July 2015 - Safety-Net Association of Pennsylvania

CMS Proposes New Medicaid Substance Abuse Initiatives

The Centers for Medicare & Medicaid Services (CMS) has announced a new initiative designed to improve how states identify and serve Medicaid beneficiaries with substances use disorders (SUD).
According to a recent notice sent by CMS to state Medicaid directors, the agency is proposing

… an opportunity to allow states embarking on broad and deep system transformations in the area of SUD to pursue 1115 demonstrations to improve the care and outcomes for individuals with SUD. This new initiative would be available to states that are developing comprehensive strategies to ensure a full continuum of services, focusing greater attention to integration efforts with primary care and mental health treatment, and working to deliver services that are considered promising practices or have fidelity to evidence-based models consistent with industry standards. In addition, we seek to support states that are interested in developing new payment mechanisms and performance quality initiatives…

The aim of this initiative is to enable states that are pursuing significant delivery system transformation efforts in the area of SUD to better identify individuals with an SUD in the Medicaid population, increase access to care for these individuals, increase provider capacity, to deliver effective treatments for SUD, and use quality metrics to evaluate the success of these interventions.

The notice outlines the specific goals of the initiative, the reforms CMS seeks, examples of the kinds of changes it envisions, the results it expects to see, and the process for pursuing section 1115 waivers to launch such initiatives.
For a more detailed look at what CMS is attempting to achieve and how it envisions states working to achieve it, see the letter “New Service Delivery Opportunities for Individuals with a Substance Use Disorder” sent by CMS to the nation’s Medicaid directors.

PA Safety Net Admin2015-07-30T06:00:07+00:00July 30th, 2015|Uncategorized|Comments Off

The Challenges Medicaid Faces

As it celebrates is fiftieth birthday, Medicaid now covers 70 million Americans at a cost of $500 billion a year. As the program continues to grow amid the expansion facilitated by the Affordable Care Act, Kaiser Health News has identified the five biggest challenges the program faces today:

controlling costs
getting all states to expand income eligibility
providing better oversight of managed care
ensuring access to doctors and dentists
meeting the growing demand for long-term care

For a closer look at these challenges and what they entail, see this Kaiser Health News article.

PA Safety Net Admin2015-07-29T06:00:55+00:00July 29th, 2015|Affordable Care Act|Comments Off

439,000 Added to PA Medicaid Rolls

150,000 Pennsylvanians have enrolled in Medicaid since the Wolf administration officially launched its HealthChoices expansion on April 27.
Added to the 289,000 who enrolled during the Corbett administration’s Healthy Pennsylvania program, that means about 439,000 Pennsylvanians have obtained Medicaid coverage since the state expanded its Medicaid program as authorized by the 2010 federal health care reform law.
To learn more about the latest Medicaid enrollments, their financial impact on the state, and how the HealthChoices expansion works, see this Wolf administration news release.

PA Safety Net Admin2015-07-27T06:00:19+00:00July 27th, 2015|Affordable Care Act, HealthChoices PA, Healthy PA|Comments Off

GAO Looks at Behavioral Health Options

Access to behavioral health services can be a challenge for low-income adults, so the U.S. Government Accountability Office (GAO) recently looked into those challenges.
In a new report, the GAO examined how many low-income adults have behavioral health problems, where they can go to receive the care they need – including whether there are differences in those options depending on whether the state in which the reside has expanded its Medicaid program – how Medicaid expansion states are providing coverage for behavioral health for newly eligible beneficiaries, and how obtaining Medicaid coverage affects the ability of such individuals to get the care they seek.
Access to behavioral health care can be an especially major challenge in the low-income communities typically served by Pennsylvania’s safety-net hospitals.
Read about the GAO’s findings in the report Options for Low-Income Adults to Receive Treatment in Selected States, which you can find here.

PA Safety Net Admin2015-07-24T06:00:04+00:00July 24th, 2015|Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

Graduate Medical Education: Boon or Bane for Hospitals’ Bottom Line?

Do hospitals make money on graduate medical education? Do they lose money subsidizing positions above and beyond the funding they receive for completing the training of the next generation of doctors? Are there other benefits hospitals reap from medical education training programs – and are those benefits worth the cost?
This is an important question for the many Pennsylvania safety-net hospitals that also are teaching hospitals.
Crain’s Detroit Business has taken a look at some of the surprisingly complex considerations that go into answering what seem like very simple questions. Go here for its report “Hospitals say they subsidize graduate medical education, but cost-benefit unknown.”

PA Safety Net Admin2015-07-23T06:00:32+00:00July 23rd, 2015|Medicare|Comments Off

Unleashing Nurse Practitioners Could Save PA Billions, Report Says

A new report suggests that enabling nurse practitioners to practice without collaborating physicians could save Pennsylvanians $6.4 billion in health care costs over the next ten years.
In addition, nurse practitioners are more likely than physicians to serve in rural and medically underserved areas and would provide primary care at a time when the state is facing a predicted shortfall in primary care physicians.
Twenty-one states already permit nurse practitioners to practice without a collaborating physician.
The study, “Value of Full Practice Authority in Pennsylvania,” was performed by law students at the Duke University School of Law and underwritten by the Pennsylvania Coalition of Nurse Practitioners. Find the study here.

