Safety Net Association of PA

1. What is the Safety-Net Association of Pennsylvania?

The Safety-Net Association of Pennsylvania, or “SNAP,” is an advocacy organization for private, acute-care safety-net hospitals that care for especially high proportions of low-income patients. Our mission is to educate policy-makers in Harrisburg about the role, status, and future of the health care safety-net in Pennsylvania; to advocate for the communities that safety-net hospitals serve; to build consensus to ensure the continued viability of safety-net hospitals; and to advocate vigorously for state health care policies that meet the needs of safety-net hospitals.

2. What is a safety-net hospital?

A safety-net hospital is a hospital that treats an especially high proportion of low-income patients. SNAP measures a hospital's service to low-income patients by looking at the combination of services it provides to three low-income groups: Medical Assistance, Medicare SSI, and uninsured patients. SNAP defines safety-net hospitals as acute-care hospitals that care for a greater proportion of low-income patients than 75 percent of all acute-care hospitals in the state. The Pennsylvania General Assembly directed that this same low-income measure be used to distribute tobacco settlement funds for uncompensated care.

3. What do safety-net hospitals look like?

Safety-net hospitals are located throughout Pennsylvania in urban, suburban, and rural areas and in 20 of the state's 67 counties. They are large and small, teaching and non-teaching. The common thread that binds them is that safety-net hospitals all serve high proportions of low-income patients - distinctly greater proportions than other hospitals in the state.

4. Why are safety-net hospitals worse off financially?

Government programs such as Medical Assistance, CHIP, and Adult Basic - major payers of safety-net hospitals – significantly underpay for hospital services. In Pennsylvania today, Medical Assistance payments generally cover less than 80 percent of the cost of providing care. When payments do not cover the costs of treatment for a significant portion of the patients that a hospital serves, that hospital is put in financial jeopardy. The more Medical Assistance patients these hospitals serve, the more money they lose – and Pennsylvania's safety-net hospitals care for more Medical Assistance patients than other hospitals. Because of where they are located, moreover, hospitals that care for more Medical Assistance patients also care for more uninsured patients – yet another financial challenge these safety-net hospitals must overcome. Overall, safety-net hospitals serve more than three times as many Medical Assistance patients and nearly two-thirds more uninsured patients than other Pennsylvania hospitals.

5. Why don't government payers treat safety-net hospitals differently?

Before SNAP came along, no one ever suggested it. A major part of SNAP's job is simply to create awareness of the special challenges that safety-net hospitals face – and the special needs they have as a result.

6. Is the health care safety net different in other states?

Yes - very different. In other states, the health care safety net consists primarily of public hospitals. Pennsylvania, however, does not have any public hospitals, so safety-net responsibilities have fallen to the private sector. In fact, Pennsylvania is the largest state in the nation with no public hospitals. In those other states, public hospitals receive significant local, county, and state subsidies to support their safety-net activities; Pennsylvania's private safety-net hospitals do not – and they suffer financially as a result. Despite this, the commonwealth's safety-net hospitals view themselves as working in partnership with the state in service to low-income Pennsylvanians.

7. What is SNAP doing to help safety-net hospitals?

SNAP is the only advocacy group in Pennsylvania that focuses exclusively on the interests and needs of safety-net hospitals. SNAP advances the agenda of safety-net hospitals through education, research, and advocacy. First, SNAP works to ensure that public policy-makers understand the unique challenges that safety-net hospitals face and the importance of preserving these hospitals as the only way of ensuring access to health care for all Pennsylvanians. Second, SNAP performs detailed analyses of hospitals and their financial performance that help document and define these special challenges. Third, SNAP offers creative, workable solutions to the problems we identify: instead of simply asking for help, SNAP attempts to develop and advocate politically and financially feasible ways to provide that help. Finally, SNAP advocates the interests of safety-net hospitals and works to build consensus among stakeholders – including government - for policies that will promote, preserve, and protect Pennsylvania's health care safety net.

8. Can public policy really be changed to help safety-net hospitals?

Absolutely – and in fact, it already has, and the uncompensated care payments paid from tobacco settlement funds are proof that it can be done. In Pennsylvania today, policy-makers are genuinely concerned about the ability of all Pennsylvanians to obtain the health care they need and have demonstrated their willingness to help hospitals that provide the lion's share of that care.

But SNAP believes that first, they must be shown which hospitals are providing most of that care and how best to provide the help those hospitals need. For this reason, safety-net hospitals need to work together in a bipartisan manner, bringing together organizations from all parts of the state with friends on both sides of the political aisle to change state health care and reimbursement policies and practices in ways that will benefit safety-net hospitals.

9. SNAP has been around for a few years now. What has it accomplished so far?

A lot. Specifically:

On November 26, 2002, the Pennsylvania House of Representatives unanimously adopted House Resolution 743, advocated vigorously by SNAP, that officially recognized the existence of safety-net hospitals in Pennsylvania as defined by SNAP and called on the General Assembly to “take into account the special situation of these vital hospitals when implementing public policy.”
SNAP played a major role in directing selected Medical Assistance FY 2005 fee-for-service outpatient rate increases to selected safety-net hospitals.
SNAP was instrumental in the restoration of four hospitals to the list of those that qualify for Medical Assistance disproportionate share payments.
SNAP issued a paper on health care quality and the Medical Assistance reimbursement system that helped shape the quality component that was introduced into the state's Medical Assistance program.
SNAP's call for comprehensive Medical Assistance hospital payment reform was the driving force behind the current reform effort, and SNAP's recommendations for reform provided the starting point for reform talks - and continue to play a major role in those talks.
Most important, SNAP has introduced the term “safety-net hospital” into the language of health care policy in Pennsylvania. Elected and appointed officials in both the administration and the General Assembly now routinely use the term “safety-net hospital” – a term that did not exist in those circles before SNAP was formed in the fall of 2002. This, we believe, will pay major dividends for Pennsylvania's safety-net hospitals in the months and years to come.

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