Archive for September 2016

MACPAC Looks at Medicaid DSH

With Medicaid disproportionate share payments (Medicaid DSH) facing future reductions, the agency charged with advising Congress on Medicaid and Children’s Health Insurance payment and access matters is considering what changes the federal supplemental Medicaid payment program might need. At a recent meeting in Washington, D.C., the Medicaid and CHIP Payment and Access Commission discussed the changing role and purpose of Medicaid DSH as more Americans obtain health insurance through private or public sources. MACPAC commissioners noted that hospital uncompensated care is falling, especially in states that have taken advantage of the Affordable Care Act to expand their Medicaid programs. A new Medicaid DSH formula set to be used for FY 2018, based more heavily than the current formula on the … Read More

Posted in Affordable Care Act, Medicaid supplemental payments, Pennsylvania safety-net hospitals


The federal agency responsible for advising Congress on Medicaid and Children’s Health Insurance Program payment and access issues met last week in Washington, D.C. According to the Medicaid and CHIP Payment and Access Commission, The initial sessions of MACPAC’s September 2016 Commission meeting focused on hospital payment policy, first discussing MACPAC’s new work to develop an index of Medicaid inpatient payments across states and relative to Medicare, and later looking at how Affordable Care Act coverage expansions have affected hospitals serving a disproportionate share of low-income patients, including those with Medicaid coverage. The Commission then reviewed state policies for covering and paying for services in residential care settings, part of the drive to rebalance long-term services and supports from institutions … Read More

Posted in Uncategorized

Medicare Readmissions Down Almost Everywhere

Hospitals in 49 of the 50 states have reduced their Medicare readmissions since the federal health care program introduced its readmissions reduction program in 2010. Only hospitals in Vermont have failed to cut readmissions. Nationally, readmissions fell more than five percent in 43 states and more than ten percent in 11 states. Overall, readmissions fell 100,000 in 2015 alone compared to 2010 and have fallen 565,000 since 2010. As the program ages more medical conditions are being subjected to the readmissions reduction program’s requirements. In the coming year, the Centers for Medicare & Medicaid Services estimates it will penalize 2500 hospitals $538 million for failing to reduce their readmissions. Learn more about CMS’s efforts to reduce readmissions among Medicare patients … Read More

Posted in Medicare, Uncategorized

Senate May Tackle Socio-economic Risk Adjustment

With a House bill to adjust Medicare payment penalties based upon the socio-economic challenges posed by the patients some hospitals serve folded into a House bill that passed in June, the Senate may take up this issue during its fall session. Health economists, policy experts, and providers generally agree that the performance of hospitals that serve especially large numbers of low-income patients is affected in a number of areas, including Medicare readmissions, meeting value-based purchasing criteria, and others. And while the Centers for Medicare & Medicaid Services acknowledges the challenge, the agency has rejected calls for risk adjustment so far, repeatedly writing that it does not “want to mask potential disparities or minimize incentives to improve the outcomes of disadvantaged … Read More

Posted in Medicare

New ACO Model Targets Social Determinants of Health

The federal government is altering a previously announced accountable care organization model to help it target the social determinants of health of the patients it serves. The Accountable Health Communities model, launched by the Centers for Medicare & Medicaid Services and the Center for Medicare and Medicaid Innovation in January, has been modified to target “community-dwelling Medicare and Medicaid beneficiaries with unmet health-related social needs.” According to a CMS fact sheet, The foundation of the Accountable Health Communities Model is universal, comprehensive screening for health-related social needs of community-dwelling Medicare, Medicaid, and dual-eligible beneficiaries accessing health care at participating clinical delivery sites. The model aims to identify and address beneficiaries’ health-related social needs in at least the following core areas: … Read More

Posted in Uncategorized

Federal Medicaid Per Capita Spending Limits?

As they have in the past, some members of Congress have suggested of late that Medicaid might benefit from being transformed into a program with limited spending per capita: that is, such an approach would limit the amount of money the federal government would provide to states on a per capita basis. Such an approach would almost certainly have serious implications for Pennsylvania safety-net hospitals. What issues would need to be addressed to develop such an approach? What data would be needed? Earlier this year the chairmen of the Senate Finance Committee and the House Energy and Commerce Committee asked the U.S. Government Accountability Office to answer these and other questions. Now, the GAO has published its answers in a new … Read More

Posted in Pennsylvania Medicaid laws and regulations, Pennsylvania safety-net hospitals

SNAP Comments on Proposed Medicaid DSH Regulation

The Safety-Net Association of Pennsylvania has written to the Centers for Medicare & Medicaid Services to object to how the agency proposes changing its methodology for calculating eligible hospitals’ Medicaid disproportionate share (Medicaid DSH) payments. In particular, SNAP opposes the manner in which CMS would treat payments from Medicare and third-party payers made on behalf of Medicaid-eligible individuals. In SNAP’s view, the letter notes, …the hospital-specific DSH limit has come to penalize the very hospitals that Medicaid DSH payments were designed to support. The SNAP letter explains that What concerns SNAP at this time is CMS’s apparent decision to rationalize and codify in regulations a narrower interpretation of the Medicaid DSH limit than what Congress described in section 1923(g) of … Read More

Posted in Medicaid supplemental payments, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania

CMS Posts Tentative List of Essential Community Providers

The Centers for Medicare & Medicaid Services has posted on its web site a draft list of essential community providers for 2018. To qualify as essential community providers, organizations must serve predominantly low-income, medically underserved patients.  Qualified health plans must contract with at least 30 percent of the essential community providers in their markets and must offer contracts in good faith to at least one such provider in each of six categories, including federally qualified health centers, hospitals, and family planning providers. Providers that believe they have mistakenly been excluded from the list may petition for inclusion. Find the draft list here.

Posted in Uncategorized

There’s More to Quality Than Readmissions, Study Suggests

Hospitals with high readmissions rates may also have lower mortality rates for some conditions, according to a new study. The study, published in the Journal of Hospital Medicine, found that patients suffering from heart failure, stroke, and chronic obstructive pulmonary disease who are served in hospitals with higher readmission rates have a slightly better chance of survival than if they were treated in hospitals with lower readmission rates. Such findings call into question the value of focusing on readmissions as a measure of the quality of care hospitals provide – a focus exemplified by Medicare’s hospital readmissions reduction program. Find the study “Associations between hospital-wide readmission rates and mortality measures at the hospital level: Are hospital-wide readmissions a measure of quality?” here and … Read More

Posted in Medicare

Hospital Group Models Risk-Adjusted Medicare Readmissions

The Missouri Hospital Association has published data that demonstrates that risk-adjusting Medicare readmissions based on social determinants of health reduces the readmission rates of hospitals that care for large numbers of low-income patients. The data, modeling, and risk adjustment methodology, developed by the association based on data from Missouri hospitals, published on the association’s “Focus on Hospitals” web site, and described in an article on the NEJM Catalyst web site, showed that SDS [note:  sociodemographic status)-enriched models yielded significant relative reductions in the range of risk-standardized readmission ratios for each of…6 outcomes…Overall, SDS enrichment best improved the 30-day readmission assessments of hospitals that served higher concentrations of Medicaid patients and higher-poverty communities. The lack of risk adjustment for socioeconomic risk factors has been … Read More

Posted in Medicare, Uncategorized
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