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Safety-Net Hospitals Gird for Loss of Medicaid DSH Money

Safety-net hospitals and others will lose a significant portion of their Medicaid disproportionate share (Medicaid DSH) payments on November 22 unless Congress delays implementation of the cut in those payments that was mandated by the Affordable Care Act.

And hospitals that receive these payments are now preparing for the worst.

The Medicaid DSH cut was included in the 2010 health care reform law in anticipation of a great reduction in the number of uninsured people leaving hospitals providing much less uncompensated care and therefore not in need of as much DSH money. The law’s reach has not proven to be as great as anticipated, however, and two developments since the law’s passage have put a damper on the expected rise in the number of insured Americans: a court decision that made it optional for states to expand their Medicaid program and the repeal of the requirement that everyone purchase health insurance.

Four times Congress has voted to delay the Medicaid DSH cut because so many people remained uninsured. Now, however, the most recent delay in implementation of the cut, via a provision in the continuing resolution currently funding the federal government, expires on November 21, and hospitals – many of them already with razor-thin margins – are preparing for the worst: a major reduction of their federal Medicaid DSH money.

Pennsylvania’s safety-net hospitals would face potentially major harm if this cut were to be implemented, so last month SNAP asked members of Pennsylvania’s congressional delegation to support a bipartisan movement in Congress to delay the Medicaid DSH cut for two years.

Learn more about the prospect of a major Medicaid DSH cut later this month, how it might affect safety-net hospitals – including the kinds of private safety-net hospitals represented by NASH – and what some hospitals are doing to prepare for the possibility in the Stateline article “Rural and Safety Net Hospitals Prepare for Cut in Federal Support.”

PA Safety Net Admin2019-11-04T06:00:59+00:00November 4th, 2019|Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals|Comments Off

SNAP Joins Letter Urging Preservation of Tobacco Funding

The Safety-Net Association of Pennsylvania has joined 10 other organizations in urging Pennsylvania’s General Assembly to use 100 percent of Tobacco Settlement Fund monies for health-related services and programs in the coming fiscal year.

Safety-Net Association of Pennsylvania logo For FY 2018-2019, Pennsylvania borrowed against future proceeds from the Tobacco Settlement Fund to help balance the state budget. Debt service payments will soon be due and the Wolf administration has proposed paying that debt service with proceeds from the state’s sales and use taxes. In a letter to state legislators, SNAP and the others endorse this aspect of the administration’s proposed budget FY 2019-2020 budget.

Tobacco fund proceeds are vital to Pennsylvania’s safety-net hospitals, helping to compensate them for some of the care they provide to uninsured and underinsured residents of the communities they serve. Funds used in this manner, moreover, are matched by the federal government, doubling their impact on communities in need.

See the letter here.

PA Safety Net Admin2019-05-16T06:00:26+00:00May 16th, 2019|Medicaid supplemental payments, Pennsylvania proposed FY 2020 budget, Pennsylvania safety-net hospitals|Comments Off

Safety-Net Hospitals, Others Benefit From Changes in Medicare Readmissions Program

Safety-net hospitals are among the leading beneficiaries of changes implemented this year in Medicare’s hospital readmissions reduction program.

According to a new study, safety-net, academic, and rural hospitals have enjoyed improved performance under the program since Medicare began organizing hospitals into peer groups based on the proportion of low-income patients they serve rather than simply comparing individual hospital performance to that of all other hospitals.

While the current fiscal year is still under way, it appears that safety-net hospitals will enjoy a collective decline of $22 million in Medicare readmissions penalties while 44.1 percent of teaching hospitals and 43.7 percent of rural hospitals will face smaller penalties than last year.

Learn more about the readmissions reduction program and how changes in that program have significantly altered its outcomes in the JAMA Internal Medicine study “Association of Stratification by Dual Enrollment Status With Financial Penalties in the Hospital Readmissions Reduction Program.”

PA Safety Net Admin2019-04-29T10:20:17+00:00April 29th, 2019|Medicare|Comments Off

Safety-Net Hospitals Struggle in Medicare Joint Replacement Model

Non-safety-net hospitals are outperforming safety-net hospitals in the Medicare’s Comprehensive Care for Joint Replacement model, which was introduced in 2016.

According to a new study published in Health Affairs,

…in comparison to non-safety-net hospitals, 42 percent fewer safety-net hospitals qualified for rewards based on their quality and spending performance (33 percent of safety-net hospitals qualified, compared to 57 percent of non-safety-net hospitals), and safety-net hospitals’ rewards per episode were 39 percent smaller ($456 compared to $743). Continuation of this performance trend could place safety-net hospitals at increased risk of penalties in future years.

What might be done to address this disparity? The study suggests that

Medicare and hospital strategies such as those that reward high-quality care for vulnerable patients could enable safety-net hospitals to compete effectively in CJR.

Learn more in the Health Affairs article Performance of Safety-Net Hospitals in Year 1 of the Comprehensive Care for Joint Replacement Model.

