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

Docs Less Likely to Participate in ACOs in Disadvantaged Communities

A new study has found that physicians who practice in areas with higher proportions of low-income, uninsured, less-educated, disabled, and African-American residents are less likely than others to participate in accountable care organizations.
If ACOs ultimately are found to improve health care quality while better managing costs, their benefits might be limited in such communities, thereby exacerbating health care disparities. If this trend holds true in Pennsylvania, it could be harmful to many of the communities served by the state’s safety-net hospitals.
To learn more, go here to see the Health Affairs report “Physicians’ Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More Affluent Communities.”

PA Safety Net Admin2016-08-23T10:41:08+00:00August 23rd, 2016|Pennsylvania safety-net hospitals, Uncategorized|Comments Off

Medicare Readmissions Penalties Rise

Medicare will impose more than $500 million in penalties in FY 2017 on hospitals that readmit too many Medicare patients within 30 days of their discharge from the hospital.
The penalties, part of Medicare’s hospital readmissions reduction program, represent a 20 percent increase over the penalties the program levied in FY 2016.
Under the program, most (but not all) hospitals are evaluated on their performance with patients with six medical conditions: heart attacks, heart failure, chronic lung disease, hip and knee replacement, and the need for coronary bypass surgery. The maximum penalty is three percent of hospitals’ Medicare payments and the average penalty in FY 2017 will be 0.73 percent – up from 0.61 percent in FY 2016.
The program is widely credited with driving a national reduction in the number of Medicare patients readmitted to the hospital within 30 days of discharge, although as the program’s FY 2017 penalties suggest, reducing those readmissions is proving a considerable challenge for some hospitals.
Ever since the program’s introduction, critics have maintained that hospitals that serve large numbers of low-income patients are treated unfairly by the program. Such patients, a growing body of research has found, are more difficult to treat and more likely to lack the financial, social, and family supports needed to recover from illnesses and injuries without requiring a return to the hospital. Pennsylvania’s safety-net hospitals serve especially large numbers of such patients.
Learn more about how the readmissions reduction program works and how it will treating hospitals in FY 2017 in this Kaiser Health News report.

PA Safety Net Admin2016-08-11T06:00:36+00:00August 11th, 2016|Uncategorized|Comments Off

Feds Announce Process for Phasing Out Medicaid Pass-Through Payments

A number of states supplement the Medicaid revenue of high-volume Medicaid hospitals – and draw down additional federal Medicaid matching funds – by making special pass-through payments through Medicaid managed care organizations. Such payments are often used to distribute the proceeds from state hospital taxes.
The Centers for Medicare & Medicaid Services has looked upon such payments with growing disapproval in recent years and has now advised state Medicaid programs on how it plans to phase out the practice entirely.
In a bulletin to state Medicaid directors titled “The Use of New or Increased Pass-Through Payments in Medicaid Managed Care Delivery Systems,” CMS has announced its intention to ban the pass-through payments over a period of years, with limited exceptions that meet specific new criteria.
In announcing the policy, CMS acknowledges the challenges inherent in ending the use of such payments and indicates its intention to address this issue, and the phase-out process, in future regulations
Such pass-through payments are an important of Pennsylvania’s Medicaid program and the state’s private safety-net hospitals benefit considerably from them.
Go here to see the CMS bulletin on a subject of interest to many high-volume Medicaid hospitals.

PA Safety Net Admin2016-08-09T06:00:39+00:00August 9th, 2016|Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

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

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