Archive for March 2016

Group Organizes Advocacy in Support of 340B Program

Under pressure from federal regulators and MedPAC, the advocacy group 340B Health is attempting to rally hospital groups behind the 340B prescription drug discount program that requires pharmaceutical companies to provide discounts to qualified hospitals for drugs dispensed on an outpatient basis to Medicaid patients. Last year the Health Resources and Services Administration, which runs the program, issued proposed regulations that would change how the program operates and is governed. Recently, MedPAC proposed reducing the size of the discount hospitals receive for the drugs, with the savings to be redirected to fund additional Medicare disproportionate share (Medicare DSH) payments for selected hospitals. More than 2100 organizations participate in the 340B program, including most Pennsylvania safety-net hospitals. For a closer look … Read More

Posted in Pennsylvania safety-net hospitals

Beware Medicaid Block Grants, Analysis Suggests

When the federal government turns housing, health, and social services programs into block grants, funding for such programs erodes over time, according to a new analysis by the Center on Budget and Policy Priorities. The study found that Policymakers advancing these proposals often accompany them… with assurances that the new block grant would get the same overall amount of funding as currently goes to the individual programs that it would replace.  This new analysis of several decades of budget data strongly suggests, however, that even if a new block grant’s funding in its initial year matched the prior funding for the programs merged into the block grant, the initial level likely wouldn’t be sustained.  History shows that when social programs … Read More

Posted in Uncategorized

Socio-Economic Factors Again Tied to Hospital Readmissions

Another study has linked socio-economic factors to increased hospital readmissions. This latest study, published in the Journal for Healthcare Quality, found that … meaningful risk-adjusted readmission rates can be tracked in a dynamic database. The clinical conditions responsible for the index admission were the strongest predictive factor of readmissions, but factors such as age and accompanying comorbid conditions were also important. Socioeconomic factors, such as race, income, and payer status, also showed strong statistical significance in predicting readmissions. Conclusions: Payment models that are based on stratified comparisons might result in a more equitable payment system while at the same time providing transparency regarding disparities based on these factors. No model, yet available, discriminates potentially modifiable readmissions from those not subject … Read More

Posted in Medicare, Pennsylvania safety-net hospitals

MedPAC Offers DSH, 340B Recommendations

The Medicare Payment Advisory Commission has recommended that Congress direct changes in the 340B prescription drug discount program and in the manner in which Medicare makes disproportionate share hospital payments (Medicare DSH). In its annual report to Congress, MedPAC recommended a reduction in 340B prescription drug payments to hospitals. The proposed reduction would cut 340B program spending approximately $300 million. MedPAC then recommended that those 340B savings be redirected to the Medicare DSH uncompensated care pool. And it also called for distributing the money in that pool based on better data on the uncompensated care hospitals provide, as reported on hospitals’ Medicare cost report S-10 worksheets, so that the Medicare DSH uncompensated care program would “…better target additional payments to … Read More

Posted in Medicare

MACPAC Unhappy With How DSH is Dished

Medicaid disproportionate share hospital payments (Medicaid DSH) are not getting to the hospitals that need them most, according to the independent agency that advises Congress and the administration on Medicaid access, payment, and care delivery issues. In its March 2016 Report to Congress on Medicaid and CHIP, the Medicaid and CHIP Payment and Access Commission found …little meaningful relationship between DSH allotments and three aspects of DSH payments that Congress asked us to study: 1) the relationship of state DSH allotments to data relating to changes in the number of uninsured individuals, 2) data relating to the amount and sources of hospitals’ uncompensated care costs, and 3) data identifying hospitals with high levels of uncompensated care that also provide access to … Read More

Posted in Affordable Care Act, Medicaid supplemental payments

Hospitals Failing to Prevent Avoidable Readmissions

Hospitals continue to fail to prevent many avoidable readmissions, a new study in JAMA Internal Medicine has concluded. Among the causes? Patients who shouldn’t have been admitted through the ER in the first place, post-discharge instructions written at too high a level for patients, failure of patients to keep follow-up appointments, and hospitals discharging patients too soon. Two of those causes – hard-to-understand discharge instructions and difficulty keeping follow-up appointments – as problems that are especially prevalent within the kinds of communities served by Pennsylvania’s safety-net hospitals. In all, the study of 12 academic medical centers concluded that 15 percent of readmissions were preventable, 12 percent were likely unpreventable, and there was about a 50 percent chance of preventing another … Read More

Posted in Uncategorized

IOM Weighs in on Social Determinants Training

If patients’ symptoms and conditions are the product of who they are, where they are from, and how they have lived, can better understanding those circumstances help providers serve those patients more effectively? Increasingly the answer to that question has been yes, it can, and now, the National Academies of Science, Engineering, and Medicine and the Institute of Medicine have proposed an approach to training caregivers on the social determinants of health. Their new publication, A Framework for Educating Health Professionals to Address the Social Determinants of Health, notes that The World Health Organization (WHO) defines social determinants of health as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping … Read More

Posted in Safety-Net Association of Pennsylvania, Uncategorized

GAO Looks at Supplemental Medicaid Payments

Following up its own 2012 report that identified more than 500 hospitals receiving supplemental Medicaid payments that resulted in Medicaid payment surpluses, the U.S. Government Accountability Office has taken a broader look at supplemental payments state Medicaid programs make to hospitals and how those payments are used. In a limited study of hospitals in four states, GAO found that some hospitals used supplemental payments for purposes other than serving Medicaid patients and the uninsured – purposes such as ordinary operations, capital purchases, a poison control center, even a helicopter. GAO also found that hospitals were more likely to receive such payments if local funding was used to draw down federal Medicaid matching funds. In some places, hospitals with local governments … Read More

Posted in Uncategorized

Latest Edition of Health Law News

The Pennsylvania Health Law Project has released the latest edition of its newsletter. The February edition includes features about Governor Wolf’s proposed FY 2017 Medicaid budget, the launch of a new “fast track” Medicaid enrollment program, the state’s plans for a new approach to providing managed long-term services and supports, and more. Find the newsletter here.

Posted in Pennsylvania Medicaid policy, Pennsylvania proposed FY 2017 budget

SNAP Comments on Balance Billing Proposal

The Safety-Net Association of Pennsylvania has submitted comments to the Pennsylvania Insurance Department addressing that department’s proposed Balance Billing Protection Act. While supporting the concept of addressing the problem of surprise balance billing for insurance-covered medical services, SNAP encouraged the Insurance Department to consider the potential market-influenced conditions that may be leading to balance billing; to foster greater transparency and better communication between consumers, insurers, and providers; to avoid any methodology for resolving reimbursement disputes that favors insurers over providers; and to require hospitals to participate in reimbursement dispute resolution only when hospitals are part of that dispute and not when they are only the site at which the disputed services were delivered. SNAP also encouraged the Insurance Department to … Read More

Posted in Uncategorized
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