Pennsylvania safety-net hospitals Archives - Page 9 of 20 - Safety-Net Association of Pennsylvania

Homeless Health Care Costs Driven More by Hospital Stays Than ER Visits

Extended hospital stays and not frequent visits to hospital emergency rooms constitute the greatest cost in caring for homeless Medicaid patients, a new analysis has found.
A review of 1100 homeless people served by the Boston Health Care for the Homeless Program found that while repeated visits to the ER do constitute a problem for caregivers, the cost of those visits is dwarfed by costs associated with the same patients spending long periods of time in the hospital.
According to the review, 30 percent of the group’s Medicaid costs were for hospital stays while only four percent were for ER services. The homeless frequently spend more time in the hospital because they are in such poor overall health.
In recent years, providers have focused much of their attention on frequent ER visitors – so-called “frequent flyers” or “super-utilizers” – but the experience of the Boston program suggests that conditions that lead to long periods of hospitalization among the homeless may need more attention as well.
Because of where they are located, Pennsylvania safety-net hospitals serve far more homeless patients than the typical hospital.
For a closer look at the Boston program and what its leaders learned, see this Boston Herald article.

PA Safety Net Admin2016-06-01T06:00:44+00:00June 1st, 2016|Pennsylvania safety-net hospitals, Uncategorized|Comments Off

New Report Highlights Benefits of 340B Program

A new report describes how the federal government’s 340B Drug Pricing Program works, how it serves low-income participants, what might happen if the program were curtailed, and why the program remains as important as ever despite the declining number of uninsured Americans.
The program, created in the early 1990s, requires pharmaceutical companies to provide outpatient drugs to eligible health care providers at significantly reduced prices. Providers qualify based on the number of low-income and uninsured patients they serve and they must be non-profit organizations.
Most Pennsylvania safety-net hospitals participate in the program.
Amid a considerable increase in the number of eligible providers, drug companies have been calling on the federal government to scale back the program.
Learn more about the 340B program in the new report “340B Program Helps Hospitals Provide Services to Vulnerable Patients: Results From a Survey of 340B Health Members,” released by the advocacy organization 340B Health. Find the report here.

PA Safety Net Admin2016-05-24T06:00:03+00:00May 24th, 2016|Pennsylvania safety-net hospitals|Comments Off

Bill Proposes Risk-Adjusting Medicare Readmissions Program

A new bill introduced in the House Ways and Means Committee would apply risk adjustment for socio-economic factors to Medicare’s hospital readmissions reduction program.
According to a committee summary of the bill, The Helping Hospitals Improve Patient Care Act of 2016 includes a provision that would direct the Secretary of Health and Human Services to

… implement a transitional risk adjustment methodology to serve as a proxy of socio-economic status for the Hospital Readmissions Reduction Program. In addition to the transitional adjustment, the section clarifies that the Secretary is able to permanently use a more refined methodology following the analysis required by the Improving Medicare Post-Acute Care Transformation Act of 2014. The section also requires a study by the Medicare Payment Advisory Commission (MedPAC), and allows for an analysis of “V-codes” and an exploration of potential exclusions.

The bill would be beneficial for Pennsylvania’s private safety-net hospitals because they serve more low-income patients who are more challenging to treat than typical hospital patients and are more likely to require post-discharge readmission to address continuing medical and social issues.
For a closer look at the bill’s socio-economic risk adjustment provision and other proposals, go here to see the committee’s summary of H.R. 5273, The Helping Hospitals Improve Patient Care Act of 2016, and go here to see the bill itself.

PA Safety Net Admin2016-05-23T06:00:17+00:00May 23rd, 2016|Medicare, Pennsylvania safety-net hospitals|Comments Off

Congressional Task Force Considers Medicaid Reforms

A House Energy and Commerce Committee group is looking at potential Medicaid reforms for 2017.
The task force, consisting entirely of Republican members, was created late last year to “… strengthen and sustain the critical program for the nation’s most vulnerable citizens.”
At a recent event at George Mason University, task force chairman Brett Guthrie (R-KY), cited continued high Medicaid spending as a reason to consider reform and noted that the degree to which the task force could tackle Medicaid in 2017 would depend on which party occupies the White House and controls Congress. He suggested that the task force would look for ways to prevent people from needing to choose between getting jobs and keeping health insurance. Among the potential legislative vehicles for reform, Guthrie said, are reauthorization of the Children’s Health Insurance Program and Medicare extenders.
Because they serve so many Medicaid and low-income patients, the task force’s deliberations will be of particular interest to Pennsylvania’s safety-net hospitals.
Learn more about the House Energy and Commerce Committee’s Medicaid Task Force here and about Rep. Guthrie’s remarks at the George Mason University forum here.

