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Serving High-Risk Patients Leads to VPB Penalties

Practices that served more socially high-risk patients had lower quality and lower costs, and practices that served more medically high-risk patients had lower quality and higher costs. These patterns were associated with fewer bonuses and more penalties for high-risk practices.

So concludes a new study that looked at the results of the first year of the Medicare Physician Value-Based Payment Modifier Program.

The study looked at 899 physician practices serving more than five million Medicare beneficiaries, and it points to the continuing challenge of how best to serve patients who pose greater socio-economic risks than the average patient.

Pennsylvania safety-net hospitals serve far more high-risk patients than the typical hospital.

Learn more these findings and how they were reached in the study “Association of Practice-Level Social and Medical Risk With Performance in the Medicare Physician Value-Based Payment Modifier Program,” which can be found here, on the web site of the Journal of the American Medical Association.

Filed under: Medicare, Pennsylvania safety-net hospitals

ACA Reduced Disparities in Access to Care

The Affordable Care Act has reduced socioeconomic disparities in access to health care in the U.S.

According to a new study published in the journal Health Affairs,

Health care access for people in lower socioeconomic strata improved in both states that did expand eligibility for Medicaid under the ACA and states that did not. However, gains were larger in expansion states. The absolute gap in insurance coverage between people in households with annual incomes below $25,000 and those in households with incomes above $75,000 fell from 31 percent to 17 percent (a relative reduction of 46 percent) in expansion states and from 36 percent to 28 percent in nonexpansion states (a 23 percent reduction). This serves as evidence that socioeconomic disparities in health care access narrowed significantly under the ACA.

Addressing socioeconomic barriers to access to care has long been one of the major roles Pennsylvania safety-net hospitals play in their individual communities.

Learn more about how the study was conducted and what it revealed in the article “The Affordable Care Act Reduced Socioeconomic Disparities In Health Care Access,” which can be found here, on the Health Affairs web site.

Filed under: Affordable Care Act, Pennsylvania safety-net hospitals

Ways and Means Seeks to Cut Medicare Red Tape

The House Ways and Means Committee’s Health Subcommittee has launched a new initiative to attempt to improve the delivery of Medicare services and eliminate statutory and regulatory obstacles to more effective care delivery.

The subcommittee describes its “Medicare Red Tape Relief Project” as

…a new initiative to deliver relief from the regulations and mandates that impede innovation, drive up costs, and ultimately stand in the way of delivering better care for Medicare beneficiaries.

In support of this initiative, the committee has announced a three-part approach in which it will seek feedback from stakeholders, host roundtables with stakeholders across the country, and pursue congressional action to address the problems identified through this process.

As part of the first step, the Health Subcommittee is inviting stakeholders to submit information about regulatory and statutory obstacles they have encountered and how they believe the federal government should address those obstacles.

Learn more about the Medicare Red Tape Relief Project and how stakeholders can report problems and recommend improvements from this subcommittee news release.

Filed under: Medicare

Congress Looks at 340B Program

Last week the House Energy and Commerce Committee took a look at the 340B prescription drug discount program, which requires pharmaceutical companies to sell discounted drugs for outpatient use to hospitals that care for especially large numbers of low-income patients.

The previous week, the Centers for Medicare & Medicaid Services issued a proposed Medicare regulation calling for significant reductions in Medicare payments for such drugs.

The hearing touched on the CMS proposal to reduce Medicare payments for 340B drugs, the high prices of prescription drugs, the 340B program’s growth over the years, the possibility that the program is being abused by hospitals and clinics, and more.

The 340B program is an essential tool in the efforts of Pennsylvania safety-net hospitals to help the many low-income residents of the communities they serve.

Learn more about the hearing and the issues raised during it this Kaiser Health News report.

Filed under: Medicare, Pennsylvania safety-net hospitals, Uncategorized

Confluence of State, Federal Activity Prompts Medicaid Talk in Harrisburg

The combination of Congress attempting either to repeal and replace or repair the Affordable Care Act and Pennsylvania facing a multi-billion budget shortfall has led some policy-makers in Harrisburg to begin talking about ways to better manage or reduce the state’s Medicaid costs.

Those costs climbed from $3.9 billion in 2004 to $6 billion in 2014.

House Chamber of the State HouseAmong the possibilities state lawmakers are discussing:  tighter rules for participation, greater efficiency, work and work search requirements for able-bodied Medicaid recipients, charging premiums for high-income families for which Medicaid provides coverage for their profoundly disabled children, and a pilot program to test whether a recipient care management program might eliminate medical errors, improve recipient health, and reduce health care costs.