PA Safety Net Admin2015-07-20T06:00:29+00:00July 20th, 2015|Uncategorized|Comments Off

GAO Identifies Medicaid Challenges

As Medicaid marks its 50th anniversary, the U.S. Government Accountability Office (GAO) testified recently before the House Energy and Commerce Committee’s Health Subcommittee on the major challenges facing the program.
GAO’s testimony focused on four major issues:

access to care
transparency and oversight
program integrity
federal financing

The GAO concluded that it

…considers Medicaid a high-risk program due to its size, growth, diversity, and gaps in oversight…

See GAO’s complete testimony here.

PA Safety Net Admin2015-07-16T06:00:43+00:00July 16th, 2015|Uncategorized|Comments Off

Study Finds Shortage of Nurses in PA

A study commissioned by the Pennsylvania State House of Representatives has found a shortage of nurses in Pennsylvania hospitals.
The study, performed by the Joint State Government Commission, found

…a clear relationship between nurse staffing and patient outcomes. Although there is not an overall shortage of nurses in Pennsylvania, Pennsylvania hospitals vary significantly from one to the next in terms of nurse staffing, which contributes to disparities in quality of care across the state. This variation is much greater than can be justified by differences in patient need and is not in the public interest.

Based on these findings, the Joint State Government Commission offered the following recommendations:

Pennsylvania should improve nurse workforce data collection and analysis.
Pennsylvania should consider implementing a public reporting system for hospital staffing levels.
Hospitals should consider consistency of nurse staffing “off-shifts” (nights, weekends, holidays).
Pennsylvania hospitals should make improvements to the nurse work environment.
Pennsylvania should increase the percent of nurses with a Bachelor’s of Science degree in nursing.
Pennsylvania should extend the whistleblower protection law to include nurses.

Go here for the Joint State Government Commission report Professional Bedside Nursing in Pennsylvania: A Staff Study.

PA Safety Net Admin2015-07-15T06:00:33+00:00July 15th, 2015|Uncategorized|Comments Off

Medicaid Highlighted in Latest Health Affairs

The journal Health Affairs has dedicated its July 2015 edition to “Medicaid’s Evolving Delivery Systems.”
The edition includes the following articles about different aspects of Medicaid:

“Medicaid’s Growing Role in Care Delivery”
Once a Welfare Add-On, Medicaid Takes Charge in Reinventing Care”
“Medicaid at 50: Remarkable Growth Fueled by Unexpected Politics”
“Medicaid Moving Forward”
“Community Health Centers and Medicaid at 50: An Enduring Relationship Essential for Health System Transformation”
“Many Medicaid Beneficiaries Receive Care Consistent With Attributes of Patient-Centered Medical Homes”
“MetroHealth Care Plus: Effects of a Prepared Safety Net on Quality of Care in a Medicaid Expansion Population”
“Lessons From Medicaid’s Divergent Paths on Mental Health and Addiction Services”
“The Supreme Court Ruling That Blocked Providers From Seeking Higher Medicaid Payments Also Undercut the Entire Program”
“An Examination of Medicaid Delivery System Reform Incentive Payment Initiatives Under Way in Six States”
“Early Medicaid Expansion in Connecticut Stemmed the Growth in Hospital Uncompensated Care”
“Reducing Medicaid Churning: Extending Eligibility for Twelve Months or to End of Calendar Year is Most Effective”

Medicaid is, of course, among Pennsylvania safety-net hospitals’ most important payers.
Find the July edition of Health Affairs here.

PA Safety Net Admin2015-07-14T06:00:48+00:00July 14th, 2015|Uncategorized|Comments Off

GAO Reports on 340B Program

The U.S. Government Accountability Office (GAO) recently completed a review of the federal 340B Drug Pricing Program.
The program, which requires pharmaceutical companies to provide drug discounts to qualified hospitals that serve especially large proportions of low-income patients, has come under fire recently because approximately 40 percent of U.S. hospitals now participate in the program and there have been questions about how hospitals use the program and its drug discounts.
The GAO found that Medicare Part B spending on drugs was much higher at participating 340B hospitals than it was at non-participating hospitals, suggesting that participating hospitals prescribe more drugs and more expensive drugs. It found that

The Centers for Medicare & Medicaid Services (CMS), which administers the Medicare program, uses a statutorily defined formula to pay hospitals for drugs at set rates regardless of hospitals’ costs for acquiring the drugs. Therefore, there is a financial incentive at hospitals participating in the 340B program to prescribe more drugs or more expensive drugs to Medicare beneficiaries.

In the review, GAO recommended that

Congress should consider eliminating the incentive to prescribe more drugs or more expensive drugs than necessary to treat Medicare Part B beneficiaries at 340B hospitals.

Go here to find the GAO report Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals.
A number of groups have criticized GAO’s findings. Learn about their perspective in articles in Healthcare Finance News, Modern Healthcare, and Becker’s Hospital Review.

PA Safety Net Admin2015-07-13T06:00:49+00:00July 13th, 2015|Medicare|Comments Off

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