SNAPShots

HomeSNAPShots

Archive for Uncategorized

Medicaid is Toughest Insurer for Providers

Medicaid is the hardest insurer for providers when it comes to billing. Or so reports a new study published in the journal Health Affairs. According to this analysis, Medicaid claims take longer to file, are more likely to be rejected, more likely to be challenged, and take longer to be paid than Medicare and private insurance claims.  While the biggest problem is Medicaid fee-for-service claims, even Medicaid managed care claims pose more problems than Medicare and private insurance claims. This can pose a special challenge to Pennsylvania safety-net hospitals because they care for so many more Medicaid patients than the typical hospital. Learn more about the challenges providers face when working with Medicaid in the Health Affairs report “The Complexity … Read More

Posted in Uncategorized

Tackling Social Determinants of Health

The growing awareness of the impact of social determinants of health comes at a time when health care providers are assuming unprecedented degrees of risk for the health of their patients, leaving many providers wondering how best to invest resources that will meet both their own needs as well as the needs of their high-cost, high-need patients. A new document from the Commonwealth Fund, “Investing in social services as a core strategy for healthcare organizations:  Developing the business case,” seeks to serve as a manual for providers seeking to move into this relatively new territory. The report takes providers through key steps in the process, including establishing a common definition of social service investment; identifying common barriers to social service … Read More

Posted in Uncategorized

340B Program Getting the Job Done

The oft-scrutinized section 340B prescription drug discount program is doing what the program is supposed to do, according to a new analysis published on the Health Affairs Blog. According to the report, 340B DSHs treat significantly more low-income patients than non-340B hospitals, provide a disproportionate amount of the nation’s uncompensated and unreimbursed care, and are more likely to provide specialized services that are critical to low-income patients but which are often underpaid. In addition, 340B …has saved billions in drug costs while providing free or discounted care to millions of patients who might otherwise be unable to get needed care. This is accomplished at no cost to taxpayers. In addition, the report concludes that 340B-eligible hospitals: care for significantly more … Read More

Posted in Medicare, Uncategorized

Miller, Three Others Confirmed for Cabinet Posts

The Pennsylvania state senate has confirmed Wolf administration nominees for four health-related cabinet positions. Approved by the senate were Department of Human Services Secretary Teresa Miller, Department of Health Secretary Dr. Rachel Levine, Department of Drug and Alcohol Programs Secretary Jennifer Smith, and Insurance Commissioner Jessica Altman.  All had been serving on an interim basis. For more information about the new secretaries, see this Central Penn Business Journal article.

Posted in Uncategorized

States Adopt New Tools to Control Rising Medicaid Drug Costs

Faced with continued increases in the cost of prescription drugs in their Medicaid programs, states are pursuing new approaches in attempts to control those rising costs. In the past states have employed approaches such as beneficiary prescription limits, negotiating supplemental rebates from manufacturers, requiring prior authorization, implementing state maximum allowable cost programs, and operating preferred drug lists. Recently, however, states are turning to a number of new mechanisms to limit the growth of Medicaid prescription drug costs, including: introducing spending growth caps for Medicaid prescription drug costs, with unplanned increases in spending triggering a closer look at overall drug spending and a focus on specific drugs for utilization review; closed formularies; doing more to promote the use of generic drugs; … Read More

Posted in Uncategorized

NQF to Medicaid: Do a Better Job of Addressing Social Determinants of Health

State Medicaid programs need to do a better job of measuring and addressing the social risks their patients face, the National Quality Forum has asserted in a new report. To do so, NQF concluded, state Medicaid programs should “…work more with healthcare organizations and communities to better manage social disparities.” How? According to the NQF, state Medicaid programs should: Acknowledge that Medicaid has a role in addressing social needs that impact health. Create a comprehensive, accessible, routinely updated list of local community resources for healthcare organizations. Harmonize tools that assess social needs that impact health to ensure that they collect and document the same type of information. Create standards for inputting and extracting social needs data from electronic health records … Read More

Posted in Uncategorized

ED Myths Exposed

The uninsured do not use emergency rooms more than the insured. And the expansion of health insurance coverage increases rather than decreases ER use. So concludes the new Health Affairs study “The Uninsured Do Not Use the Emergency Department More – They Use Other Care Less.”  Find the study here.

Posted in Uncategorized

The Value-Based Payment Modifier: Program Outcomes and Implications for Disparities

Physicians who serve large numbers of low-income patients are more likely to incur penalties under Medicare value-based purchasing programs. So concludes a new study in Annals of Internal Medicine. According to the report, Performance differences between practices serving higher- and those serving lower-risk patients were affected considerably by additional adjustments, suggesting a potential for Medicare’s pay-for-performance programs to exacerbate health care disparities.  This result is based on a study of the Medicare Value-Based Payment Modifier program, which no longer operates, but could have implications for other programs that seek to reward or penalize practitioners based on the outcomes they produce. Such findings could lead practitioners to avoid serving such patients so they can avoid penalties, which in turn could jeopardize … Read More

Posted in Medicare, Pennsylvania safety-net hospitals, Uncategorized

New PA Website With Resources for Seniors and the Disabled

Pennsylvania has launched a new website called Pennsylvania Link to Community Care to help seniors and people with disabilities find resources to help them address the challenges they face in their lives. The site, a collaboration between the state’s Human Services and Aging departments, lists services in 12 categories:  advocacy, behavioral health, employment, finance, health care, housing, in-home services, legal, meals, protection from abuse, support groups, and transportation.  It also provides information to and links about programs, organizations, and services. To learn more, see this state news release about the new site or go here to see the Pennsylvania Link to Community Care site itself.

Posted in Uncategorized

Diabetes Admissions Up in PA

Hospital admissions for diabetes rose 13 percent in Pennsylvania between 2000 and 2016.  While admissions among older Pennsylvanians declined, the rate for younger people under the age of 45 increased 38 percent over that period of time. Diabetes admissions in Pennsylvania resulted in $205 million in payments to hospitals in 2016, but according to the Pennsylvania Health Care Cost Containment Council, about 86 percent of 2016 adult admissions could have been prevented with more timely and appropriate care and disease management. Learn more about the prevalence of diabetes admissions in Pennsylvania in the new PHC4 research brief “Pennsylvania Hospital Admissions for Diabetes,” which can be found here.

Posted in Uncategorized
P:(717)234-6970; F:(717)234-6971
2012 Safety-Net Association of Pennsylvania