Pennsylvanians will have increased health insurance options in 2024, according to the Pennsylvania Insurance Department’s 2024 Individual and Small Group Affordable Care Act (ACA) announced Thursday.
More marketplace competition and rate increases that are lower than last year and tracking below the rate of medical inflation are among the reasons for the greater number of options.
“Pennsylvanians want access to comprehensive, ACA-compliant health insurance at an affordable price,” Pennsylvania Insurance Commissioner Mike Humphreyssaid in a statement. “The Shapiro Administration is dedicated to the health, well-being, and financial security of all Pennsylvanians and we’re committed to ensuring that consumers have affordable options to stay insured.”
Highmark is expanding into five new counties (Montgomery, Bucks, Chester, Delaware, and Philadelphia counties) and Geisinger will expand its individual and small group offerings into Bedford County, increasing choice for consumers. Consumers in Montgomery, Bucks, and Philadelphia counties will see more health insurer offering coverage in the individual market as Pennsylvania welcomes another new entrant, Jefferson Health Plans, to the southeastern market.
This marks the sixth year Pennsylvania is seeing increased competition. State residents will also have new options for dental plans, including new stand-alone dental plans available in 59 PA counties, underwritten by UnitedHealthcare. Pennsylvanians will see these new plan options when they shop on Pennie.
Pennsylvanians can find the lowest costs on quality health plans through Pennie, the state’s official health insurance marketplace. Pennie reduces the cost of coverage and care, and 9 in 10 current enrollees qualify. All health plans available through Pennie have consumer protections, including coverage for pre-existing conditions. Anyone who does not have health coverage through work or a government plan, such as Medicare or Medicaid, may be eligible for lower premiums through Pennie.
“Pennie offers many Pennsylvanians a way to save costs while having the protection of high-quality health coverage, which builds on the Insurance Department’s critical work to ensure stable and competitive health insurance options,” said Pennie Executive Director Devon Trolley. “We encourage anyone that is uninsured or looking for better health coverage to visit pennie.com to protect your health, wallet, and peace of mind.”
Pennie’s upcoming Open Enrollment Period is the only time of year to enroll in individual and family health coverage for 2024. Open Enrollment begins this Nov. 1, and Dec. 15 is the deadline for coverage that starts on Jan. 1. Outside of Open Enrollment, only individuals with life changes, such as losing coverage from Medicaid and family events, can enroll throughout the year.
The rate of Central Pennsylvanians under age 65 without health insurance fell between 2020 and 2021, according to data released by the Census Bureau.
That follows the trend nationwide, where the rate of uninsured decreased in 280 U.S. counties while increasing in just 80 counties, helped by Medicaid expansion and other pandemic-era relief initiatives. The new numbers come from the Small Area Health Insurance Estimates program, the only source for single-year estimates of people with health insurance in each of the nation’s 3,142 counties.
From 2020 to 2021, uninsured rates dropped in Lancaster County from 14% to 11.3%; in Perry County from 13.2% to 9.2%; in Lebanon County from 10.3% to 8%; in Dauphin County from 8.9% to 6.8%; in Adams County from 8% to 7.6%; in York County from 7.4% to 6.3%; and in Cumberland County from 7.4% to 6.1%.
The rate of Pennsylvanians under 65 without health insurance declined from 7.7% in 2020 to 6.7% in 2021.
At 11.3%, Lancaster holds the highest uninsured rate of any county in the state.
Donald B. Kraybill, senior fellow emeritus at the Young Center for Anabaptist and Pietist Studies at Elizabethtown College, wrote in an email that “lower health insurance rates in the Lancaster region (includes parts of Berks County, York County and Chester County) are likely lower because of the Amish, horse and buggy driving (Old Order) Menno(nite) and Plain-dressing car-driving conservative Mennonite populations that are self-insured through church-related programs.”
Other highlights from the SAHIE data:
· Estimated county uninsured rates ranged from 2.4% to 46.3%, with a median county rate of 10.4%.
· The Northeast and Midwest had the nation’s largest share of counties with low (under 10.0%) uninsured rates, and the South had the largest share with high (above 15.0%) uninsured rates.
