Pennsylvania safety-net hospitals Archives - Page 8 of 21 - Safety-Net Association of Pennsylvania

Medicaid MCOs Skimping on Care?

Medicaid MCOs may be skimping on care, according to a recent Kaiser Health News report.

According to Kaiser, for-profit companies that sub-contract with Medicaid managed care organizations to review requests for services often deny care to Medicaid patients to save money for the MCOs that employ them and to benefit themselves financially.

The Kaiser article presents examples of companies that have been identified engaging in such practices, explains how they go about their work, and outlines the dangers to Medicaid recipients posed by such practices.

Because they serve so many more Medicaid patients than the typical hospital, Pennsylvania safety-net hospitals, their patients, and the communities they serve can be greatly affected by such practices.

Learn more in the Kaiser Health News article “Coverage Denied: Medicaid Patients Suffer As Layers Of Private Companies Profit.”

PA Safety Net Admin2019-01-09T15:54:59+00:00January 9th, 2019|Pennsylvania Medicaid, Pennsylvania safety-net hospitals|Comments Off

The Continued Need for Medicaid DSH

While the Affordable Care Act has greatly increased the number of Americans with health insurance and reduced the demand for uncompensated care from hospitals, many hospitals still see significant numbers of uninsured patients.
Some of those patients simply have not taken advantage of the health reform law’s creation of easier access to affordable insurance while others live in states that have not expanded their Medicaid programs.
Hospitals that care for especially large numbers of such uninsured patients qualify for Medicaid disproportionate share hospital payments, commonly referred to as Medicaid DSH. The purpose of these payments is to help these hospitals with the unreimbursed costs they incur caring for such patients.
The Affordable Care Act calls for reducing Medicaid DSH payments to hospitals. Many hospitals and hospital groups oppose this cut and are asking Congress to block its implementation. Pennsylvania’s safety-net hospitals benefit considerably from Medicaid DSH payments.
The Commonwealth Fund recently published a commentary calling for delaying scheduled Medicaid DSH cuts. Go here to see the article “Keep Harmful Cuts in Federal Medicaid Disproportionate Share Hospital Payments at Bay.”

PA Safety Net Admin2017-12-27T06:00:23+00:00December 27th, 2017|Affordable Care Act, Federal Medicaid issues, Medicaid supplemental payments|Comments Off

The Value-Based Payment Modifier: Program Outcomes and Implications for Disparities

Physicians who serve large numbers of low-income patients are more likely to incur penalties under Medicare value-based purchasing programs.
So concludes a new study in Annals of Internal Medicine.
According to the report,

Performance differences between practices serving higher- and those serving lower-risk patients were affected considerably by additional adjustments, suggesting a potential for Medicare’s pay-for-performance programs to exacerbate health care disparities.

This result is based on a study of the Medicare Value-Based Payment Modifier program, which no longer operates, but could have implications for other programs that seek to reward or penalize practitioners based on the outcomes they produce.
Such findings could lead practitioners to avoid serving such patients so they can avoid penalties, which in turn could jeopardize access to care in some communities. That, in turn, could have implications for Pennsylvania safety-net hospitals and the communities they serve.
Learn more about the study, its findings, and its implications by going here to see the Annals of Internal Medicine report “The Value-Based Payment Modifier: Program Outcomes and Implications for Disparities.”

PA Safety Net Admin2017-12-07T06:00:27+00:00December 7th, 2017|Medicare, Pennsylvania safety-net hospitals, Uncategorized|Comments Off

New Help With Addressing Low-Income Patients’ Social Services Needs?

One of the long-time barriers to states and hospitals addressing low-income patients’ social services needs and the social determinants of health has been a lack of resources for such assistance. Medicaid, in particular, has not been a financial participant in such efforts.
But that may be changing.
The new federal Medicaid managed care regulation, updated nearly two years ago, allows for the inclusion of some non-clinical services as covered Medicaid services and for funding for such services to be folded into Medicaid managed care plans’ capitation rates and medical loss ratios. The updated regulation also encourages greater coordination of care for Medicaid patients and coverage for long-term services and supports in the home and community for medically qualified patients.
Because they serve so many low-income patients, Pennsylvania safety-net hospitals are especially interested in policy changes that might enable them to serve such patients more effectively.
The Commonwealth Fund has taken a closer look at how the 2016 Medicaid managed care regulation may facilitate addressing the psycho-social needs of Medicaid beneficiaries. Go here to see its report “Addressing the Social Determinants of Health Through Medicaid Managed Care.”

PA Safety Net Admin2017-12-05T06:00:32+00:00December 5th, 2017|Federal Medicaid issues, Pennsylvania safety-net hospitals|Comments Off

CMS Guidance on MCO Payments is Good News for PA Hospitals

New guidance from the Centers for Medicare & Medicaid Services on the use of directing additional Medicaid resources to hospitals through Medicaid managed care organizations is good news for Pennsylvania safety-net hospitals.
Such payments have been routed through the state’s Medicaid managed care plans for several years, but as the state and hospital industry continue negotiating renewal of the state’s hospital tax – its “Quality Care Assessment” – it was not entirely clear whether the federal government would permit continued use of this mechanism.
An early November bulletin from CMS, however, clarifies that this approach is still permissible, which is good news for Pennsylvania safety-net hospitals and SNAP members hoping to benefit from the state’s hospital assessment.
Go here to see the CMS memo “Delivery System and Provider Payment Initiatives under Medicaid Managed Care Contracts.”

