Pennsylvania safety-net hospitals Archives - Page 14 of 20 - Safety-Net Association of Pennsylvania

MACPAC Looks at Medicaid, CHIP Issues

The non-partisan federal agency charged with advising Congress, the Department of Health and Human Services, and the states on matters involving Medicaid and the Children’s Health Insurance Program (CHIP) met last week in Washington, D.C.
The Medicaid and CHIP Payment and Access Commission (MACPAC) addressed a number of CHIP-related issues during its September 18-19 meetings, including the future of the program, its funding, state experiences with CHIP changes, and consumer protections.
MACPAC also looked at a variety of Medicaid issues, including state Medicaid expansions through premium assistance, enrollment so far in 2014, the Centers for Medicare & Medicaid Services’ Medicaid program integrity plan, early experiences of new enrollees, and future reductions in Medicaid disproportionate share payments (Medicaid DSH).
CHIP and Medicaid are especially important for Pennsylvania’s safety-net hospitals because they serve so many low-income patients. Those hospitals also are very concerned about future reductions in Medicaid DSH payments.
For a summary of the commission’s deliberations, see this CQ HealthBeat article presented by the Commonwealth Fund.
To see the presentations made during the two-day session go here, to MACPAC’s web site.

PA Safety Net Admin2014-09-23T06:00:28+00:00September 23rd, 2014|Uncategorized|Comments Off

Medicaid Patients are High Users But Not Abusers of ER Services, Report Says

Medicaid patients use hospital emergency rooms more frequently than privately insured and uninsured patients but are not overusing or abusing ER services.
So says the Medicaid and CHIP Payment and Access Commission (MACPAC) in a recent report that contradicts the widely held belief that Medicaid patients abuse hospital ER services.
According to “Revisiting Emergency Department Use in Medicaid,” “Higher ED use among Medicaid enrollees is explained mostly by the higher rates and more severe cases of chronic disease and disability they experience relative to those who are privately insured and uninsured.”
In addition, MACPAC found, “High ED use also can be a sign of poor access to primary, specialty, dental, and outpatient mental health care in other settings.” In 2012, for example, “…about one in four adult Medicaid enrollees who reported a recent visit to the ED went there because of difficulty accessing another provider, not because of a serious health problem.”
MACPAC also concluded that “The majority of ED visits by non-elderly Medicaid patients are for urgent symptoms and serious medical problems that require prompt medical attention…Non-urgent visits account for just 10 percent of all Medicaid-covered ED visits for non-elderly patients, a proportion comparable to that of privately insured patients.”
Pennsylvania’s safety-net hospitals serve far more Medicaid patients than the typical acute-care hospital and therefore face far greater challenges in meeting these patients’ needs.
Learn more about MACPAC’s findings in “Revisiting Emergency Department Use in Medicaid,” which can be found here.

PA Safety Net Admin2014-09-02T06:00:03+00:00September 2nd, 2014|Uncategorized|Comments Off

Charity Care? Wait a Minute

Many hospitals are considering whether they should continue to provide charity care to people who were eligible for Affordable Care Act subsidies to purchase health insurance but chose instead to remain uninsured.
The issue for many is whether the availability of charity care is an inducement for some people not to purchase health insurance and whether such patients are unwilling or unable to pay for care.
Some hospitals have decided not to provide non-emergency charity care to those who chose not to purchase subsidized health insurance. Others are currently considering whether they need to revise their approach to charity care. Still others have decided that they will not change their charity care policies.
Charity care is an especially critical issue for the state’s safety-net hospitals because they serve so many more low-income and uninsured patients than the typical Pennsylvania hospital.
Learn more about this latest phase in the evolution of charity care and how hospitals are approaching it in this Kaiser Health News report.

PA Safety Net Admin2014-08-28T06:00:40+00:00August 28th, 2014|Affordable Care Act|Comments Off

IOM Releases Graduate Medical Education Report

‘’…there is an unquestionable imperative to assess and optimize the effectiveness of the public’s investment in GME (graduate medical education).”
So says the Institute of Medicine (IOM) in its new report Graduate Medical Education That Meets the Nation’s Health Needs.
The IOM also calls for “significant changes to GME financing and governance to address current deficiencies and better shape the physician workforce for the future.”
The report notes that government today, mostly through Medicare, plays the primary role in financing graduate medical education. It observes that while there is a common perception that the nation faces a shortage of physicians, simply increasing the number of residency slots that Medicare supports – a limit set in 1997 – without addressing geographic and specialty distribution issues will not solve the problem.
In the report, the IOM proposes six goals for improving GME financing.

Encourage production of a physician workforce better prepared to work in, help lead, and continually improve an evolving health care delivery system that can provide better individual care, better population health, and lower cost. 
Encourage innovation in the structures, locations, and designs of GME programs to better achieve Goal 1. 
Provide transparency and accountability of GME programs, with respect to the stewardship of public funding and the achievement of GME goals. 
Clarify and strengthen public policy planning and oversight of GME with respect to the use of public funds and the achievement of goals for the investment of those funds. 
Ensure rational, efficient, and effective use of public funds for GME in order to maximize the value of this public investment. 
Mitigate unwanted and unintended negative effects of planned transitions in GME funding methods.

