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Archive for July 2015

CMS Proposes New Medicaid Substance Abuse Initiatives

The Centers for Medicare & Medicaid Services (CMS) has announced a new initiative designed to improve how states identify and serve Medicaid beneficiaries with substances use disorders (SUD). According to a recent notice sent by CMS to state Medicaid directors, the agency is proposing … an opportunity to allow states embarking on broad and deep system transformations in the area of SUD to pursue 1115 demonstrations to improve the care and outcomes for individuals with SUD. This new initiative would be available to states that are developing comprehensive strategies to ensure a full continuum of services, focusing greater attention to integration efforts with primary care and mental health treatment, and working to deliver services that are considered promising practices or … Read More

Posted in Uncategorized

The Challenges Medicaid Faces

As it celebrates is fiftieth birthday, Medicaid now covers 70 million Americans at a cost of $500 billion a year.  As the program continues to grow amid the expansion facilitated by the Affordable Care Act, Kaiser Health News has identified the five biggest challenges the program faces today: controlling costs getting all states to expand income eligibility providing better oversight of managed care ensuring access to doctors and dentists meeting the growing demand for long-term care For a closer look at these challenges and what they entail, see this Kaiser Health News article.

Posted in Affordable Care Act

439,000 Added to PA Medicaid Rolls

150,000 Pennsylvanians have enrolled in Medicaid since the Wolf administration officially launched its HealthChoices expansion on April 27. Added to the 289,000 who enrolled during the Corbett administration’s Healthy Pennsylvania program, that means about 439,000 Pennsylvanians have obtained Medicaid coverage since the state expanded its Medicaid program as authorized by the 2010 federal health care reform law. To learn more about the latest Medicaid enrollments, their financial impact on the state, and how the HealthChoices expansion works, see this Wolf administration news release.

Posted in Affordable Care Act, HealthChoices PA, Healthy PA

GAO Looks at Behavioral Health Options

Access to behavioral health services can be a challenge for low-income adults, so the U.S. Government Accountability Office (GAO) recently looked into those challenges. In a new report, the GAO examined how many low-income adults have behavioral health problems, where they can go to receive the care they need – including whether there are differences in those options depending on whether the state in which the reside has expanded its Medicaid program – how Medicaid expansion states are providing coverage for behavioral health for newly eligible beneficiaries, and how obtaining Medicaid coverage affects the ability of such individuals to get the care they seek. Access to behavioral health care can be an especially major challenge in the low-income communities typically … Read More

Posted in Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals

Graduate Medical Education: Boon or Bane for Hospitals’ Bottom Line?

Do hospitals make money on graduate medical education?  Do they lose money subsidizing positions above and beyond the funding they receive for completing the training of the next generation of doctors?  Are there other benefits hospitals reap from medical education training programs – and are those benefits worth the cost? This is an important question for the many Pennsylvania safety-net hospitals that also are teaching hospitals. Crain’s Detroit Business has taken a look at some of the surprisingly complex considerations that go into answering what seem like very simple questions.  Go here for its report “Hospitals say they subsidize graduate medical education, but cost-benefit unknown.”

Posted in Medicare

Unleashing Nurse Practitioners Could Save PA Billions, Report Says

A new report suggests that enabling nurse practitioners to practice without collaborating physicians could save Pennsylvanians $6.4 billion in health care costs over the next ten years. In addition, nurse practitioners are more likely than physicians to serve in rural and medically underserved areas and would provide primary care at a time when the state is facing a predicted shortfall in primary care physicians. Twenty-one states already permit nurse practitioners to practice without a collaborating physician. The study, “Value of Full Practice Authority in Pennsylvania,” was performed by law students at the Duke University School of Law and underwritten by the Pennsylvania Coalition of Nurse Practitioners.  Find the study here.

Posted in Uncategorized

GAO Identifies Medicaid Challenges

As Medicaid marks its 50th anniversary, the U.S. Government Accountability Office (GAO) testified recently before the House Energy and Commerce Committee’s Health Subcommittee on the major challenges facing the program. GAO’s testimony focused on four major issues: access to care transparency and oversight program integrity federal financing The GAO concluded that it …considers Medicaid a high-risk program due to its size, growth, diversity, and gaps in oversight… See GAO’s complete testimony here.

Posted in Uncategorized

Study Finds Shortage of Nurses in PA

A study commissioned by the Pennsylvania State House of Representatives has found a shortage of nurses in Pennsylvania hospitals. The study, performed by the Joint State Government Commission, found …a clear relationship between nurse staffing and patient outcomes.  Although there is not an overall shortage of nurses in Pennsylvania, Pennsylvania hospitals vary significantly from one to the next in terms of nurse staffing, which contributes to disparities in quality of care across the state.  This variation is much greater than can be justified by differences in patient need and is not in the public interest. Based on these findings, the Joint State Government Commission offered the following recommendations: Pennsylvania should improve nurse workforce data collection and analysis. Pennsylvania should consider … Read More

Posted in Uncategorized

Medicaid Highlighted in Latest Health Affairs

The journal Health Affairs has dedicated its July 2015 edition to “Medicaid’s Evolving Delivery Systems.” The edition includes the following articles about different aspects of Medicaid: “Medicaid’s Growing Role in Care Delivery” Once a Welfare Add-On, Medicaid Takes Charge in Reinventing Care” “Medicaid at 50:  Remarkable Growth Fueled by Unexpected Politics” “Medicaid Moving Forward” “Community Health Centers and Medicaid at 50:  An Enduring Relationship Essential for Health System Transformation” “Many Medicaid Beneficiaries Receive Care Consistent With Attributes of Patient-Centered Medical Homes” “MetroHealth Care Plus:  Effects of a Prepared Safety Net on Quality of Care in a Medicaid Expansion Population” “Lessons From Medicaid’s Divergent Paths on Mental Health and Addiction Services” “The Supreme Court Ruling That Blocked Providers From Seeking Higher … Read More

Posted in Uncategorized

GAO Reports on 340B Program

The U.S. Government Accountability Office (GAO) recently completed a review of the federal 340B Drug Pricing Program. The program, which requires pharmaceutical companies to provide drug discounts to qualified hospitals that serve especially large proportions of low-income patients, has come under fire recently because approximately 40 percent of U.S. hospitals now participate in the program and there have been questions about how hospitals use the program and its drug discounts. The GAO found that Medicare Part B spending on drugs was much higher at participating 340B hospitals than it was at non-participating hospitals, suggesting that participating hospitals prescribe more drugs and more expensive drugs.  It found that The Centers for Medicare & Medicaid Services (CMS), which administers the Medicare program, … Read More

Posted in Medicare
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