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 treats an especially high proportion of Medical Assistance patients and provides the services that those patients need most. In SNAP’s view, safety-net hospitals provide more care to Medical Assistance patients than the state-wide average, which is 15 percent of inpatient days (based on currently available data), and also deliver babies and/or provide inpatient behavioral health services – the two most common reasons that Medical Assistance recipients are admitted to hospitals. If a hospital does not deliver babies or provide inpatient behavioral health care, it is considered a safety-net hospital only if at least 25 percent of its inpatient days are in service to Medical Assistance patients. The 25 percent mark represents one standard deviation above the state-wide statistical mean – a measure that indicates that such hospitals’ service to the Medical Assistance population is considered greater to a statistically significant degree and, in SNAP’s view, therefore deserving of this special designation.

3. What do safety-net hospitals look like?

Safety-net hospitals are located throughout Pennsylvania, and while they share the common characteristic of their unusual level of service to low-income Pennsylvanians, they are diverse in other ways: they include community hospitals, teaching hospitals, children’s hospitals, and academic medical centers; they are large, small, and medium-sized hospitals; they are located in urban, suburban, and rural areas as well as in the western, eastern, and central parts of the state; and they can be found in 31 of Pennsylvania’s 67 counties.

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

A major payer of safety-net hospitals, Medical Assistance significantly underpays for hospital services. In Pennsylvania today, Medical Assistance payments generally cover less than 80 percent of the cost of providing inpatient care and only about 50 percent of the cost of outpatient services. This means that the more Medical Assistance patients a hospital serves, the more money it loses – and Pennsylvania’s safety-net hospitals provide far more care to Medical Assistance patients than other hospitals. 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. Because of where they are located, moreover, hospitals that care for especially large numbers and high proportions Medical Assistance patients also care for more uninsured patients – yet another financial challenge these safety-net hospitals must overcome.

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

The state’s approach to recognizing the disproportionate amount of care provided by safety-net hospitals to low-income Pennsylvanians is both antiquated and inadequate. A major part of SNAP's job is to create awareness of the special challenges that safety-net hospitals face and the special needs they have as a result. SNAP also advocates vigorously for Medical Assistance reimbursement policies that direct more state resources to where they are needed most: the safety-net hospitals that are doing the most to care for low-income and uninsured Pennsylvanians.

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

Yes – very different. In many 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 largely 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 and local communities in service to low-income Pennsylvanians.

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

SNAP is the only hospital 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. In a lot of states, it’s not uncommon to see smaller hospital associations that focus on specific geographic areas or types of care, but when you look closer, you see that they’re really part of their state’s largest hospital association. Is SNAP any different from those groups?

Definitely. SNAP is an independent advocate of the needs of safety-net hospitals that is not affiliated with any other hospital association in any way. It is funded solely by its members and its staff takes direction solely from those members. SNAP pursues its own, independent agenda and charts its own course of action, and while SNAP welcomes opportunities to work with other hospital groups when our interests coincide, it follows its own, independent course with little need to compromise its objectives because its members’ interests are so similar.

9. I’m associated with a safety-net hospital. Why should we join SNAP?

Because Medical Assistance is absolutely critical to your hospital’s financial health and no other group is making your Medical Assistance reimbursement its first and only priority. When push comes to shove, general interest hospital organizations will always sacrifice your Medical Assistance interests for those of its other members. Why wouldn’t they? After all, safety-net hospitals constitute only one-third of the state’s acute-care hospitals, and have you ever heard of a general interest association advocating policy changes that would benefit one-third of its members at the possible expense of the other two-thirds? No one can reasonable expect that of a general hospital group – not even SNAP members expect it – and that’s why it’s so important to have an association that makes your Medical Assistance interests its first and only priority. As a member of SNAP, you play a direct role in deciding what issues the organization addresses, what positions it takes, and how it pursues its interests. Can you think of any broad-based associations that don’t leave you feeling like you take orders from them?

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