Archive for November 2015
As the end of 2015 nears, CMS has used its blog to reflect on its continued efforts to move the U.S. health care system from one that pays for the volume of care provided to one that pays for the value of that care. The blog notes the replacement of the sustainable growth rate (SGR formula) with a new payment system that better supports patient-centered care; the creation of the Home Health Value-Based Purchasing model; and the introduction of Medicare reimbursement for advance care planning. The blog also describes the many programs launched by the Affordable Care Act-created Center for Medicare and Medicaid Innovation, including the Pioneer ACO Model, the Medicare Shared Savings Program, the Comprehensive Care for Joint Replacement … Read More
The Obama administration has informed state Medicaid programs that they may use federal Medicaid money to help the chronically homeless obtain housing. While a June bulletin to state Medicaid directors technically only clarified existing policy, it signaled states that the administration will be receptive to Medicaid waivers that propose using Medicaid funding to help the homeless obtain housing. Increasingly, state Medicaid programs have been finding that helping the homeless with housing is a key to improving their physical and behavioral health and can offer later savings as the individuals who have received such assistance live more stable lives, especially as more homeless people qualify for Medicaid benefits in states that have expanded their Medicaid programs. The Safety-Net Association of Pennsylvania … Read More
Pennsylvania’s non-general acute-care hospitals are generally in good financial health, although their financial performance varied in FY 2014. According to a new report published by the Pennsylvania Health Care Cost Containment Council, in FY 2014 psychiatric hospital operating margins rose from 8.29 percent to 9.87 percent long-term acute care hospital operating margins fell from 5.77 percent to 5.24 percent rehab hospital operating margins decreased from 12.93 percent to 12.74 percent specialty hospital operating margins more than doubled, from 5.25 percent to 11.38 percent For a closer look at the financial performance of non-general acute-care hospitals, find links to the report Non-General Acute Care Hospitals – Volume Three here, on the web site of the Pennsylvania Health Care Cost Containment Council.
The Pennsylvania Health Law Project has released the latest edition of its newsletter. The November 2015 edition includes new Children’s Health Insurance Program (CHIP) benefits, Pennsylvania Medicaid’s new specialty pharmacy drug program, and Pennsylvania’s receipt of a federal planning grant for certified community behavioral health clinics. Find the latest Health Law PA News here.
A new study has found that state Medicaid programs are rejecting nearly 50 percent of requests to administer expensive hepatitis C drugs to patients. According to a review of prescription data for Pennsylania, Delaware, Maryland, and New Jersey, 46 percent of requests for such treatment for Medicaid patients were denied. Only five percent of similar requests were denied for Medicare patients and 10 percent for those with private insurance. The study represents the first documentation of a concern raised when the expensive drugs first hit the market: that insurers would limit access to them. The U.S. Department of Health and Human Services recently sent letters to state Medicaid programs expressing concern about the possible denial of expensive prescription drugs to … Read More
The U.S. Department of Health and Human Services’ Office of the Inspector General (OIG) has published its work plan for the 2016 fiscal year. In 2016, the OIG will continue to examine all aspects of HHS endeavor, including Medicare, Medicaid, hospital services, public health activities, and more. In the coming year it will continue a number of hospital-focused projects while also focusing more on health care delivery, health care reform, alternative payment methodologies, and value-based purchasing initiatives. Among the OIG’s planned Medicare projects in 2016 – some of them continued from the past and some of them new, quoted directly from the work plan – are: Hospitals’ use of outpatient and inpatient stays under Medicare’s two-midnight rule. We will determine how … Read More
The U.S. House Energy & Commerce Committee has created a new task force “to strengthen and sustain the critical program for the nation’s most vulnerable citizens.” According to a committee news release, the task force “…will examine the program to determine how to ensure the program is best serving the needs of those who rely on it.” The task force’s work will undoubtedly be of interest to Pennsylvania safety-net hospitals, all of which care for unusually large numbers of Medicaid patients. For further information about the new task force, its members, and its mission, see this House Energy & Commerce Committee news release.
The Pennsylvania Health Care Quality Alliance has released its annual report on the performance of the state’s hospitals. The group compared hospital performance over time on 16 process measures: three heart attack measures, two heart failure measures, three pneumonia measures, six surgical care measures, and one prevention measure. It found that hospital performance in the state improved during the July 2013 to June 2014 over previous years and that those improvements mirrored similar improvements nationally. Overall, the group found that the performance of Pennsylvania’s hospitals on these measures was better than average nationally. The alliance also evaluated patient satisfaction with Pennsylvania hospitals as quantified by hospital consumer assessment of healthcare providers and systems (HCAHPS) measures. It found modestly improved performance that … Read More
More data is needed about the supplemental Medicaid payments states make to hospitals and how those payments are financed, according to a new report from the U.S. Government Accountability Office (GAO). According to the GAO, states are increasingly funding non-disproportionate share (Medicaid DSH) supplemental Medicaid payments to hospitals with funds from local governments and providers that are then matched by the federal government. In some states those supplemental payments, with the help of federal Medicaid matching funds, result in hospitals receiving reimbursement from Medicaid that exceeds the cost of the care they provide to their Medicaid patients. Pennsylvania’s safety-net hospitals receive a number of such supplemental Medicaid payments. In response to this concern, the GAO has urged the Centers for Medicare … Read More