Pennsylvania safety-net hospitals Archives - Page 16 of 21 - Safety-Net Association of Pennsylvania

MedPAC: Keep Paying More For Medicare Primary Care Services

The federal government should continue paying extra for primary care services provided to Medicare patients, Congress has been told by its chief advisor on Medicare payment policy.
According to the Medicare Payment Advisory Commission (MedPAC), the independent federal agency that advises Congress on Medicare payment matters, Medicare has long undervalued primary care services in comparison to specialty medical care, and in 2010 the Affordable Care Act introduced a ten percent bonus for primary care services provided to seniors through 2015.
With the expiration of that bonus coming in a little more than a year, MedPAC has told Congress it should seek to continue the practice but perhaps by making the additional payment on a per beneficiary basis rather than a per visit basis, to make such an approach part of the broader effort to discourage the volume provision of services and to encourage outcomes-oriented care.
In its June 2014 report to Congress, MedPAC also outlines how such a payment might work.
Pennsylvania’s safety-net hospitals all care for significant numbers of Medicare patients, including many low-income seniors.
Learn more about MedPAC’s overall recommendations, including this one involving Medicare primary care payments, in this MedPAC fact sheet. Find the entire MedPAC June 2014 report to Congress here.

PA Safety Net Admin2014-06-17T06:00:28+00:00June 17th, 2014|Affordable Care Act|Comments Off

Thousands in PA Await Word on Medicaid Eligibility

More than 60,000 Pennsylvanians are waiting to hear from the state about their application for Medicaid benefits.
The 60,000 are among more than 1.7 million people nation-wide who have applied for Medicaid are still waiting for a decision on their eligibility – some for as long as eight months.
More than half of those still waiting are in California while some live in states that, like Pennsylvania, have not expanded their Medicaid programs.
The delays have been attributed to problems transferring data received on the federal health insurance exchange to state governments, state programs overwhelmed with volume, technical problems in the states, and other reasons.
Many of those who still await word on their application for Medicaid benefits undoubtedly live in communities served by the state’s private safety-net hospitals.
Learn more about this problem, what is being done about it, and how it affects access to care in this Kaiser Health News article.

PA Safety Net Admin2014-06-10T06:00:52+00:00June 10th, 2014|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

Members of Congress Urge Delay in Medicare DSH Cuts

Fifty-eight members of the House of Representatives have written to House leadership asking them to delay the continued implementation of Affordable Care Act-mandated Medicare disproportionate share (Medicare DSH) cuts.
The letter, to House Speaker John Boehner and minority leader Nancy Pelosi, notes that

…hospitals that qualify for Medicare DSH are, by definition, the very providers caring for the greatest numbers of low-income and low-income elderly patients. In recent years, hospitals have incurred $270 billion in Medicare cuts, including reductions in their annual cost-of-living adjustments, penalties through Medicare’s value-based purchasing and readmissions reduction programs, reduced Medicare bad debt reimbursement, and continued cuts from sequestration. Medicare DSH cuts at this time could jeopardize the health care safety net that our constituents and yours need and deserve.

Medicare DSH payments are vital to most of Pennsylvania’s private safety-net hospitals.
Read the entire congressional letter here.

PA Safety Net Admin2014-06-05T06:00:07+00:00June 5th, 2014|Affordable Care Act|Comments Off

CMS to Examine How States Set Medicaid Managed Care Rates

The Centers for Medicare & Medicaid Services (CMS) is launching an initiative to explore how states set the rates they pay managed care organizations to serve Medicaid patients.
The initiative consists of two parts: first, CMS is examining the adequacy of the process states employ to set their rates – a process that affects the adequacy of the rates themselves; and second, it is drafting updated Medicaid managed care regulations.
Because Pennsylvania safety-net hospitals serve so many Medicaid patients, this effort could have a future impact on the payments they receive for serving these patients.
Learn more about this new undertaking in this Kaiser Health News report.

PA Safety Net Admin2014-05-29T06:00:25+00:00May 29th, 2014|Pennsylvania Medicaid policy|Comments Off

Study Points to Risk of DSH Cuts

A new study suggests that future cuts in Medicare disproportionate share (Medicare DSH) and Medicaid DSH payments could pose problems for hospitals that serve large numbers of uninsured patients.
According to a new report in the journal Health Affairs,

Such cuts in government funding of uncompensated care could pose challenges to some providers, particularly in states that have not adopted the Medicaid expansion or where implementation of health care reform is proceeding slowly.

Medicare DSH and Medicaid DSH payments help underwrite the uncompensated care hospitals provide to their uninsured patients. These payments are a vital source of revenue for Pennsylvania’s safety-net hospitals and Pennsylvania is among the states that have not yet adopted Medicaid expansion.
Even after Affordable Care Act reforms take effect, 25 to 30 million Americans are expected to remain uninsured. Medicare DSH payments are expected to decline $22.1 billion between now and 2019 and Medicaid DSH payments, temporarily delayed by two separate actions of Congress, are expected to decline $17.1 billion through 2020.
Learn more about the Health Affairs study in this Washington Post article and find the study itself here, on the web site of Health Affairs.

