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Archive for May 2016

Bill Proposes Modifying Ban on Higher Medicare Outpatient Payments

A new bill introduced in the House Ways and Means Committee would limit a recent prohibition on establishing new off-campus hospital outpatient facilities that can receive hospital-based Medicare outpatient payments. Under the Bipartisan Budget Act of 2015, new off-campus, hospital-based outpatient facilities would be paid for Medicare-covered outpatient services like regular physician offices and not like hospital outpatient departments. The Helping Hospitals Improve Patient Care Act of 2016, however, would permit new outpatient departments that were in “mid-build” at the time the 2015 law passed to be exempt from that law’s limits on outpatient payments. According to a Ways and Means summary of the bill, Section 201 provides for an exception to section 603 of the Bipartisan Budget Act of … Read More

Posted in Medicare

Help on the Way for Those With Hepatitis C?

Pennsylvanians insured by Medicaid who have Hepatitis C have often found themselves blocked from access to new treatments that can cure the disease. But that may be changing. While states’ finances have been groaning under the cost of new budget-busting treatments, a growing trend is to increase access to the costly treatments rather than keep it very limited. Last week the Pharmacy and Therapeutics Committee of the state’s Medicaid program voted to ease the state’s current limits on access to treatment that costs between $31,000 and $58,000 a patient. Currently, about 30,000 Pennsylvania Medicaid beneficiaries suffer from Hepatitis C and another 10,000 are thought to be infected but not yet suffering. The committee’s vote is advisory; the final decision rests … Read More

Posted in Pennsylvania Medicaid policy

New Report Highlights Benefits of 340B Program

A new report describes how the federal government’s 340B Drug Pricing Program works, how it serves low-income participants, what might happen if the program were curtailed, and why the program remains as important as ever despite the declining number of uninsured Americans. The program, created in the early 1990s, requires pharmaceutical companies to provide outpatient drugs to eligible health care providers at significantly reduced prices. Providers qualify based on the number of low-income and uninsured patients they serve and they must be non-profit organizations. Most Pennsylvania safety-net hospitals participate in the program. Amid a considerable increase in the number of eligible providers, drug companies have been calling on the federal government to scale back the program. Learn more about the 340B … Read More

Posted in Pennsylvania safety-net hospitals

Bill Proposes Risk-Adjusting Medicare Readmissions Program

A new bill introduced in the House Ways and Means Committee would apply risk adjustment for socio-economic factors to Medicare’s hospital readmissions reduction program. According to a committee summary of the bill, The Helping Hospitals Improve Patient Care Act of 2016 includes a provision that would direct the Secretary of Health and Human Services to … implement a transitional risk adjustment methodology to serve as a proxy of socio-economic status for the Hospital Readmissions Reduction Program. In addition to the transitional adjustment, the section clarifies that the Secretary is able to permanently use a more refined methodology following the analysis required by the Improving Medicare Post-Acute Care Transformation Act of 2014. The section also requires a study by the Medicare … Read More

Posted in Medicare, Pennsylvania safety-net hospitals

Socio-Economic Factors Leading Cause in Pediatric Asthma Readmissions

African-American children suffering from asthma are readmitted to hospitals more often than other children primarily because of socio-economic factors, a new study published in JAMA Pediatrics has concluded. In a study conducted in Cincinnati, according to the report, “Socioeconomic hardship variables explained 53% of the observed disparity” in readmissions among African-American children with asthma. The study also found that A total of 80% of the observed readmission disparity between African American and white children could be explained after statistically balancing available biologic, environmental, disease management, access to care, and socioeconomic and hardship variables across racial groups. These findings are especially relevant to Pennsylvania safety-net hospitals because the communities they serve often have especially large numbers of low-income and low-income African-American children. Read more … Read More

Posted in Uncategorized

Covered by Medicare But Underinsured

Nearly a quarter of the country’s 50 million Medicare beneficiaries are underinsured and ill-equipped financially to handle the program’s cost-sharing responsibilities. Or so concludes a new report from the Commonwealth Fund. According to the report, Medicare’s cost-sharing requirements – premiums, co-pays, deductibles, and services not covered by the program, such as dental and vision care – far outstrip the resources of more than 11 million low-income program participants, leaving many to spend more than 20 percent of their income on health care costs. In its new report “On Medicare But At Risk: A State-Level Analysis of Beneficiaries Who Are Underinsured or Facing High Total Cost Burdens,” the Commonwealth Fund describes the health care costs Medicare does and does not cover, … Read More

Posted in Medicare, Pennsylvania safety-net hospitals

PA Proposes Medicaid Observation Rate

Under a newly proposed policy, Pennsylvania would pay hospitals and physicians an observation rate for Medicaid patients who are treated in their emergency departments but for whom they cannot make an immediate decision on the need for admission. As described in a Pennsylvania Bulletin notice published last Saturday, Observation services are a well-defined set of clinically appropriate and medically necessary services, which include short-term treatment, assessment and reassessment, that are furnished while a decision is made as to whether to admit an MA beneficiary to the inpatient hospital setting for further treatment or to discharge the MA beneficiary from the hospital outpatient setting. The Department is recognizing the need for observation services because a physician may not be able to … Read More

Posted in Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy

Congressional Task Force Considers Medicaid Reforms

A House Energy and Commerce Committee group is looking at potential Medicaid reforms for 2017. The task force, consisting entirely of Republican members, was created late last year to “… strengthen and sustain the critical program for the nation’s most vulnerable citizens.” At a recent event at George Mason University, task force chairman Brett Guthrie (R-KY), cited continued high Medicaid spending as a reason to consider reform and noted that the degree to which the task force could tackle Medicaid in 2017 would depend on which party occupies the White House and controls Congress. He suggested that the task force would look for ways to prevent people from needing to choose between getting jobs and keeping health insurance. Among the … Read More

Posted in Uncategorized

Patient Safety Authority Issues Annual Report

The Pennsylvania Patient Safety Authority has issued its 2015 annual report. Go here for a news release summarizing the report and here for the report itself.  

Posted in Uncategorized

Affordability a Challenge for Many Newly Insured

Many Americans who have obtained private health insurance through the Affordable Care Act continue to have problems affording health care. According to a Kaiser Family Foundation report based on focus groups six states, low-income individuals with new private insurance report continued problems with: medical debt affording care that is not covered by their insurance plans handling out-of-pocket expenses, including deductibles unexpected bills for treatment they thought was covered Such patients pose a challenge for many Pennsylvania safety-net hospitals because of their inability to afford their co-pays and deductibles, leaving these hospitals with unexpected uncompensated care and bad debt. Because they care for more low-income patients than the average hospital, this is a bigger problem for the state’s safety-net hospitals. For … Read More

Posted in Affordable Care Act, Uncategorized
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