Embed Size (px)
DESCRIPTION
Sustaining Safety Net Hospitals. Pamela Riley, M.D., M.P.H. Program Officer, Vulnerable Populations The Commonwealth Fund Alliance for Health Reform Briefing Washington, D.C. June 4, 2012. What is the Health Care Safety Net?. - PowerPoint PPT Presentation
Citation preview
THE COMMONWEALTH
FUND
Sustaining Safety Net Hospitals
Pamela Riley, M.D., M.P.H.Program Officer, Vulnerable Populations
The Commonwealth Fund
Alliance for Health Reform BriefingWashington, D.C.
June 4, 2012
What is the Health Care Safety Net?
• Health care providers that organize and deliver a significant level of health care and other health-related services to uninsured, Medicaid, and other vulnerable patients (Institute of Medicine).
• Core safety net providers are required by organizational mission or legal mandate to provide care to patients regardless of ability to pay.
• Includes hospitals (public; non-profit; academic medical centers), community health centers, local health departments.
Institute of Medicine. America’s Health Care Safety Net: Intact but Endangered. Washington: National Academies Press, 2000.
What is the Role of Safety Net Hospitals?
• Provide inpatient, primary and subspecialty care for Medicaid, low-income, and uninsured populations.
• Provide other specialized services (trauma centers, burn units, inpatient psychiatric care).
• Serve as sites for training physicians and other health professionals.
• Serve as economic engines of communities—safety net hospitals contributed over $120 billion in 2009 to state economies, and to over 800,000 jobs nationally.
Source: National Association of Public Hospitals and Health Systems. Safety Net Health Systems: Keeping Americans Healthy and Working, October 2011.
Discharges at NAPH Member Hospitals and Health Systems, by
Payer Source, 2009
Nationwide Estimates of Hospital Discharges, by Payer Source, 2010
Source: NAPH Hospital Characteristics Survey, 2009
Other 3%
Source: HCUP Nationwide Inpatient Sample (NIS), 2010, Agency for Healthcare Research and Quality (AHRQ)
What Populations do Safety Net Hospitals Serve?
Disproportionate Needs of Patients Served by Safety Net Hospitals and System Characteristics to Address Needs
Disproportionate Needs Safety-Net System Characteristics
Health-related needs
Chronic conditionsDisabilityMental illnessSubstance abuseReproductive health care
Team careCare managementCare coordination/IntegrationMedical homeCo-located servicesIntegrated services
Personal and social factors adversely affecting health
Dangerous workUnhealthy environmentsUnsafe environmentsChronic stressShortage of personal timeIlliteracyLow social supportHomelessnessPoor nutritionHealth risk behaviors (smoking, substance abuse, inactivity)Disability
Social servicesPatient educationOutreach servicesFacilitated enrollment in public programsWraparound services
Personal and social factors affecting health care access
No sick leaveLanguage barriersCultural disparitiesTransportationNontraditional work hoursTransient residenceDisability
Extended hours of serviceLanguage servicesTransportation servicesCultural sensitivityElectronic heath recordsHome visitsHome health careTelephone advice linesElectronic visits
Source: E. L. Schor, J. Berenson, A. Shih, S. R. Collins, C. Schoen, P. Riley, and C. Dermody, Ensuring Equity: A Post-Reform Framework to Achieve High Performance Health Care for Vulnerable Populations, The Commonwealth Fund, October 2011.
What is the Impact of the Affordable Care Act on Safety Net Hospitals and the Populations they Serve?
• Potential for increased Medicaid revenues—an estimated 16 million people will acquire Medicaid under ACA.
• Cuts in disproportionate share hospital (DSH) payments, which help cover costs of caring for Medicaid and uninsured patients.– Safety net hospitals have higher average uncompensated
care costs as a share of total costs (16%, compared to 6% nationally)
• An estimated 26 million people under age 65 will remain uninsured after full implementation of the ACA—safety net hospitals will still be needed to care for this population.
Source: Congressional Budget Office, CBO and JCT’s Estimates of the Effects of the Affordable Care Act on the Number of People Obtaining Employment-Based Health Insurance, March 2012; National Association of Public Hospitals and Health Systems. America’s Public Hospitals and Health Systems, 2009: Results of the Annual NAPH Hospital Characteristics Survey, December 2010.
Today’s Panelists
Deborah Bachrach, J.D.Special Counsel, Healthcare Transaction and Policy, Manatt, Phelps & Phillips, LLP, New York, NY
Billy Millwee, M.Sc., M.A.Texas Medicaid Director, Austin, TX
Arthur Gianelli, M.B.A., M.P.H.President and Chief Executive Officer, Nassau Health Care Corporation, East Meadow, NY
Patrick Conway, M.D., M.Sc.Chief Medical Officer, Centers for Medicare and Medicaid Services, Baltimore, MD
Key Questions• Regarding Medicaid and DSH payment policies, what are
potential federal policy options to better target existing funds to hospitals serving low-income, high-need patients?
• What is currently being done to address the current financial challenges facing safety net hospitals, and to prepare safety net hospitals for funding changes under the ACA?
• How can ACA provisions affecting safety net hospital financing be implemented to maintain the financial stability of safety net hospitals while promoting high-quality, efficient care?
