Archive for March 2015
A federal program that helps selected health care providers obtain discounted drugs for low-income patients they are serving on an outpatient basis may soon face major changes. The 340B prescription drug pricing program, created more than 20 years ago to help serve low-income individuals, has come under fire in recent years in both the House and the Senate over how qualified, participating providers – disproportionate share hospitals, Federally Qualified Health Centers and their look-alikes, children’s hospitals, critical access hospitals, rural referral centers, and others – use the savings they derive from the program. While there is a general expectation that providers will use those savings to provide additional services to low-income patients, they are required neither to do that nor … Read More
The Pennsylvania Department of Human Services has published a “HealthChoices Key Events and Milestones” table outlining the key steps in the state’s transition from the Healthy PA Medicaid expansion to the Wolf administration’s Medicaid expansion through the state’s existing HealthChoices program. Listed on the timetable are the major steps in that transition and target dates for the completion of each. Find that timetable here.
One of the primary arguments made by the Safety-Net Association of Pennsylvania in favor of state Medicaid reimbursement policies that support the work of safety-net hospitals is that many of the low-income patients they serve have had sporadic contact with the health care system over the years and often present with medical problems that go well beyond the immediate reason that brings them to hospitals. Now comes new information that supports that argument. The medical testing company Quest Diagnostics has found that the number of Medicaid patients its testing has found to have diabetes has risen more than 24 percent during two recent six-month review periods in states that have expanded their Medicaid programs while the number of such patients … Read More
Every year the U.S. Department of Health and Human Services’ Office of the Inspector General (OIG) examines the operations of various department offices, programs, and policies and offers recommendations for changes and improvements. Some of those recommendations are adopted and others are not. The OIG annually publishes a document reiterating what it believes to be its most important and potentially useful recommendations that were not adopted, and that publication was just released. Among the Medicare and Medicaid recommendations it has presented again are: Establish accurate and reasonable Medicare payment rates for hospital inpatient services. Establish accurate and reasonable Medicare payment rates for hospital transfers. Reduce hospital outpatient department payment rates for ambulatory surgical center-approved procedures. Prevent inappropriate payments to Medicare … Read More
Means-testing for Medicare beneficiaries. Modest raises for doctors now and the promise of no cuts for a decade. An extension of the Children’s Health Insurance Program (CHIP) for ten years. These and other provisions are part of a new bill expected to move to the House this week that would eliminated the use of the Medicare sustainable growth rate formula (SGR) that threatens to cut Medicare payments to doctors 21 percent beginning on April 1. For years Congress has implemented temporary measures to prevent similar cuts but now, it appears to be serious about addressing the problem permanently by eliminating the SGR formula and introducing in its place a new payment system for doctors that pays them based on the … Read More
The Pennsylvania Department of Human Services (DHS) has posted a document outlining its plan for transitioning from the Healthy Pennsylvania Medicaid expansion to what it terms a “traditional Medicaid expansion.” The document summarizes what the state is doing, why it is doing it, and how it plans to move from the previous approach to the new one. It also includes links to expansion-related documents and explanations, presents the cost of the transition and the new program, and explains to interested parties how they can comment on the state’s plans. Find the notice document “Transition to Traditional Medicaid Expansion” here.
States are relying more on provider taxes and other sources to raise their share of Medicaid funding, a new study by the U.S. Government Accountability Office (GAO) has found. According to the GAO, state use of such funding rose 21 percent from 2008 to 2012. Most of the money came from health care provider taxes, provider donations, intergovernmental transfers, and Medicaid certified public expenditures. While the study examined the issue nation-wide it focused on Medicaid financing in three states: California, Illinois, and New York. Use of provider taxes is of special interest to Pennsylvania safety-net hospitals because it appears the state’s proposed FY 2016 budget may call for funding more of the state’s Medicaid program with proceeds from hospital provider … Read More
Safety-net hospitals are more likely than others to fare poorly under Medicare’s value-based purchasing program. Or so concludes a new study published in the journal Health Affairs. Researchers examined the impact of the addition of patient mortality measures to the program in 2014, and according to the abstract of the new study, We found that safety-net hospitals were more likely than other hospitals to be penalized under the VBP program as a result of their poorer performance on process and patient experience scores. In 2014, 63 percent of safety-net hospitals versus 51 percent of all other sample hospitals received payment rate reductions under the program. See the new study “Safety-Net Hospitals More Likely Than Other Hospitals To Fare Poorly Under Medicare’s Value-Based … Read More
With a March 31 deadline looming before Medicare payments to physicians are scheduled to decline more than 20 percent, it appears Congress may be considering permanent repeal of the underlying root of the problem rather than yet another short-term patch. At the heart of the problem is the sustainable growth rate formula, or SGR, that determines how Medicare pays physicians. For years Congress has applied short-term solutions to the SGR problem and paid for those solutions with short-term spending cuts. Now it appears congressional leaders are contemplating a permanent repeal of the troublesome formula. The cost of doing so is about $175 billion for ten years, and Congress reportedly is considering cuts in both benefits and provider payments. Because many … Read More
A new bill introduced in Congress last week would require Medicare to consider the socio-economic status of the patients individual hospitals serve as part of its hospital readmissions reduction program. The Establishing Beneficiary Equity in the Hospital Readmissions Program Act of 2015 was introduced as S. 688 in the Senate, sponsored by Senators Rob Portman (R-OH) and Joe Manchin (D-WV), and in the House by Representatives Jim Renacci (R-OH) and Eliot Engel (D-NY) as H.R. 1343. Rep. Renacci introduced a similar measure last year. This year’s version has bipartisan sponsorship in both the House and Senate. Since the launch of Medicare’s readmissions reduction program several years ago, a number of studies have suggested that the program is unfair to hospitals … Read More