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Archive for September 2015

Court Rebuffs HHS on Medicare Two-Midnight Rule Pay Cut

A federal court has told the U.S. Department of Health and Human Services that it will have to do more to justify a 0.2 percent cut in inpatient payment rates that is part of the controversial Medicare two-midnight rule. The court decided that in addition to providing a better rationale for the pay cut, Medicare also will need to have a public comment period for that rationale. Medicare had already delayed implementation of the two-midnight rule. To learn more about this court decision, see this McKnight Long-Term Care News article.

Posted in Medicare

DHS Explains Latest Medicaid Initiatives

The Pennsylvania Department of Human Services describes two recent steps to improve the delivery of health care to low-income Pennsylvanians – the introduction of its new “Community HealthChoices” program and the re-bidding of managed care organization contracts for its HealthChoices physical health program – in the latest edition of its newsletter The Impact. Find that edition here.

Posted in HealthChoices PA, Pennsylvania Medicaid policy

PA Puts New HealthChoices Contracts Up for Bid

The Pennsylvania Department of Human Services (DHS) has issued a request for proposals (RFP) for organizations interested in serving the state’s Medicaid population through its HealthChoices Medicaid managed care program. The HealthChoices program, introduced in 1997, currently serves nearly 2.5 million Pennsylvanians. Among them, 200,000 have enrolled in the program since the state’s Medicaid expansion began in January. The contracts will put a greater emphasis on value-based purchasing and will require participating insurers to provide at least 30 percent of their services in a value-based or outcomes-based manner within three years.  Among the tools managed care organizations are expected to employ to achieve this goal are accountable care organizations, bundled payments, and patient-centered homes. With a projected value of about … Read More

Posted in HealthChoices PA, Meetings and notices

Medicare Readmissions Program Unfair to Safety-Net Hospitals, Study Finds

Medicare’s readmissions reduction program penalizes hospitals based largely on the patients they serve rather than their performance serving them, a new study has concluded. According to the report “Patient Characteristics and Differences in Hospital Readmission Rates,” published in the journal JAMA Internal Medicine, Patient characteristics not included in Medicare’s current risk-adjustment methods explained much of the difference in readmission risk between patients admitted to hospitals with higher vs lower readmission rates. Hospitals with high readmission rates may be penalized to a large extent based on the patients they serve. Among those two dozen socio-economic factors: patient income, education, and ability to bathe, dress, and feed themselves. The study found, for example, that the worst-performing hospitals under Medicare’s hospital readmissions reduction … Read More

Posted in Medicare

PA to Push for Value-Based Purchasing of Care

The Secretary of Pennsylvania’s Department of Health has issued a call for greater use of value-based purchasing of health care services in the state. At a conference hosted by the Pittsburgh Business Group on Health, Secretary Karen Murphy invited insurers and employers to work together to pursue a value-based approach to the purchase of health care that would reduce the cost of care while improving the results of the care patients receive. To support this initiative, Secretary Murphy has created a new innovation center in the state’s Health Department and appointed a deputy secretary to lead this effort. Learn more about the state’s intentions in this Pittsburgh Business Times article.  

Posted in Uncategorized

DHS Issues RFI for Vendors to Help Monitor Payments

Pennsylvania’s Department of Human Services (DHS), which administers the state’s Medicaid program, is seeking information from vendors that offer data mining and predictive analytics that might help the state monitor Medicaid and other payments. DHS seeks to use such services to “…detect patterns of waste, fraud, and abuse in its programs on a prospective or retrospective basis.” Among the challenges such vendors might address in their responses, as stated in the RFI, are: Identifying claim review strategies that efficiently and proactively prevent or address potential errors (e.g., prepayment edit specifications or parameters). Providing mechanisms to investigate patterns that may indicate abuse of services by clients. Producing innovative views of utilization or billing patterns that illuminate potential errors. Maximizing recoveries by … Read More

Posted in Meetings and notices

MedPAC Looks at Various Issues at September Public Meeting

The independent federal agency that advises Congress on Medicare payment issues held its monthly public meeting in Washington, D.C. During the two days of meetings, the Medicare Payment Advisory Commission (MedPAC) discussed its work on six specific issues: developing a unified payment system for post-acute care a preliminary analysis of Medicare Advantage encounter data for Part B services factors affecting variation in Medicare Advantage plan star ratings Medicare drug spending emergency department services provided at stand-alone facilities payments from drug and device manufacturers to physicians and teaching hospitals Each discussion was accompanied by an issue brief and a presentation; find those documents here.

Posted in Medicare

Medicare Proposes Addressing Health Disparities

The Centers for Medicare & Medicaid Services (CMS) has unveiled its first plan to reduce health disparities among Medicare beneficiaries. The plan, produced by CMS’s Office of Minority Health and titled “The CMS Equity Plan for Improving Quality in Medicare,” will seek to improve care for …Medicare populations that experience disproportionately high burdens of disease, lower quality of care, and barriers to accessing care. These include racial and ethnic minorities, sexual and gender minorities, people with disabilities, and those living in rural areas. This is the very population served in disproportionate numbers by many of Pennsylvania’s private safety-net hospitals. The program will focus on six priorities: expanding the collection, reporting, and analysis of standardized data evaluating disparity impacts and integrating … Read More

Posted in Medicare, Pennsylvania safety-net hospitals

PA Insurance Commissioner to Hold Hearing on Balance Billing

Pennsylvania Insurance Commissioner Teresa Miller will hold a public hearing next month to begin exploring the practice of balance billing. According to a department news release, the hearing will …be an opportunity to begin exploring options to make sure consumers are informed about their care and do not face these unexpected bills without recourse, as well as to identify some possible consumer-friendly solutions to the issue. Miller believes this hearing will be a substantive first step in tackling the issue of balance billing, and giving consumers more peace of mind and predictability in coverage. The hearing will be held on October 1 in Harrisburg. For more information about balance billing and the issues the Insurance Department hopes to begin addressing … Read More

Posted in Uncategorized

PA Included in New Medicare Value-Based Insurance Program Demonstration

Pennsylvania is one of seven states that will participate in a new value-based purchasing demonstration program for Medicare Advantage plans. According to a fact sheet published by the Centers for Medicare & Medicaid Services (CMS), Value-Based Insurance Design (VBID) generally refers to health insurers’ efforts to structure enrollee cost sharing and other health plan design elements to encourage enrollees to use high-value clinical services – those that have the greatest potential to positively impact enrollee health. VBID approaches are increasingly used in the commercial market, and evidence suggests that the inclusion of clinically-nuanced VBID elements in health insurance benefit design may be an effective tool to improve the quality of care while reducing its cost for Medicare Advantage enrollees with … Read More

Posted in Medicare
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