Archive for July 2016

ACA Slowly, Surely Improving Health Status

A new survey has found that the combination of Affordable Care Act-driven enhanced access to health insurance and improved performance by health care providers is producing better health status in communities across the U.S. The survey looked at health status in 306 regional health care markets based on factors such as access to care, quality, avoidable hospital use, health care costs, and health outcomes found modest improvements in these areas and attributed those improvements to expanded access to health insurance and government quality programs introduced through the Affordable Care Act. The gains the survey documented occurred from 2011 through 2014. To learn more about how the survey was administered and what it found and to see and compare health status … Read More

Posted in Affordable Care Act

Report to CMS on Risk Adjustment of Medicare Payments

The National Academies of Sciences, Engineering, and Medicine has issued its latest report to the Centers for Medicare & Medicaid Services on how to adjust Medicare payments to hospitals based on the socio-economic risk factors hospitals’ patients pose. At the request of CMS, the Academies created an expert committee to …identify criteria for selecting social risk factors, specific social risk fascinators Medicare could use, and methods of accounting for those factors in Medicare quality measurement and payment applications. The committee created for this purpose viewed its goal to be  …to guide the selection of social risk factors that could be accounted for in VBP [value-based purchasing] so that providers or health plans are rewarded for delivering quality care and value, … Read More

Posted in Medicare, Pennsylvania safety-net hospitals, Uncategorized

PA Pursues New Approach to Opioid Addiction Treatment

Pennsylvania has secured federal funding to underwrite the creation of 20 centers of excellence to help people overcome opioid-related substance abuse problems. According to a Department of Human Services news release, The COEs [centers of excellence] coordinate care for people with Medicaid. Rather than just treating the addiction, DHS will treat the entire person through team-based treatment, with the explicit goal of integrating behavioral health and primary care and, when necessary, evidence-based medication assisted treatment. The 20 centers of excellence, which will be licensed by the state’s Department of Drug and Alcohol Programs, are expected to be open by October 1. To learn more about the state’s new approach to serving those with opioid abuse problems and to find a … Read More

Posted in Pennsylvania Medicaid policy

New PA Budget Boosts PA Safety-Net Hospitals

Pennsylvania’s recently adopted FY 2017 budget restores to safety-net hospitals selected supplemental Medicaid payments that were not included in the budget Governor Tom Wolf originally proposed in February. The state’s FY 2017 budget restores, to FY 2016 levels, Medicaid OB/NICU, burn center, trauma center, and critical access hospital payments. All had been targeted for reduction or elimination in the governor’s budget proposal. The new budget includes modest increases for the Medicaid fee-for-service program, for managed care spending, and for physician practice plans. It also designates an additional $3.75 million for academic medical centers. The human services code revisions needed to direct the Department of Human Services to make these Medicaid payments also have been adopted.

Posted in Pennsylvania proposed FY 2017 budget

Medicaid Directors Seek Help With Hepatitis C Drugs

The combination of new cures for hepatitis C, the high cost of those cures, and the large population of low-income people suffering from the disease has the nation’s Medicaid directors asking for help from Congress. “Medicaid programs have decades of experience providing care to medically complex patients, but Hepatitis C is the first real case where a very high per patient cost has been combined with a very large patient population needing treatment,” the National Association of Medicaid Directors declared in a recent news release. To help them address the high cost of providing a new generation of drugs to the estimated one million Medicaid recipients with hepatitis C, Medicaid directors have asked Congress to introduce policies that reduce the … Read More

Posted in Pennsylvania Medicaid policy, Uncategorized

CMS Proposes 2017 Medicare Outpatient Payment Policies

The Centers for Medicare & Medicaid Services has revealed how it proposes paying hospitals for Medicare-covered outpatient services in 2017. Among other matters, the 764-page proposed regulation addresses: proposed rate increases for outpatient and ambulatory surgery center services; new site-neutral outpatient payment policies; changes in the value-based purchasing program; changes in hospital outpatient quality reporting requirements; electronic health record policies; and changes in ambulatory surgical center quality reporting requirements. Interested parties have until September 6 to submit written comments to CMS. The final rule will be published later this year and take effect on January 1, 2017. To learn more about what CMS has proposed for Medicare outpatient payments go here to see a CMS fact sheet and here to see the proposed regulation … Read More

Posted in Medicare

New Approach to Super-Utilizers: Free Housing

A Chicago hospital is experimenting with a new way of serving its most frequent uninsured ER visitors: arranging for free housing. The University of Illinois Hospital has found that many of its most frequent ER patients, while suffering from numerous and chronic medical problems, turn to its ER for overnight accommodations during harsh weather. Under a pilot program, the hospital is spending $1000 a month to put its homeless super-utilizers into free housing. With overnight hospital stays for uninsured patients costing $3000, the program offers the potential for significant savings for the hospital. In addition to free housing, participating patients are assigned a case manager to help coordinate their health care needs. Such patients can be found outside of places … Read More

Posted in Pennsylvania safety-net hospitals
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