PA Safety Net Admin2017-11-16T14:19:15+00:00November 16th, 2017|HealthChoices, Pennsylvania Medicaid, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off

CMS Shares Vision for Medicaid

Medicaid is about to undergo major changes, CMS administrator Seema Verma outlined in a news release yesterday and in a speech to state Medicaid directors.
According to the news release, those changes include:

re-establishing a state-federal partnership that Verma believes has become too much federal and not enough state
giving states greater freedom to innovate
offering new guidelines for how states can align their individual programs with federal Medicaid objectives
new guidance on section 1115 waivers
longer section 1115 waivers with simpler review processes
CMS willingness to consider proposals to impose work requirements on Medicaid beneficiaries
Medicaid and CHIP “scorecards” that track and publish state and federal Medicaid and CHIP outcomes

Pennsylvania safety-net hospitals serve more Medicaid patients than the typical hospital and would therefore be affected more by any major changes in how Medicaid operates.
Go here to see CMS administrator Verma’s full new release and to find links to relevant documents, web sites, and Ms. Verma’s speech about the changes. Go here to read a Washington Post report on Ms. Verma’s speech and here to see a Kaiser Health News report.

PA Safety Net Admin2017-11-08T06:00:43+00:00November 8th, 2017|Federal Medicaid issues|Comments Off

A New Twist on Telehealth

Residents of urban areas often have the same access-to-care problems as rural residents, although the latter receive far more attention.
So concludes a new report published on the Health Affairs Blog.
According to the analysis, urban and rural residents have similar access problems – and among urban residents, the problems in some instances are even greater. One distinction:

…while rural America has access problems because there are not enough doctors, urban America has access problems because there are not enough appointments.

One potential solution to this problem, the report suggests, is focusing on access instead of geography and making telehealth services more available to rural and urban residents alike. To date, most telehealth efforts have focused on serving residents of rural areas only.
Doctor giving patient an ultrasound Pennsylvania has safety-net hospitals in both urban and rural areas and many of the communities they serve have access-to-care problems that might benefit from greater access to telehealth services.
Learn more about the issue and this new perspective in the article “Giving Urban Health Care Access Issues The Attention They Deserve in Telemedicine Reimbursement Policies,” which can be found here, on the Health Affairs Blog.

PA Safety Net Admin2017-10-18T06:00:12+00:00October 18th, 2017|Uncategorized|Comments Off

House Committee to Hold 340B Hearing

The House Energy and Commerce Committee’s oversight subcommittee will hold a hearing on Wednesday about the 340B Drug Pricing Program.
At the hearing, titled “Examining How Covered Entities Utilize the 340B Drug Pricing Program,” the subcommittee hopes

…to hear directly from entities participating in the program to get a better understanding of how the program is used, including how much money is saved, the types of drugs purchased and prescribed within the program, how entities track their savings, and how those savings are used to improve patient care.

All Pennsylvania safety-net hospitals participate in the 340B program.
Learn more about the hearing and the witness list from the subcommittee’s news release on the subject.

PA Safety Net Admin2017-10-09T06:00:52+00:00October 9th, 2017|Uncategorized|Comments Off

House Members Seek Delay of DSH Cuts

221 members of the House of Representatives have written to House leaders asking them to delay cuts in Medicaid disproportionate share payments (Medicaid DSH) that are scheduled to begin on October 1.
The cuts, mandated by the Affordable Care Act, have already twice been delayed by Congress, both times for two years, and now, a majority of House members have written to House speaker Paul Ryan and minority leader Nancy Pelosi asking them to advance legislation to delay Medicaid DSH cuts once again.
The purpose of Medicaid DSH payments is to help hospitals that serve especially large numbers of low-income patients to absorb some of the losses they incur serving uninsured and underinsured people. Pennsylvania safety-net hospitals receive, and greatly benefit from, Medicaid DSH payments.
See the letter to House leaders here and see NAUH’s letter to House members here.

PA Safety Net Admin2017-10-04T14:33:14+00:00October 4th, 2017|Federal Medicaid issues|Comments Off

U.S. House Committee Looks at 340B

Are hospitals using the savings generated by their participation in the section 340B prescription drug discount program to help their low-income and uninsured patients?
That’s what the U.S. House Energy and Commerce Committee’s Health Subcommittee is asking.
Earlier this year the committee requested such information from the Health Services and Resources Administration, which runs the 340B program, and now it’s asking hospitals as well.
Specifically, the subcommittee sent five-page letters to 19 providers that participate in the 340B program asking them about:

the quantity of 340B-purchased drugs they dispense to Medicare beneficiaries, Medicaid beneficiaries, and those with private insurance
the quantity of 340B-purchased drugs they dispense to uninsured patients
their savings from the 340B program and how they calculate those savings
how much charity care they provide
how they use 340B savings to serve vulnerable populations

The letters address many other 340B-related issues as well.
Most Pennsylvania safety-net hospitals participate in the 340B program and view it as a critical tool in their ability to meet the needs of their many low-income patients.
Learn more about the Health Subcommittee’s letter by reading this news release describing this initiative and go here to view the letters the subcommittee sent to selected 340B providers.

PA Safety Net Admin2017-09-22T06:00:05+00:00September 22nd, 2017|Uncategorized|Comments Off

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