GAO Looks at Behavioral Health Options

gaoAccess 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 the nation’s private 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.

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?

Stock PhotoThis is an important question for the many private 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.”

South Carolina Hospitals Reduce Readmissions

A state-wide effort among South Carolina hospitals has reduced readmissions in that state.

With most of the state’s hospitals participating, the Preventing Avoidable Readmissions Together program (PART) used multi-disciplinary rounds, post-discharge phone calls, teach-back, better discharge summaries, and timely follow-up appointments to reduce readmissions rates more than ten percent among patients with acute myocardial infarction, heart failure, and chronic pulmonary disease.

Private safety-net hospitals have found the financial penalties posed by Medicare’s hospital readmissions reduction program to be especially challenging.

How did they do it? A recent article in the journal Population Health Management explains. Find it here.

Medicaid Highlighted in Latest Health Affairs

The journal Health Affairs has dedicated its July 2015 edition to “Medicaid’s Evolving Delivery Systems.”

health affairsThe 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 private safety-net hospitals’ most important payers.

Find the July edition of Health Affairs here.


Report on Public Health and Health Care

The Institute of Medicine (IOM) has published a report summarizing its February workshop that explored the relationship between public health and health care.

According to the IOM, the workshop

iom_logo… was designed to discuss and describe the elements of successful collaboration between health care and public health organizations and professionals; reflect on the five principles of primary care–public health integration (which can be applied more broadly to the health care–public health relationship): shared goals, community engagement, aligned leadership, sustainability, and data and analysis; and explore the “elephants in the room” when public health and health care interact: what are the key challenges and obstacles and what are some potential solutions, including strengths both sides bring to the table. The workshop presentations reflected on collaboration in four contexts: payment reform, the Million Hearts initiative, hospital – public health collaboration, and asthma control.

Because of the nature of the communities they serve and the work they do, private safety-net hospitals are often important parts of public health efforts in cities across the country.

Find the IOM report Collaboration between Health Care and Public Health: Workshop Summary here.

Post-Mortem on the Medicaid Primary Care Fee Bump

The Affordable Care Act required state Medicaid programs to raise their fees for primary care services to the same level as Medicare rates, with the federal government shouldering the full cost of the difference. The rationale for the increase was that with millions of additional Americans expected to enroll in Medicaid in the coming years, a rate increase would encourage more primary care physicians to serve Medicaid patients because historically, many choose not to do so because of what they believe to be inadequate payments.

That two-year Medicaid primary care fee bump ended on December 31, 2014. Sixteen states and the District of Columbia felt the increase was beneficial enough to extend it using their own resources.

The question of whether the fee increase accomplished its objective and is worth re-establishing remains unanswered. The brief nature of the experiment – only two years – and the delays many states experienced before they started paying the enhanced rates left little time for meaningful research. One quantitative analysis suggests the rate increase helped, there have been several more qualitative approaches to research, and some studies remain under way.

health affairsBecause they care for so many more Medicaid patients than the typical hospital, the adequacy of Medicaid payments has long been of special concern to the nation’s private safety-net hospitals.   In fact, extension of the fee increase is among NAUH’s policy priorities for 2015.

For a closer look at the Affordable Care Act’s Medicaid primary care fee bump, how it worked, its impact, and its future, see the new health policy brief “Medicaid Primary Care Parity” here, on the web site of the journal Health Affairs.

New 340B Rules Expected Soon

The federal Health Resources and Services Administration (HRSA) is expected to release new rules governing its section 340B prescription drug discount pricing program in the near future.

The new rules have long been in development and were in the verge of being published late last year when the agency decided to try another approach to addressing some of the program’s problems, but now, new draft guidelines are being reviewed by the White House Office of Management and Budget (OMB) in anticipation of being published soon in the Federal Register.

law booksThe 340B program, which provides discounts on prescription drugs to hospitals and others that serve large numbers of low-income patients, has encountered controversy in recent years with providers complaining about the lack of transparency in drug manufacturers’ prices and the manufacturers claiming that the program’s benefits are being extended to some patients who do not qualify for the assistance.

The 340B program is a vital resource for most private safety-net hospitals.

To learn more about the program and what might be expected when the new rules are proposed, see this CQ HealthBeat article presented by the Commonwealth Fund.

Proposed FY 2016 Medicare Payment Regulation Released

The Centers for Medicare & Medicaid Services (CMS) has released its proposed Medicare inpatient prospective payment system regulation for FY 2016.
law booksAmong the Medicare issues addressed in detail in the 1500-page draft regulation are:

  • inpatient payment rates
  • bundled payments
  • Medicare disproportionate share hospital payments (Medicare DSH)
  • quality reporting requirements
  • the value-based purchasing program
  • the hospital-acquired conditions program
  • the hospital readmissions reduction program
  • the two-midnight rule
  • wage index adjustments

The National Association of Urban Hospitals (NAUH) has prepared a detailed summary of the proposed regulation tailored especially to the interests of private safety-net hospitals, with a special emphasis on Medicare DSH and the hospital readmissions reduction program. To request a copy of this summary, hit the “contact us” link in the upper right-hand section of this web page.

Learn more about the proposed regulation in this CMS fact sheet and find a link to the entire proposed regulation as well.

Medicare-Medicaid Coordination Office Reports to Congress

The federal agency created by the Affordable Care Act to facilitate better coordination of federal benefits for those eligible for both Medicare and Medicaid has issued its annual report on its activities to Congress along with a number of recommendations for future policy changes.

cmsIn addition to reporting on its work over the past year, the Medicare-Medicaid Coordination Office recommended that Congress consider legislation to:

  • Create a pilot to expand the PACE program (Programs of All-Inclusive Care for the Elderly) to people between the ages of 21 and 55.
  • Ensure retroactive Medicare Part D coverage for newly eligible low-income beneficiaries.
  • Establish an integrated appeals process for dually eligible (Medicare and Medicaid) enrollees.
  • Allow for federal/state coordinated review of duals special need plan marketing materials.

The report also identified three areas the agency intends to explore further in the coming year:

  • Coverage standards for overlapping Medicare and Medicaid benefits.
  • Cost-sharing rules for qualified Medicare beneficiaries.
  • Quality measures and Medicare-Medicaid enrollees.

Because they serve so many low-income, dually eligible patients, private safety-net hospitals often have a considerable stake in this office’s efforts.

Find the Medicare-Medicaid Coordination Office’s complete report to Congress here.

MACPAC Looks at Value-Based Purchasing in Medicaid

At a recent meeting of the Medicaid and CHIP Payment and Access Commission (MACPAC), the agency’s staff made a presentation on how different states are pursuing value-based purchasing in their Medicaid programs.

The presentation focused on current efforts in three states: Connecticut, Maryland, and Oklahoma, describing the policy approach those states have taken, the models they employ, the implementation challenges they have faced, and how they evaluate the effectiveness of their efforts.

Because they care for so many Medicaid patients, the nation’s private safety-net hospitals have a special interest in new approaches to Medicaid payment policy.

Find the MACPAC presentation here.