PA Safety Net Admin2019-03-01T06:00:22+00:00March 1st, 2019|Medicare|Comments Off

Hospital Uncompensated Care Down

As was surely expected, reforms introduced through implementation of the Affordable Care Act have driven down uncompensated care costs for many hospitals.
How much?
A new study published by the Commonwealth Fund offers the following findings:

uncompensated care declines in expansion states are substantial relative to profit margins;
for every dollar of uncompensated care costs hospitals in expansion states had in 2013, the Affordable Care Act erased 41 cents by 2015; and
Medicaid expansion reduced uncompensated care burdens for safety-net hospitals that are not made whole by Medicaid disproportionate share payments (Medicaid DSH).

Learn more, including how the decline in uncompensated care costs affected different kinds of hospitals in different kinds of states, in the report “The Impact of the ACA’s Medicaid Expansion on Hospitals’ Uncompensated Care Burden and the Potential Effects of Repeal,” which can be found here, on the Commonwealth Fund’s web site.

PA Safety Net Admin2017-05-16T06:00:57+00:00May 16th, 2017|Affordable Care Act, Pennsylvania safety-net hospitals|Comments Off

Weighing the Impact of ACA Repeal

How might repeal of the Affordable Care Act affect the financial health of different kinds of hospitals?
The New York Times recently took a look at how the 2010 reform law’s repeal would affect two Pennsylvania health systems: the Temple University Health System, led by a heavily Medicaid-dependent safety-net hospital located in one of the poorest communities in the country; and Main Line Health, a non-profit organization with several hospitals all located in affluent communities.
See what the Times found here.

PA Safety Net Admin2017-01-10T06:00:03+00:00January 10th, 2017|Affordable Care Act, Pennsylvania safety-net hospitals|Comments Off

Feds Launch Medicare-Medicaid ACO Model

The Center for Medicare and Medicaid Innovation has announced a new Medicare-Medicaid Accountable Care Organization Model that it says

…is focused on improving quality of care and reducing costs for Medicare-Medicaid enrollees. The MMACO Model builds on the Medicare Shared Savings Program (Shared Savings Program), in which groups of providers take on accountability for the Medicare costs and quality of care for Medicare patients. Through the Model, CMS will partner with interested states to offer new and existing Shared Savings Program ACOs the opportunity to take on accountability for the Medicaid costs for their assigned Medicare-Medicaid enrollees.

cms In this new model, the Innovation Center

… seeks to encourage participation from safety-net providers in Alternative Payment Models. Medicare-Medicaid ACOs that qualify as “Safety-Net ACOs” will be eligible to receive pre-payment of Medicare shared savings to support the ACO’s investment in care coordination infrastructure.

The Innovation Center envisions pursuing such undertakings with six states, which will be chosen on a competitive basis.
Learn more about the Medicare-Medicaid Accountable Care Organization model here, on the Innovation Center’s web site.

PA Safety Net Admin2016-12-22T14:27:49+00:00December 22nd, 2016|Uncategorized|Comments Off

Perspective on Medicaid

A new report looks at how Medicaid has affected the health and health care of people throughout the country.
The Commonwealth Fund report “Understanding the Value of Medicaid” examines the impact of the Affordable Care Act’s expansion of Medicaid and notes that the program currently serves 73 million children, seniors, low-income working adults, and people with disabilities.
It also examines how Medicaid expansion has enhanced access to care and even given some people medical benefits comparable to those offered by private insurance.
Finally, the report notes that safety-net hospitals that serve especially large numbers of low-income patients now serve fewer uninsured patients and are better able to invest in new staff, clinics, and equipment, thereby enhancing the quality of care they deliver.
For a closer look at the impact Medicaid has on the American health care system, see this Commonwealth Fund report.

PA Safety Net Admin2016-10-14T06:00:35+00:00October 14th, 2016|Pennsylvania safety-net hospitals|Comments Off

Medicaid Expansion Producing Benefits for Safety-Net Providers

Seeing fewer uninsured patients, safety-net hospitals in states that have expanded their Medicaid programs as provided for under the Affordable Care Act are finding themselves able to use money previously caring for the uninsured for things like more and better primary and behavioral health services, more staff, new or improved health centers and clinics, and better equipment.
This conclusion is drawn in a new study from the Georgetown University Health Policy Institute based on interviews with leaders of eleven hospital systems and federally qualified health centers (FQHCs) in seven states: four that expanded their Medicaid programs and three that did not.
While Pennsylvania was not one of the states included in the study, it is one of more than 30 states that has expanded its Medicaid program.
To learn more about what the study revealed, go here to read Beyond the Reduction in Uncompensated Care: Medicaid Expansion is Having a Positive Impact on Safety Hospitals and Clinics.

PA Safety Net Admin2016-06-21T06:00:03+00:00June 21st, 2016|Affordable Care Act, Pennsylvania Medicaid policy, 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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