To fulfill these goals, the report offers three specific recommendations:

Investing strategically: Maintain Medicare GME funding at its current level, but modernize payment methods to reward performance, ensure accountability, and incentivize innovation in the content and financing of GME. The current Medicare GME payment system should be phased out. 
Building an infrastructure to facilitate strategic investment: Establish a two-part governance infrastructure for federal GME financing. A GME Policy Council in the Office of the Secretary of the Department of Health and Human Services should oversee policy development and decision making. A GME Center within the Centers for Medicare & Medicaid Services should function as an operations center with the capacity to administer payment reforms and manage demonstrations of new payment models. 
Establishing a two-part Medicare GME fund: Allocate Medicare GME funds to two distinct subsidiary funds—a GME Operational Fund to finance ongoing residency training activities and a Transformation Fund to finance development of new programs, infrastructure, performance methods, payment demonstrations, and other priorities identified by the GME Policy Council.

Graduate medical education is an important issue for the Pennsylvania safety-net hospitals that also are teaching hospitals. The state’s Medicaid program is an important source of medical education funding for these hospitals as well.
To learn more about why the study was undertaken, what problems it sought to address, what the IOM learned, and what it proposed, follow this link to the IOM’s web site and the complete report as well as a report summary.

PA Safety Net Admin2014-08-01T06:00:22+00:00August 1st, 2014|Pennsylvania Medicaid policy|Comments Off

Group to Assess Impact of Socioeconomic Factors on Care

The National Quality Forum (NQF) will perform a “robust trial” to assess the role and impact of sociodemographic factors on health care outcomes.
In a news release, the NQF announced that

Sociodemographic factors can be socioeconomic, e.g., income, education, and occupation, and demographic, e.g., race, ethnicity, and primary language. Growing evidence shows that sociodemographic factors may influence patient outcomes, which has implications for comparative performance measurement used in pay-for-performance programs.

Among the socioeconomic and sociodemographic factors the NQF will consider are income, education, and occupation, and demographic considerations such as race, ethnicity, and primary language.
With the Affordable Care Act requiring Medicare to adjust payments based on outcomes such as hospital readmissions, value-based purchasing requirements, hospital-acquired conditions, and more, reviews of the preliminary results of such programs have led some to question whether hospitals that serve especially large numbers of low-income patients – like Pennsylvania’s safety-net hospitals – may be especially and unfairly harmed by such programs.
Learn more about the NQF plan for a new study from this news release and find a link to further information about the planned study as well.

PA Safety Net Admin2014-07-25T06:00:35+00:00July 25th, 2014|Affordable Care Act|Comments Off

Protect Uncompensated Care Payments, SNAP Tells State Officials

Although only 25 percent of the state’s acute-care hospitals, Pennsylvania’s private safety-net hospitals account for 45 percent of the $1 billion in uncompensated care those hospitals provide to uninsured Pennsylvanians every year.
And now, as the governor and legislature consider the state’s FY 2015 budget, the Safety-Net Association of Pennsylvania is urging those officials to preserve state payments that help qualified hospitals with those uncompensated care costs and enable them to continue constituting the core of Pennsylvania’s health care safety net.
Tobacco Uncompensated Care Fund payments are supplemental state payments to hospitals that provide significant amounts of uncompensated care; they are underwritten by proceeds from the national master tobacco settlement of 1998 and matched by the federal government. As lawmakers work on the state’s FY 2015 budget, SNAP is urging them to expend available FY 2014 funding already authorized for this purpose and not to use FY 2015 tobacco settlement funding for any purpose other than what was prescribed in Act 71 of 2013.
These views and background information on the role private safety-net hospitals play in caring for low-income, Medicaid-covered, and uninsured Pennsylvanians are addressed in a new SNAP position paper, “The Importance of Preserving Uncompensated Care Payments.” Find that position paper here.

PA Safety Net Admin2014-06-27T06:00:37+00:00June 27th, 2014|Pennsylvania Medicaid policy, Pennsylvania state budget issues|Comments Off

PA Safety-Net Hospitals Mean Jobs

While providing most of the care to Pennsylvania’s Medicaid and uninsured populations, the state’s 41 private safety-net hospitals also employ more people than other hospitals and pay better wages than most employers.
They also are among the biggest employers in their communities, drive local economic development, and generate millions in local and state tax revenue.
As state lawmakers consider Pennsylvania’s FY 2015 budget, the Safety-Net Association of Pennsylvania urges them to preserve adequate funding for the state’s Medicaid program so these hospitals can continue their work serving Pennsylvanians in need and functioning as one of the state’s major economic engines.
Read more about the outsized role private safety-net hospitals play in Pennsylvania’s health care safety net and its economy in the new SNAP paper “Pennsylvania Safety-Net Hospitals: Economic Engines Driving Pennsylvania Communities,” which can be found here.