As the new governor and new state Legislature take the reins on their first budget, there is a sense of anticipation of what their leadership will bring to the commonwealth. While the Shapiro administration and General Assembly have developed their priorities, we urge them to seize this opportunity to build a national model for senior care right here in Pennsylvania that can help providers evolve to meet the needs of one of the nation’s largest senior populations.
Last year represented a good start toward this goal. After virtually flat-funding medical assistance for nursing homes for more than a decade, Pennsylvania increased funding by 17.5% to begin addressing funding disparities and help providers meet new staffing mandates. Despite the increase, Pennsylvania’s mission-driven nursing homes continue to suffer a workforce and funding crisis that has forced a majority of homes surveyed to turnaway residents in need of post-acute care.
This simply cannot happen in a state where seven out of every 10 nursing home residents rely solely on Medicaid funding. Nursing homes certainly don’t expect a repeat of last year’s historic investment, but a reasonable 5% Medicaid increase must be part of the 2023-24 state budget to help providers meet higher staffing mandates and keep up with the rising costs of care.
Nearly 100% of survey respondents indicated they’ve raised starting wages since last year’s Medicaid funding increase was announced, but they’re still having trouble hiring workers. In fact, over 55% reported turning away hospital admissions because of a lack of sufficient workforce and funding. We cannot continue to turn away Pennsylvanians who need our services.
More beds will be taken offline if we don’t start addressing this situation head on. The commonwealth must continue to recognize the ongoing, crippling financial pressures that long-term care providers face by increasing Medicaid funding to help nursing homes hire more workers and keep up with inflation. Many nursing homes are still suffering from the fallout of the pandemic, coupled with record-high inflation that has led to costs reaching an all-time high. If we fail to do this, high-quality nursing homes will continue to turn down hospital admissions and the number of empty beds will only increase, leaving many Pennsylvanians without the care they need.
Another change that would further improve nursing home staffing is included in Senate Bill 668, introduced by Sens. Judy Ward and Maria Collett, which would help establish stronger career ladders for CNAs in skilled nursing by allowing them to pursue additional training and certification as medication aides.
Other parts of the aging services ecosystem also need support to ensure older Pennsylvanians have access to the care and support they need regardless of their age or stage in life. One example is the Living Independence for the Elderly program, or LIFE, also known nationally as PACE. This critical part of the continuum offers a coordinated care system that helps seniors live independently in their homes and communities. Additional investment is needed for LIFE to keep pace with rising health care costs and chronic funding instability and to create greater parity with other programs and funding models. A 5% increase in the 2023-24 state budget will ensure that LIFE remains a viable option for older adults needing and wanting services in their own homes and communities.
In addition, Medicaid funding needs to be extended to assisted living to provide much-needed relief for both providers and seniors struggling to fit their needs within the current system. Right now, too many of our seniors are denied access to this level of care purely because of financial constraints rather than their care needs. We also want to support Pennsylvanians who still have the capacity to live on their own by continuing to fund the Pennsylvania Housing Tax Credit Program to address the shortage of affordable rental housing for low-income seniors.
There isn’t any doubt in my mind: The Shapiro administration, General Assembly and aging services providers all want the same thing – the best care for Pennsylvania seniors. With one of the oldest populations in the nation, it’s critical that Pennsylvania takes action to address workforce challenges, historic underfunding and barriers to quality care.
Senior care providers look forward to working with the Shapiro administration and state lawmakers on the critical mission of providing high-quality care and support for Pennsylvania’s growing senior population. There is a tremendous opportunity to help all aging services providers and their employees build a comprehensive senior care system that will be the envy of the rest of the country.
What a legacy that would be.
Garry Pezzano is the president and CEO of LeadingAge PA. Follow him on Twitter @GarryPezzano and learn more about aging services @LeadingAgePA.
A change in Medicaid will allow certain medical providers to offer care outside a clinical setting to beneficiaries experiencing homelessness.
The Pennsylvania Department of Human Services (DHS) Wednesday said the program, known as street medicine, will allow providers to use physical and behavioral health services to address the needs of people experiencing unsheltered homelessness, reducing overall costs.
“As a physician, I understand that people experiencing homelessness often have complex needs and face many barriers to health care,” said DHS Secretary Dr. Val Arkoosh. “At DHS, we are consistently working to improve access to care and to ensure that all Pennsylvanians receive high-quality and compassionate health care that can stabilize circumstances and help improve their overall quality of life.”
