Diabetes Admissions Up in PA

Hospital admissions for diabetes rose 13 percent in Pennsylvania between 2000 and 2016.  While admissions among older Pennsylvanians declined, the rate for younger people under the age of 45 increased 38 percent over that period of time.

Diabetes admissions in Pennsylvania resulted in $205 million in payments to hospitals in 2016, but according to the Pennsylvania Health Care Cost Containment Council, about 86 percent of 2016 adult admissions could have been prevented with more timely and appropriate care and disease management.

Learn more about the prevalence of diabetes admissions in Pennsylvania in the new PHC4 research brief

“Pennsylvania Hospital Admissions for Diabetes,” which can be found here.

Filed under: Uncategorized

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its latest Health Law News.

Included in the November edition are articles about:

  • a proposal to impose a work requirement on Pennsylvania Medicaid recipients
  • the CHIP program
  • leadership changes in health care-related state agencies
  • the rollout of the Community HealthChoices program of managed long-term services and supports
  • HealthChoices managed care contracts
  • changes in several state waiver programs

Find these stories here in the latest edition of Health Law News.

Filed under: HealthChoices, Pennsylvania Medicaid, Pennsylvania Medicaid policy

Bill Seeks to Block 340B Cut

Legislation introduced in Congress would block the attempt by the Centers for Medicare & Medicaid Services to slash $1.6 billion in annual payments to hospitals for prescription drugs for outpatients prescribed through the federal section 340B prescription drug discount program.

Earlier this month CMS finalized its plan to reduce controversial 340B payments and shift $1.6 billion in savings into Medicare provider payments.  If adopted, the bipartisan legislation co-sponsored by Representatives David McKinley (R-WV) and Mike Thompson (D-CA) would prevent the reduction of 340B payments, which are made to hospitals that care for especially large proportions of low-income patients.

The 340B program is an essential source of resources for private Pennsylvania safety-net hospitals and many stand to lose hundreds of thousands of dollars, or even millions of dollars a year, if the payment cut is not reversed.

Go here to see Rep. McKinley’s news release on the bill and here to see the bill itself, which is H.R. 4392, “To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes.”

Filed under: Pennsylvania safety-net hospitals

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.”

Filed under: HealthChoices, Pennsylvania Medicaid, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania

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.

Filed under: Federal Medicaid issues

PA Delays New Long-Term Care Program

The Pennsylvania Department of Human Services will delay for six months the introduction of its Community HealthChoices program in southeastern Pennsylvania.

The program’s implementation in the five-county Philadelphia area, scheduled to begin on July 1, 2018, has been pushed back to January 1, 2019.

Preparations are currently under way to launch Community HealthChoices in 14 southwestern Pennsylvania counties on January 1, 2018.

Community HealthChoices is a new state program of managed long-term services and supports for Pennsylvanians over the age of 55 who are eligible for both Medicare and Medicaid.

Learn more about the program’s delay in southeastern Pennsylvania in this Philadelphia Inquirer article.

Filed under: Pennsylvania Medicaid policy, Uncategorized

PHC4 Reports on Hospital Performance

The Pennsylvania Health Care Cost Containment Council has released its annual report on hospital performance for discharges between October of 2015 and September of 2016.

The report, which details the performance of all of the state’s acute-care hospitals and some children’s and specialty hospitals, looks at hospital-specific outcomes for 16 individual medical conditions and surgical procedures.

Among the measures reported by PHC4 are number of cases, risk-adjusted mortality, risk-adjusted 30-day readmissions, and case-mix-adjusted average hospital charges.

Among its findings, PHC4 reported that mortality and readmission rates decreased in most categories and did not increase significantly in any.

The PHC4 report comes in different volumes for different parts of the state.  Find a description of the reports, a summary of their findings, and the three reports themselves here, on PHC4’s web site.

Filed under: Uncategorized

Survey Says: More Than One in Four Underinsured

28 percent of insured adults under the age of 64 were uninsured in 2016, according to a Commonwealth Fund survey.

The survey also found that:

  • More than half of the uninsured are insured through their employer.
  • Nearly one in four insured through their employer are underinsured.
  • More than one in four Medicaid recipients were underinsured.
  • Half of the underinsured report problems paying their medical bills.
  • Individuals with higher deductibles are more likely to report problems paying their medical bills.
  • More than 45 percent of the underinsured report skipping care they need because of cost.
  • Low-income people and those with chronic health problems are more likely to be underinsured.

Learn more about the survey’s findings, its implications, and possible means of addressing these problems in the Commonwealth Fund report How Well Does Insurance Coverage Protect Consumers from Health Care Costs?, which can be found here.

Filed under: Uncategorized

Wolf Vetoes Medicaid Work Requirement

Pennsylvania Governor Tom Wolf has vetoed a bill that included a requirement that certain Medicaid recipients either work or search for work.

 Learn more about the governor’s veto, and his reason for doing so, in this Associated Press news report.

Filed under: Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy

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 ultrasoundPennsylvania 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.


Filed under: Uncategorized

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2012 Safety-Net Association of Pennsylvania