Archive for December 2016
Medicare patients with social risk factors fare worse than others in programs that measure quality and the providers that serve them also perform worse than others on quality measures. This news comes from a new report presented to Congress by the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Planning Evaluation. The report, mandated by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, focused on nine Medicare payment programs: the hospital readmissions reduction program the hospital value-based purchasing program the hospital acquired condition reduction program the Medicare Advantage (Part C) quality star rating program the Medicare shared savings program the physician value-based payment modifier program the end-stage renal disease quality incentive program the … Read More
Medicare’s hospital-acquired conditions program unfairly penalizes large, large urban, and teaching hospitals, according to a new study. According to “Complication Rates, Hospital Size, and Bias in the CMS Hospital-Acquired Condition Reduction Program,” published recently in the American Journal of Medical Quality, the hospital-acquired conditions program, which last year penalized nearly 800 hospitals, disproportionately penalizes large, large urban, and teaching hospitals because its threshold for identifying poor-performing hospitals is too broad, it relies on results that in many cases are not statistically different, and it fails to recognize when hospital performance improves. To correct these biases, the study’s authors recommend adding risk-adjustment components, such as hospital size, to identify poor performers. Many of Pennsylvania’s safety-net hospitals are large and have teaching programs. … Read More
The Pennsylvania Health Law Project has published its November-December 2016 newsletter. Included in this edition are stories about a new effort to enroll children in the state’s Medicaid and Children’s Health Insurance Program, the new fees for Medicare Part A and Part B for 2017, a delay in the implementation of the state’s proposed Community HealthChoices program of managed long-term services and supports, and more. Go here for the latest edition of PA Health Law News.
Pennsylvania will be one of eight states to participate in a new federal two-year Certified Community Behavioral Health Clinic demonstration program. According to the federal Substance Abuse and Mental Health Services Administration, the program is …designed to improve behavioral health services in their communities. This demonstration is part of a comprehensive effort to integrate behavioral health with physical health care, increase consistent use of evidence-based practices, and improve access to high quality care for people with mental and substance use disorders. A federal spokesperson explained that The demonstration program will improve access to behavioral health services for Medicaid and CHIP beneficiaries, and will help individuals with mental and substance use disorders obtain the health care they need to maintain their … Read More
The Center for Medicare and Medicaid Innovation has announced a new Medicare-Medicaid Accountable Care Organization Model that it says …is focused on improving quality of care and reducing costs for Medicare-Medicaid enrollees. The MMACO Model builds on the Medicare Shared Savings Program (Shared Savings Program), in which groups of providers take on accountability for the Medicare costs and quality of care for Medicare patients. Through the Model, CMS will partner with interested states to offer new and existing Shared Savings Program ACOs the opportunity to take on accountability for the Medicaid costs for their assigned Medicare-Medicaid enrollees. In this new model, the Innovation Center … seeks to encourage participation from safety-net providers in Alternative Payment Models. Medicare-Medicaid ACOs that qualify … Read More
A new study has found that interventions that address patient problems such as difficulty affording food, housing, and medicine may lead to better health for those patients. According to a new study published in JAMA Internal Medicine, when the group Health Leads screened patients for unmet basic needs and helped address those needs, those patients showed significant improvement in blood pressure and cholesterol levels. While not conclusive – the interventions did not improve blood glucose levels – the study suggests that the kinds of patients served by Pennsylvania safety-net hospitals, who often turn to such hospitals for care with significant socio-economic risk factors, would benefit from a broader array of services than hospitals alone typically provide. Learn more by going here to view the JAMA … Read More
With the president-elect and congressional leaders vowing to repeal and replace the Affordable Care Act, the question arises about how such actions might affect Pennsylvania. That includes 680,000 Pennsylvanians who enrolled in the state’s Medicaid program after the reform law allowed for that program’s expansion, more than 400,000 people who signed up for insurance on the federal health insurance exchange, the state’s taxpayers who might be left with the bill for some or all of these costs if the reform law’s financial support were to disappear in the near future, and others. The Pittsburgh Tribune-Review considers these and other questions and offers answers from some of those closest to the situation. See its story here.
Five foundations have joined forces to pursue new approaches to serving patients with complex medical needs. The Commonwealth Fund, the John A. Hartford Foundation, the Peterson Center on Healthcare, the Robert Wood Johnson Foundation, and The SCAN Foundation engaged the Institute for Healthcare Improvement to identify promising ways of better serving patients with complex medical needs. Many such patients, the foundations believe, have adequate access to medical care yet struggle to find the coordination needed between medical, behavioral, and social services to stay well and avoid costly hospitalizations. The group’s first public product is The Playbook, which it describes as …a dynamic website that highlights the challenges facing adults with complex health and social needs and provides direction on how to meet … Read More