PA Safety Net Admin2014-06-26T06:00:56+00:00June 26th, 2014|Pennsylvania state budget issues, Safety-Net Association of Pennsylvania|Comments Off

340B Program Under the Microscope

Federal officials continue to cast a wary eye on a program that gives discounts on prescription drugs to hospitals that care for large numbers of low-income patients.
The federal 340B Prescription Drug Program requires drug manufacturers to give discounts to eligible providers for the prescriptions they provide patients on an outpatient basis; the hospitals then provide their low-income patients with their prescriptions at a discount or free of charge. The program has grown a great deal in recent years and now, critics argue that some hospitals that currently receive the discounts should not qualify for them and others are not reinvesting the savings the program generates in care for low-income patients.
Hospitals, meanwhile, note that program savings enable them to fund clinics and otherwise unaffordable programs and services and help them absorb the cost of uncompensated care.
The controversy has drawn congressional interest, and the federal agency that administers the program, the Health Resources and Services Administration, was expected to produce new guidelines governing eligibility and the use of prescription drug discounts. Those guidelines have been delayed in the wake of a federal court ruling involving orphan drug sales that has called into question the agency’s regulation-issuing authority.
Most Pennsylvania safety-net hospitals participate in the program.
Learn more about the 340B Prescription Drug Program, its growth in recent years, the concerns raised about it amid that growth, and what to expect next in this Kaiser Health News article.

PA Safety Net Admin2014-06-25T06:00:32+00:00June 25th, 2014|Uncategorized|Comments Off

SNAP Speaks Out on PA Budget Issues

In a series of three new position papers, the Safety-Net Association has laid out the case for why Pennsylvania needs to fund its Medicaid program adequately in the state’s upcoming 2015 fiscal year.
The first paper, “Pennsylvania Safety-Net Hospitals: Economic Engines Driving Pennsylvania Communities,” documents the degree to which safety-net hospitals not only provide significant numbers of jobs but also offer higher wages than other hospitals and other Pennsylvania employers.
The second paper, “The Importance of Preserving Uncompensated Care Payments,” notes that Pennsylvania’s safety-net hospitals, just 25 percent of the state’s acute-care hospitals, provide nearly 50 percent of the $1 billion worth of uncompensated care hospitals in the state provide every year. The state helps underwrite some of those costs through Tobacco Uncompensated Care fund payments – proceeds of the national tobacco settlement of 1998 – but that funding is now in jeopardy.
And the third paper, “The Need for Stable and Predictable Funding Amid Increasing Challenges,” outlines the enormous and at times conflicting pressures that government and others are exerting on hospitals and explains that while safety-net hospitals look forward to these challenges, they need stable and predictable Medicaid funding to help them rise to the occasion.
SNAP issues these papers as lawmakers in Pennsylvania struggle with an FY 2014 revenue shortfall of more than $500 million and an anticipated shortfall of another $880 million in the coming 2015 fiscal year.
See SNAP’s three new position papers here.

PA Safety Net Admin2014-06-20T06:00:20+00:00June 20th, 2014|Pennsylvania Medicaid policy, Pennsylvania state budget issues, Safety-Net Association of Pennsylvania|Comments Off

Stop Hurting Hospitals That Serve the Poor, HHS Told

Medicare’s hospital readmissions reduction program is unfairly penalizing hospitals that serve especially large numbers of low-income patients, 34 members of Congress have written in a letter to recently appointed Health and Human Services Secretary Sylvia Mathews Burwell and Centers for Medicare & Medicaid Services (CMS) administrator Marilyn Tavenner.
The letter, sponsored by Rep. James Renacci (R-Ohio), notes that while the program has

…incentivized hospitals to reduce readmissions, there are some factors outside of a hospital’s control that make it difficult for the patient to avoid readmission. The current penalty methodology…has created an unintended consequence for hospitals that service our most vulnerable populations – dual-eligible beneficiaries; low-income seniors, or people with disabilities that are eligible for both Medicare and Medicaid.

The letter also notes financial penalties imposed by the program “jeopardizes the viability of hospitals that service our nation’s most vulnerable population” and that H.R. 4188, the Establishing Beneficiary Equity in the Hospital Readmissions Program,

…adjusts the penalty methodology for hospitals servicing larger amounts of dual-eligible beneficiaries and excludes patients with certain extenuating circumstances from the penalty calculations. Adjusting the penalty to account for certain disparities in patient population can make a big difference to hospitals across the country and the nine million dually-eligible beneficiaries that rely on these hospitals for their critical care needs.

Pennsylvania’s safety-net hospitals are among those hurt by the program in its current form.
Read the House letter to Secretary Burwell and Administrator Tavenner here.

PA Safety Net Admin2014-06-19T06:00:16+00:00June 19th, 2014|Uncategorized|Comments Off

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