PA Safety Net Admin2014-05-07T06:00:01+00:00May 7th, 2014|Affordable Care Act, Health care reform, Pennsylvania Medicaid policy|Comments Off

PA Recoups Tobacco Money in Court Ruling

A Philadelphia court has restored $120 million of Pennsylvania’s share of the annual proceeds from the master settlement that tobacco manufacturers entered into with state governments in 1998.
Last year, an arbitration panel ruled that Pennsylvania had failed to enforce selected tax collection requirements properly and reduced the state’s share of the settlement proceeds by $180 million. The state appealed the ruling, and last week the court restored $120 million of the $180 million reduction mandated by the arbitration panel.
Pennsylvania uses the proceeds of the tobacco settlement for a number of purposes, including to make Tobacco Uncompensated Care Fund payments to hospitals that serve especially large numbers of uninsured patients and to underwrite clinical, health services, and biomedical research under the state’s Commonwealth Universal Research Enhancement Program (CURE).
Tobacco Uncompensated Care Fund payments are a vital source of support for many Pennsylvania safety-net hospitals.
Learn more about the tobacco funding issue, the court’s ruling, and the implications of that ruling in this Allentown Morning Call article.

PA Safety Net Admin2014-04-15T06:00:29+00:00April 15th, 2014|Medicaid supplemental payments|Comments Off

Bill in Congress Would Benefit PA Safety-Net Hospitals

New legislation introduced in Congress would add a risk adjustment component to Medicare’s hospital readmissions reduction program.
Such a measure would benefit Pennsylvania’s safety-net hospitals.
H.R. 4188, the Establishing Beneficiary Equity in the Hospital Readmission Program Act, proposes modifying Medicare’s hospital readmissions reduction program. Under the bill, hospitals’ performance in preventing Medicare readmissions would be risk-adjusted for patients who are dually eligible for Medicare and Medicaid; for patients who are considered non-compliant; for patients whose readmission has been classified as based on psychosis or substance abuse; and for patients who have specific medical conditions.
Hospitals found to have too many Medicare readmissions suffer financial penalties under Medicare’s hospital readmissions reduction program. Recent studies suggest that in its current form, the program unfairly targets safety-net hospitals for financial penalties.
Learn more about the bill from this news release from its sponsor, Rep. James Renacci (R-Ohio), or find the bill itself here.

PA Safety Net Admin2014-03-17T06:00:07+00:00March 17th, 2014|Uncategorized|Comments Off

Increase Use of Value-Based Purchasing, HHS Told

A study performed for the U.S. Department of Health and Human Services calls for greater use of value-based purchasing in federal health care reimbursement policy.
The study, performed by the RAND Corporation, recommends developing a national value-based purchasing strategy; developing a more deliberate approach to evaluating the effectiveness of value-based purchasing efforts; and developing performance measures that support value-based purchasing approaches.
Such an approach could be a major challenge for Pennsylvania’s safety-net hospitals, according to a Harvard School of Public Health analysis that found that in the first year of Medicare’s value-based purchasing program, hospitals that served the largest numbers of low-income patients suffered the largest financial penalties from that program.
Read more about the RAND study in this Fierce Healthcare story and find the RAND study itself here. Read another Fierce Healthcare article about the impact of value-based purchasing on safety-net hospitals here.

PA Safety Net Admin2014-03-11T06:00:25+00:00March 11th, 2014|Uncategorized|Comments Off

CMS Offers Advice on Managing Expected Upsurge in ER Visits

With Medicaid enrollment rising because of eligibility changes introduced through the Affordable Care Act, hospital emergency rooms expect to see an increase in the number of emergency room visits as new Medicaid enrollees seek care for long-neglected health problems.
In anticipation of this rise in ER visits, the Centers for Medicare & Medicaid Services (CMS) has issued an informational bulletin with suggestions for hospitals on how to manage the expected increase in ER utilization.
Among CMS’s suggestions are for hospitals to broaden access to primary care services (because much of the increased utilization will be because the newly insured still do not know where to turn for care); focus on helping especially frequent ER visits find more appropriate sources of care; and target the needs of people with behavioral health problems.
This influx of new ER patients will pose a challenge for Pennsylvania’s safety-net hospitals because even though the state has not expanded its Medicaid eligibility criteria as provided for in the Affordable Care Act, other reform-related measures should result in some increase in the state’s Medicaid population.
To learn more about CMS’s recommendations for addressing this ER challenge, including some of the legal and reimbursement-related challenges this will pose, see the CMS informational bulletin “Reducing Nonurgent Use of Emergency Departments and Improving Appropriate Care in Appropriate Settings.”

PA Safety Net Admin2014-01-24T06:00:53+00:00January 24th, 2014|Affordable Care Act|Comments Off

Safety-Net Hospitals Hurt More by Readmissions Reduction Program

Hospitals that care for large numbers of low-income seniors are disproportionately harmed by Medicare’s hospital readmissions reduction program, according to a new study.
According to the study,

Both patient dual-eligible status and a hospital’s dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations.

Because they care for so many more low-income patients than the typical hospital, Pennsylvania’s safety-net hospitals are especially vulnerable to the Medicare hospital readmissions reduction program’s financial penalties.
The study, “The Medicare Hospital Readmissions Reduction Program: Potential Unintended Consequences for Hospitals Serving Vulnerable Populations,” was published recently in Health Services Research and can be found here.

PA Safety Net Admin2014-01-22T06:00:20+00:00January 22nd, 2014|Affordable Care Act|Comments Off

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