NAUH Talks Medicare DSH With Congressional Committee

Last week representatives of the National Association of Urban Hospitals (NAUH) met with staff of the House Ways and Means Committee’s Health Subcommittee to offer the association’s views on H.R. 3288, the Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act.

NAUH LogoThe bill calls for significant changes in how Medicare makes disproportionate share payments (Medicare DSH) to hospitals.

After talking to committee staff about the role Medicare DSH payments play in enabling private safety-net hospitals to serve their low-income communities, NAUH representatives expressed concern about three aspects of the proposal:

  • its call for a new, permanent, unchanging sum for allocation for the non-uncompensated care portion of the Medicare DSH pool;
  • the permanent separation of Medicare DSH payments from Medicare payments; and
  • the creation of a new, $1 billion pool of Medicare DSH funds for hospitals in states that have not expanded their Medicaid programs as authorized by the Affordable Care Act.

NAUH was invited to meet with subcommittee staff because it is one of the few groups that expressed any concern about the Medicare DSH proposal and because of the substance of its past communication with the subcommittee about Medicare payment issues, including its use of data to support its views.

Read those comments here.

Medicare Readmissions Program Unfair to Safety-Net Hospitals, Study Finds

Medicare’s readmissions reduction program penalizes hospitals based largely on the patients they serve rather than their performance serving them, a new study has concluded.

According to the report “Patient Characteristics and Differences in Hospital Readmission Rates,” published in the journal JAMA Internal Medicine,

Patient characteristics not included in Medicare’s current risk-adjustment methods explained much of the difference in readmission risk between patients admitted to hospitals with higher vs lower readmission rates. Hospitals with high readmission rates may be penalized to a large extent based on the patients they serve.

Among those two dozen social determinants of health: patient income, education, and ability to bathe, dress, and feed themselves.

jama internal medicineThe study found, for example, that the worst-performing hospitals under Medicare’s hospital readmissions reduction program have 50 percent more patients with less than a high school education than the program’s best performers.

The study’s findings echo NAUH’s long-held and oft-expressed belief that the readmissions reduction program is unfair to private safety-net hospitals because it lacks appropriate risk-adjustment in response to the very conditions identified in the study – a belief NAUH has shared on numerous occasions with Medicare officials, including in this June 2015 correspondence (on page 4) with the Centers for Medicare & Medicaid Services (CMS).

To learn more about the study, see this Washington Post story. To find the study itself, go here, to the web site of JAMA Internal Medicine.

Medicare Proposes Addressing Health Disparities

The Centers for Medicare & Medicaid Services (CMS) has unveiled its first plan to reduce health disparities among Medicare beneficiaries by addressing social determinants of health.

Medical EquipmentThe plan, produced by CMS’s Office of Minority Health and titled “The CMS Equity Plan for Improving Quality in Medicare,” will seek to improve care for

…Medicare populations that experience disproportionately high burdens of disease, lower quality of care, and barriers to accessing care. These include racial and ethnic minorities, sexual and gender minorities, people with disabilities, and those living in rural areas.

This is the very population served in disproportionate numbers by many of the nation’s private safety-net hospitals.

The program will focus on six priorities:

  • expanding the collection, reporting, and analysis of standardized data
  • evaluating disparity impacts and integrating equity solutions across Medicare programs
  • developing and dissemination promising approaches to reducing health disparities
  • increasing the ability of the health care workforce to meet the needs of vulnerable populations
  • improving communication and language access for individuals with limited English proficiency and persons with disabilities
  • increasing physical accessibility of health care facilities

To learn more about The CMS Equity Plan for Improving Quality in Medicare, see this CMS news release.

Socio-Economic Status Affects Health, Study Shows

A new study by California state public health officials has concluded that demographic factors have a major influence on individuals’ health.

Among the social determinants of health specifically cited in the study are education, employment status, gender identity, race and ethnicity, income, and sexual orientation.

iStock_000005787159XSmallIn Portrait of Promise: The California Statewide Plan to Promote Health and Mental Health Equity, the California Department of Public Health’s Office of Health Equity identifies and describes the socio-economic determinants of health that influence health status and proposes interventions for overcoming those challenges.

NAUH has long pointed to such challenges as one of the chief distinctions between private safety-net hospitals and the typical American hospital.

See the report here.

Hospitals Stung By Readmissions Penalties

More than half of the nation’s hospitals are being penalized by Medicare for readmitting too patients.

Together, they will loses $420 million in Medicare payments.

iStock_000001497717XSmallThe penalties are part of Medicare’s hospital readmissions reduction program, which penalizes hospitals for readmitting too many patients within 30 days of their discharge. The program was created by the Affordable Care Act to encourage hospitals to pay more attention to the quality of care they deliver and the care they take when discharging patients.

Some hospitals are being penalized even though their performance has improved under the program.

The National Association of Urban Hospitals (NAUH) has long maintained that the program unfairly penalizes private safety-net hospitals that care for patients whose problems often go beyond medical concerns and are therefore more difficult to serve.  NAUH has conveyed these concerns to officials of the Centers for Medicare & Medicaid Services.

For more information about the latest round of penalties, see this Kaiser Health News story.


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.