PA Safety Net Admin2016-05-13T06:00:47+00:00May 13th, 2016|Uncategorized|Comments Off

Safety-Net Hospitals’ Readmissions Challenge

The March edition of the journal Health Affairs offers a compelling snapshot of a type of patient many safety-net hospitals serve on an almost daily basis: the “superutilizer” who lacks the ability and resources to address his own medical needs.
The article “Mr. G And The Revolving Door: Breaking The Readmission Cycle At A Safety-Net Hospital” tells the story of a patient who

…had been using drugs and alcohol since his teenage years, and he was addicted to crack cocaine and alcohol…He had been released from prison six months before we first met him, without any basic resources to help him transition back into society – not even a state ID. Lacking this fundamental necessity, he could not apply for state health insurance or a Supplemental Nutrition Assistance Program card to receive food stamps. As an ex-felon with no income, he couldn’t find a place to live. He told us he was living on the streets, where he spent his days panhandling and using the money he got to buy tacos from street vendors and hash browns from McDonald’s.

Mr. G’s first several admissions to our hospital were similar. He would walk into the emergency department, unable to breathe, and would be admitted to the hospital for treatment related to heart failure. He had a complex medical history including diabetes and extremely poor heart function – which was complicated by a clot in his heart that required the chronic use of blood thinners. Furthermore, he suffered from schizophrenia.

The hospital faced a problem in addition to caring for Mr. G.

The problem with Mr. G’s admissions, aside from their drain on hospital resources, is that to motivate hospitals to improve care, Medicare penalizes hospitals for certain patients who are readmitted within thirty days. This policy assumes that all patients have the means and internal resources to care for themselves effectively and that hospitals, by simply adhering to best practices of medical management, can avoid redundant care. Medicare fails to consider the complications imposed by poverty and the significant burden safety-net hospitals face in trying to address overwhelming social issues.

A typical admission was set in motion by Mr. G’s nonadherence to his medications, poor diet, substance abuse, or a combination of the three. With each admission, additional problems and complications cropped up that extended his stay.

The problems continue, and the article explains that

Patients like Mr. G frustrate health care providers. These patients are often dismissed as being nonadherent, and their psychosocial needs go unrecognized. Their daily challenges are compounded by poverty, mental illness, substance abuse, lack of social support, lack of transportation, and unstable housing. These factors – and other social determinants of health – set the stage for poor health outcomes in patients with low socioeconomic status.

The article concludes by noting that

Current health care policy emphasizes the reduction of readmissions but does not support the time and resources needed to achieve this goal. As the basis for payment shifts from volume to value, it will become exceedingly expensive to continue ignoring the social determinants of health.

To learn more about Mr. G, the hospital that served him, and the challenges Pennsylvania’s safety-net hospitals face when serving patients CMS has labeled “superutilizers,” go here, to the web site of the journal Health Affairs, to see the complete article “Mr. G And The Revolving Door: Breaking The Readmission Cycle At A Safety-Net Hospital.”

PA Safety Net Admin2016-04-06T06:00:21+00:00April 6th, 2016|Affordable Care Act, Medicare, Pennsylvania safety-net hospitals|Comments Off

Group Organizes Advocacy in Support of 340B Program

Under pressure from federal regulators and MedPAC, the advocacy group 340B Health is attempting to rally hospital groups behind the 340B prescription drug discount program that requires pharmaceutical companies to provide discounts to qualified hospitals for drugs dispensed on an outpatient basis to Medicaid patients.
Last year the Health Resources and Services Administration, which runs the program, issued proposed regulations that would change how the program operates and is governed. Recently, MedPAC proposed reducing the size of the discount hospitals receive for the drugs, with the savings to be redirected to fund additional Medicare disproportionate share (Medicare DSH) payments for selected hospitals.
More than 2100 organizations participate in the 340B program, including most Pennsylvania safety-net hospitals.
For a closer look at the 340B program, the changes that have been proposed, and what hospitals are attempting to do about it, see this report from CQ Roll Call presented by the Commonwealth Fund.

PA Safety Net Admin2016-03-31T06:00:37+00:00March 31st, 2016|Pennsylvania safety-net hospitals|Comments Off

Socio-Economic Factors Again Tied to Hospital Readmissions

Another study has linked socio-economic factors to increased hospital readmissions.
This latest study, published in the Journal for Healthcare Quality, found that

… meaningful risk-adjusted readmission rates can be tracked in a dynamic database. The clinical conditions responsible for the index admission were the strongest predictive factor of readmissions, but factors such as age and accompanying comorbid conditions were also important. Socioeconomic factors, such as race, income, and payer status, also showed strong statistical significance in predicting readmissions.

Conclusions: Payment models that are based on stratified comparisons might result in a more equitable payment system while at the same time providing transparency regarding disparities based on these factors. No model, yet available, discriminates potentially modifiable readmissions from those not subject to intervention highlighting the fact that the optimum readmission rate for any given condition is yet to be identified.

