Institute report Reversing the Medicaid Fee Bump: How Much Could Medicaid Physician Fees for Primary Care Fall in 2015?, which you can find here, on the Urban Institute’s web site.

PA Safety Net Admin2014-12-17T06:00:15+00:00December 17th, 2014|Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

Access to Primary Care a Medicaid Problem, HHS OIG Says

Many of the primary care providers that participate in Medicaid managed care programs are inaccessible to those plans’ members, according to a new report by the U.S. Department of Health and Human Services’ Office of the Inspector General (OIG).
As states’ Medicaid rolls grow and they direct more of their Medicaid beneficiaries into managed care plans, those beneficiaries may be encountering difficulty converting their access to health insurance into access to health care.
According to the OIG report Access to Care: Provider Availability in Medicaid Managed Care,

We found that slightly more than half of providers could not offer appointments to enrollees. Notably, 35 percent could not be found at the location listed by the plan, and another 8 percent were at the location but said that they were not participating in the plan. An additional 8 percent were not accepting new patients. Among the providers who offered appointments, the median wait time was 2 weeks. However, over a quarter had wait times of more than 1 month, and 10 percent had wait times longer than 2 months. Finally, primary care providers were less likely to offer an appointment than specialists; however, specialists tended to have longer wait times.

In response to these problems, the OIG recommended that the Centers for Medicare & Medicaid Services (CMS) work with states to

… (1) assess the number of providers offering appointments and improve the accuracy of plan information, (2) ensure that plans’ networks are adequate and meet the needs of their Medicaid managed care enrollees, and (3) ensure that plans are complying with existing State standards and assess whether additional standards are needed.

Pennsylvania’s safety-net hospitals will need to monitor this situation closely in the coming months as the state’s Medicaid expansion begins, bringing as many as 600,000 new beneficiaries into the program.
See the complete OIG report here.

PA Safety Net Admin2014-12-15T06:00:51+00:00December 15th, 2014|Healthy PA, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

Residents of Disadvantaged Neighborhoods More Likely to Require Readmission

Medicare beneficiaries living in the most disadvantaged neighborhoods are more likely than others to require readmission to the hospital for problems associated with congestive heart failure, pneumonia, or myocardial infarction.
This is one of the findings in a new Annals of Internal Medicine study titled “Neighborhood Socioeconomic Disadvantage and 30-Day Rehospitalization: A Retrospective Cohort Study.”
The study, based on data from 2004 through 2009, compared Medicare readmission rates in different geographic areas using what is called a validated area deprivation index that measures relative socioeconomic disadvantage to identify the most disadvantaged areas. Researchers concluded that

The 30-day rehospitalization rate did not vary significantly across the least disadvantaged 85% of neighborhoods, which had an average rehospitalization rate of 21%. However, within the most disadvantaged 15% of neighborhoods, rehospitalization rates increased from 22% to 27% with worsening ADI.

These findings document the special challenges Pennsylvania’s private safety-net hospitals face in serving some of the most disadvantaged communities in the state.
Find the study here, on the web site of the Annals of Internal Medicine.

PA Safety Net Admin2014-12-12T06:00:34+00:00December 12th, 2014|Uncategorized|Comments Off

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