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

No-Hospitalization Group Plans To Be Banned

Companies will no longer be able to provide their employees with group health insurance plans that do not cover inpatient hospitalization.
This news came in a recent notice published by the Internal Revenue Service.
Recently, many large employers with lower-wage workers were purchasing low-cost health insurance that does not cover hospitalization. The IRS, however, has ruled that such plans do not meet the Affordable Care Act’s minimum value threshold. Companies were only able to purchase such plans because they are not required meet the reform law’s essential health benefits package requirement, which applies only to plans offered to individuals on health insurance exchanges.
The no-hospitalization policies were likely to leave many lower-income workers without the coverage they needed – and with large medical bills. They also were likely to leave hospitals with unexpected uncompensated care. This could have proven especially challenging for Pennsylvania safety-net hospitals because they serve larger numbers of lower-income workers than the typical hospital.
The administration is permitting employers that committed to such plans by November 4 to use them for one year and is offering affected workers access to premium subsidies that some of those workers did not otherwise have if they choose to purchase insurance on an exchange instead.
The IRS will issue regulations formalizing this policy next year.
To learn more about this issue and its implications for large businesses, low-wage workers, and hospitals, see this Kaiser Health News report. Go here to see the IRS notice.

PA Safety Net Admin2014-11-11T06:00:31+00:00November 11th, 2014|Affordable Care Act|Comments Off

Medicaid Directors Weigh in On Managed Care Regulation

The nation’s state Medicaid directors have offered their perspectives to the federal government on how to modernize and regulate state Medicaid managed care programs.
In a paper entitled “Medicaid Managed Care Modernization: Advancing Quality Improvement,” the National Association of Medicaid Directors urges the Centers for Medicare Services (CMS) to work with the states to develop quality reporting measures that are both useful and not overly burdensome.
The association also asks CMS to leave decisions about accrediting requirements for state Medicaid managed care programs in state hands and not to establish a national quality rating system for Medicaid managed care plans.
The regulation of Medicaid managed care plans is especially important to Pennsylvania safety-net hospitals because they care for so many Medicaid patients and managed care has become the primary means through which the state’s Medicaid program serves those patients.
Learn more about Medicaid directors’ recommendations for improving and regulating state Medicaid managed care programs in this National Association of Medicaid Directors correspondence with the Center for Medicaid and CHIP Services.

PA Safety Net Admin2014-10-27T06:00:19+00:00October 27th, 2014|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

Teaching Hospitals Pitch More Residencies

With the country facing a physician shortage and the number of medical residencies capped by the 1997 Balanced Budget Act (because Medicare and Medicaid provide the primary funding for the residencies), teaching hospitals need an additional 4000 residency slots a year.
This was the message conveyed recently to a gathering of congressional aides co-sponsored by the Association of American Medical Colleges.
This issue is of interest to Pennsylvania’s safety-net hospitals, some of which are teaching hospitals.
Such an increase would cost $10 billion over the next ten years.
Learn more about the case for more residency slots in this Kaiser Health News article.

PA Safety Net Admin2014-10-09T06:00:10+00:00October 9th, 2014|Uncategorized|Comments Off

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

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