Learn more about some of the Medicaid ideas Pennsylvania policy-makers are considering in this PennLive article.

Filed under: Pennsylvania Medicaid policy

Pennsylvania Health Law Project Newsletter

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

Included in the June/July edition are articles about the status of Pennsylvania’s FY 2018 budget, including possible changes in the state human services code; a delay in awarding new HealthChoices contracts; new quality initiatives in the state’s contracts with HealthChoices managed care organizations; an update on the implementation of Community HealthChoices, the state’s new program of managed long-term services and supports; and more.

Find the newsletter here.

Filed under: Pennsylvania Medicaid policy

Medicaid Enrollees: Access and Quality Are Good

Medicaid beneficiaries are generally satisfied with their access to care and the quality of care they receive.

Or so reports a new study based on results of the federal Medicaid Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey for December of 2014 to July of 2015.

According to the survey, nearly half of Medicaid patients rated their overall care 7.9 or greater on a scale of 10; 84 percent reported that they had been able to receive all of the care they needed over the past six months; and most were generally satisfied with the coverage.  Relatively few reported problems finding providers willing to accept their Medicaid coverage.

Survey results generally were slightly more positive in Medicaid expansion states than in non-expansion states.

Pennsylvania safety-net hospitals serve especially large numbers of Medicaid patients.

Learn more about how Medicaid beneficiaries view the quality and accessibility of the care they receive in the JAMA Internal Medicine report “What Enrollees Think of Medicaid | Health Care Reform,” which can be found here.

Filed under: Pennsylvania safety-net hospitals

PHC4 Looks at “Super-Utilizers”

The Pennsylvania Health Care Cost Containment Council has released a new research brief on so-called super-utilizers:  a small portion of the population that consumes an inordinate amount of health care.  Super-utilizers are defined as individuals with five or more hospital admissions a year.

According to the PHC4 report,

  • Three percent of hospitalized patients accounted for 10 percent of hospital payments, or $1.25 billion, in 2016.
  • Super-utilizers accounted for three percent of hospitalized patients, 10 percent of hospital payments, 12 percent of hospital admissions, and 15 percent of hospital days.
  • 46 percent of that care was paid for by Medicare, 19 percent by Medicaid, and 19 percent was for dually eligible patients.
  • The top three reasons for admissions among super-utilizers were sepsis, heart failure, and mental health disorders.
  • Diabetes and alcohol and substance abuse disorders were among the leading causes of admission for Medicaid patients.
  • The highest rates of super-utilizers were among blacks, low-income individuals, and older people.

The PHC4 report breaks down super-utilizers by county and shows the reasons for super-utilizers’ hospital admissions.  Its side-by-side comparison of 2012 and 2016 shows a decline in super-utilizer admissions to hospitals, perhaps because of efforts by hospitals to reduce admissions and avoid Medicare penalties for avoidable hospital readmissions.

Go here to find the PHC4 report Pennsylvania’s “Super-Utilizers” of Hospital Care.

Filed under: Uncategorized

SNAP Joins Others in Letter to PA Senators

SNAP was among 27 Pennsylvania health care organizations to send a joint letter to senators Bob Casey and Pat Toomey pointing out aspects of the House-passed American Health Care Act that could jeopardize access to care for medically vulnerable Pennsylvanians.

Safety-Net Association of Pennsylvania logoAmong the issues addressed in the letter are how the House-passed proposal would detract from the role of Medicaid in fighting the state’s opioid crisis; the proposed reduction in tax credits to help purchase health insurance; the challenge posed by a per capita approach to Medicaid financing; the potential loss of health care jobs; the likelihood of large numbers of Pennsylvanians losing their health insurance and state Medicaid costs rising significantly; and the erosion of consumer protections.

See the complete letter here.

Filed under: American Health Care Act, Federal Medicaid issues, Pennsylvania Medicaid, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its May newsletter.

 Included in this edition are articles on new criteria for Medicaid coverage of high-cost hepatitis C drugs and the release of a draft of the state’s proposed Medicaid quality strategy; an update on Community HealthChoices, Pennsylvania’s new program of Medicaid managed long-term services and supports; an overview of Medicaid-covered behavioral health services; a summary of recent federal proposals with implications for the state’s Medicaid program; and a report on the nomination of Teresa Miller to lead the new Department of Health and Human Services that Governor Wolf has proposed establishing.

 Find the newsletter here.

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

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2012 Safety-Net Association of Pennsylvania