The study found that low-income patients are more likely to require readmission to the hospital than those with higher incomes and hospitals that serve higher proportions of low-income patients are more likely to incur Medicare penalties for readmissions than other hospitals.
These are the very patients served in especially large numbers by Pennsylvania’s private safety-net hospitals.
To learn more about the study, how it was conducted, and what it found, find the study “Patient Factors Predictive of Hospital Readmissions Within 30 Days” here, on the web site of the Journal for Healthcare Quality.

PA Safety Net Admin2016-03-25T06:00:42+00:00March 25th, 2016|Medicare, Pennsylvania safety-net hospitals|Comments Off

Hospitals Failing to Prevent Avoidable Readmissions

Hospitals continue to fail to prevent many avoidable readmissions, a new study in JAMA Internal Medicine has concluded.
Among the causes? Patients who shouldn’t have been admitted through the ER in the first place, post-discharge instructions written at too high a level for patients, failure of patients to keep follow-up appointments, and hospitals discharging patients too soon.
Two of those causes – hard-to-understand discharge instructions and difficulty keeping follow-up appointments – as problems that are especially prevalent within the kinds of communities served by Pennsylvania’s safety-net hospitals.
In all, the study of 12 academic medical centers concluded that 15 percent of readmissions were preventable, 12 percent were likely unpreventable, and there was about a 50 percent chance of preventing another 15 percent of readmissions.
For a look at the problems the study identified and its recommendations for addressing them, go here to see the JAMA Internal Medicine article “Preventability and Causes of Readmissions in a National Cohort of General Medicine Patients.”

PA Safety Net Admin2016-03-17T06:00:09+00:00March 17th, 2016|Uncategorized|Comments Off

DSH/340B Hospitals Have Lower Medicare Drug Costs

Medicare disproportionate share (Medicare DSH) hospitals that qualify for the federal 340B prescription drug discount program have lower Medicare Part B drug costs than other Medicare providers.
So concludes a new study performed for 340B Health, an association that represents more 1100 public and non-profit hospitals and health systems that participate in the 340B drug pricing program.
According to the organization 340B Health,

Medicare pays disproportionate share hospitals in the 340B drug discount program on average 13 percent less for separately payable drugs reimbursed through Medicare Part B. This is in comparison to what it pays other hospitals and physician practices in the Part B market. The study also shows that 340B DSH hospitals are treating more vulnerable patients than other providers in terms of race, age, disability, and dual eligibility.

The study also found that 340B-eligible hospitals are

Nearly four times as likely as non-340B providers to treat patients with end-stage renal disease
More than twice as likely to treat patients dually eligible for Medicare and Medicaid
More than twice as likely to treat patients who are disabled
More than twice as likely to treat Black, Hispanic, and North American Native patients

All of Pennsylvania’s safety-net hospitals are Medicare DSH hospitals and many participate in the 340B prescription drug pricing program as well.
For a closer look at the study and its findings, go here to see a 340B Health news release on the study and go here to see the study Analysis of Separately Billable Part B Drug Use Among 340B DSH Hospitals and Non-340B Providers.

PA Safety Net Admin2016-02-19T06:00:39+00:00February 19th, 2016|Medicare, Pennsylvania safety-net hospitals|Comments Off

MACPAC: Medicaid DSH Payments Not Always Reaching Targeted Providers

In many cases, Medicaid disproportionate share payments (Medicaid DSH) are being made to hospitals that do not necessarily serve especially large proportions of Medicaid and other low-income patients.
So concludes a new report from The Medicaid and CHIP Payment and Access Commission (MACPAC), is a non-partisan legislative branch agency that performs policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on issues affecting Medicaid and the State Children’s Health Insurance Program (CHIP).
According to a new MACPAC report,

Medicaid DSH payments provide substantial support to safety-net hospitals by helping to offset uncompensated care costs for Medicaid and uninsured patients. In 2014, Medicaid made a total of $18 billion in DSH payments ($8 billion in state funds and $10 billion in federal funds). About half of all U.S. hospitals receive such payments, with most going to hospitals that serve a particularly high share of Medicaid and other low-income patients, known as deemed DSH hospitals. But more than one-third of DSH payments are made to hospitals that do not meet this standard.

To remedy this problem, MACPAC recommends more and better data collection, noting that

The current variation in state DSH allotments stems from the variations that existed in state DSH spending in 1992.

Medicaid DSH has long been a subject of great interest to Pennsylvania’s safety-net hospitals because, serving so many Medicaid and low-income patients, they are the very providers for which Medicaid DSH payments have always been intended.
The MACPAC analysis Report to Congress on Medicaid Disproportionate Share Hospital Payments covers a broad range of Medicaid DSH-related issues. Find it here, on the MACPAC web site.

PA Safety Net Admin2016-02-08T06:00:14+00:00February 8th, 2016|Pennsylvania safety-net hospitals, Uncategorized|Comments Off

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