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Congress Looks at 340B Program

Last week the House Energy and Commerce Committee took a look at the 340B prescription drug discount program, which requires pharmaceutical companies to sell discounted drugs for outpatient use to hospitals that care for especially large numbers of low-income patients. The previous week, the Centers for Medicare & Medicaid Services issued a proposed Medicare regulation calling for significant reductions in Medicare payments for such drugs. The hearing touched on the CMS proposal to reduce Medicare payments for 340B drugs, the high prices of prescription drugs, the 340B program’s growth over the years, the possibility that the program is being abused by hospitals and clinics, and more. The 340B program is an essential tool in the efforts of Pennsylvania safety-net hospitals … Read More

Posted in Medicare, Pennsylvania safety-net hospitals, Uncategorized

PHC4 Looks at “Super-Utilizers”

The Pennsylvania Health Care Cost Containment Council has released a new research brief on so-called super-utilizers:  a small portion of the population that consumes an inordinate amount of health care.  Super-utilizers are defined as individuals with five or more hospital admissions a year. According to the PHC4 report, Three percent of hospitalized patients accounted for 10 percent of hospital payments, or $1.25 billion, in 2016. Super-utilizers accounted for three percent of hospitalized patients, 10 percent of hospital payments, 12 percent of hospital admissions, and 15 percent of hospital days. 46 percent of that care was paid for by Medicare, 19 percent by Medicaid, and 19 percent was for dually eligible patients. The top three reasons for admissions among super-utilizers were … Read More

Posted in Uncategorized

New Report on PA Hospital Financial Performance

The Pennsylvania Health Care Cost Containment Council has published its annual report detailing the financial health of acute-care hospitals in the state. According to the report, hospital net patient revenue increased in FY 2016, accounts receivable are being paid faster, operating and total margins rose, and uncompensated care declined. The report describes hospital financial performance and utilization state-wide and by region and also presents FY 2016 margin, uncompensated care, and Medicare and Medicaid share data for every acute-care hospital in the state. Go here to find the PHC4 report Financial Analysis 2016:  General Acute Care Hospitals.

Posted in Uncategorized

Medicaid Per Capita Caps Explained

In a new report, the Commonwealth Fund looks at Medicaid per capita caps, an idea that has been discussed for years, that was part of the as-yet unsuccessful American Health Care Act, and a proposal that is almost certain to resurface in the near future. Among other things, the article explains what per capita caps are and how they would work describes how per capita caps differ from current Medicaid policy considers how the implementation of per capita caps might affect low-income people, providers, and insurers Learn more in the Commonwealth Fund article “Essential Facts About Health Reform Alternatives: Medicaid Per Capita Caps,” which can be found here.

Posted in Federal Medicaid issues, Uncategorized

New MACPAC Study Evaluates Medicaid, Medicare Payments

Medicaid payments to hospitals are comparable to or even higher than Medicare payments. Or at least they are once supplemental Medicaid payments are included. So concludes a new study by the Medicaid and CHIP Payment and Access Commission, a non-partisan legislative branch agency that advises the states, Congress, and the administration on Medicaid and CHIP payment and access issues. In what MACPAC bills as the “first-ever study to construct a state-level payment index to compare fee-for-service inpatient hospital payments across states and to benchmark Medicaid payments to other payers such as Medicare,” the study found that Across states, base Medicaid payment for inpatient services varies considerably, ranging from 49 percent to 169 percent of the national average. This variation is … Read More

Posted in Medicaid supplemental payments, Pennsylvania Medicaid policy, Uncategorized

Medical Homes and High-Need Patients

With five percent of patients accounting for 50 percent of health care costs, such high-need patients are the subject of increasing attention as health care providers search for better ways to serve them at less cost.  Such patients are especially challenging when they lack the financial resources and personal support systems needed to address their considerable medical needs. One of those ways is through the concept of the medical home:  an approach to primary care, also often referred to as a patient-centered medical home, that is a team-based approach to delivering patient-specific, coordinated, accessible care that focuses on quality and safety and that features as one of its defining characteristics closer contact between patients and their caregivers. Pennsylvania safety-net hospitals … Read More

Posted in Uncategorized

CMS Shares Evaluation of Medicare-Medicaid Financial Alignment Efforts

In 2011 the Centers for Medicare & Medicaid Services launched a “Medicare-Medicaid Financial Alignment Initiative” that seeks “…to provide Medicare-Medicaid enrollees with a better care experience and to better align the financial incentives of the Medicare and Medicaid programs.” How is that initiative working so far?  CMS recently released three reports that evaluate different aspects of the program.  Those reports are: “Early Findings on Care Coordination in Capitated Medicare-Medicaid Plans under the Financial Alignment Initiative” “Beneficiary Experience: Early Findings from Focus Groups with Enrollees Participating in the Financial Alignment Initiative” “Issue Brief: Special Populations Enrolled in Demonstrations under the Financial Alignment Initiative” Pennsylvania’s private safety-net hospitals serve especially large numbers of dually eligible Medicare and Medicaid beneficiaries, so such programs … Read More

Posted in Federal Medicaid issues, Medicare, Uncategorized

MACPAC Meets, Discusses Medicaid Issues

Members of the non-partisan legislative branch agency that advises Congress, the Secretary of Health and Human Services, and the states on Medicaid and Children’s Health Insurance Program matters met in Washington recently to discuss a number of issues. On the agenda of the Medicaid and CHIP Payment and Access Commission were the following issues: state Medicaid flexibility state Medicaid responses to fiscal pressures a study requested by Congress on mandatory and optional benefits and populations current Medicaid parallels to per capita financing options illustrations of state-level effects of per capita cap design elements high-cost hepatitis C drugs the role of section 1915(b) waivers in Medicaid managed care Because Pennsylvania safety-net hospitals serve so many Medicaid and CHIP participants, MACPAC’s deliberations … Read More

Posted in Federal Medicaid issues, Pennsylvania safety-net hospitals, Uncategorized

Wolf Asks Ryan to Preserve Medicaid Expansion

In a letter to House Speaker Paul Ryan, Pennsylvania Governor Tom Wolf urged Congress, no matter how it addresses the Affordable Care Act, to preserve that law’s expansion of access to Medicaid-covered health care services. The governor specifically pointed to the many people who receive substance abuse treatment through those services. If the Affordable Care Act, or Obamacare, is repealed and not replaced, over a million Pennsylvanians could lose access to health care and tens of thousands of people – people who are our friends, our neighbors, and our family members that are currently receiving treatment for a substance use disorder – would lose insurance coverage and no longer be able to afford their treatment. See Governor Wolf’s complete letter … Read More

Posted in Affordable Care Act, Uncategorized

Academies Completes Work on Social Risk Factors in Health Care

Completing its assignment from the U.S. Department of Health and Human Services, the Health and Medicine Division of the National Academies of Science, Engineering, and Medicine has published its fifth and final report on social risk factors that affect health outcomes for Medicare beneficiaries and how to account for those risk factors in Medicare payments. Among other things, the report notes that Although VBP [value-based purchasing] programs have catalyzed health care providers and plans to address social risk factors in health care delivery through their focus on improving health care outcomes and controlling costs, the role of social risk factors in producing health care outcomes is generally not reflected in payment under current VBP design. This misalignment has led to … Read More

Posted in Medicare, Pennsylvania safety-net hospitals, Uncategorized
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