Arkoosh said by creating a path for Medicaid, also known as Medical Assistance in Pennsylvania, to cover street medicine, DHS is making it easier for health care providers to meet people where they are, and to provide the care they need.
Street medicine seeks to build trust and ease barriers to care with the goal of increasing utilization of services and follow through on care, Arkoosh said.
Medical services are provided by health care professionals who are equipped with portable medical equipment. Services could include primary care, vaccine administration, wound care, preventive services, counseling, medication for the treatment of opioid use disorder, and diagnostic services, such as rapid blood screening for diabetes and high cholesterol, rapid COVID-19 and flu testing.
This change applies to Medicaid enrolled physicians, certified nurse midwives, certified registered nurse practitioners, physician assistants, psychologists, and mobile mental health treatment providers, who render services in the Medicaid Fee-for-Service or Managed Care delivery systems.
According to DHS, investments in street medicine will provide life-saving health care while also building trust within one of the state’s most vulnerable populations.
People experiencing homelessness in the U.S. die, on average, three decades earlier than their peers with housing, most commonly due to preventable and treatable chronic medical conditions, DHS said.
By allowing providers to bill for services rendered during visits with people experiencing homelessness, DHS aims to increase access to care for Medicaid beneficiaries and improve health outcomes.
Street medicine visits will provide low-cost, high-impact resources that will also divert people from costly visits to frequently overwhelmed emergency rooms, DHS said.
Pennsylvania providers caring for individuals with intellectual disabilities and autism (ID/A) continue to deal with low wages, high vacancy rates, and high turnover, according to a new study conducted by the Center for Healthcare Solutions.
Collaborating with The Arc of Pennsylvania, the Rehabilitation and Community Providers Association (RCPA), and The Provider Alliance (TPA), the Center for Healthcare Solutions produced a detailed report on the ID/A industry workforce. The study examined the financial trends driving the workforce shortage affecting ID/A settings and individuals of all ages.
The Center for Healthcare Solutions has been conducting compensation surveys for health care, human services, and ID/A providers for more than four decades. Key findings in this latest report reveal that direct support professionals in the field receive an average wage of $16.61 per hour, have a vacancy rate of 28%, and a turnover rate of 38. For residential supervisors and other program supervisors, those figures read $22.20/28%/42% and $23.12/16%/19%, respectively.
Nick Vizzoca, president and CEO of the Center for Healthcare Solutions, said in a statement the system is strained beyond its breaking point.
“There isn’t a single survey respondent that isn’t feeling the effects of this workforce shortage,” Vizzoca said.
The survey included 52 Pennsylvania organizations and represented a full array of services from every region across the state. Collected data included pay practices, hourly wages (starting, average, and maximum), scheduled positions, filled positions, and employee separations on a wide range of positions.
More than 9,000 employees were included representing 40 different positions to evaluate wage compression issues and critical data on over 7,000 direct support professionals (DSPs), residential supervisors, and other program supervisors. The report reflects salaries in effect as of Sept. 30, 2022.
Results of the survey reflect studies showing providers facing major staffing shortages, reducing caseloads, or cutting programs because of workforce issues, and trying to manage unprecedented vacancy and turnover rates, due largely to inadequate state reimbursements that keep wages low.
“This wage study reinforces what we have been saying for a long time now,” said Richard Edley, Ph.D., president and CEO of RCPA. “Low wages are directly related to the high turnover and high vacancy rates that we’re seeing among Pennsylvania’s ID/A providers, and the individuals who are affected the most are those seeking care and support.”
Along with the findings on low wages and high vacancy turnover rates, the study found that 41% of respondents are engaged in a more costly practice of contract staffing for services because of the workforce shortage. Some 14% of DSP hours are paid at the overtime rate, and providers must delve deep to provide credentialing incentives, tenure rewards, or bonuses to retain the workers they have.
“With staff leaving these professions, ID/A providers are strained to serve the thousands of Pennsylvanians currently receiving and waiting for critical services,” said Sherri Landis, executive director of The Arc of Pennsylvania.
Because human services like ID/A are funded primarily by Medicaid, providers cannot raise prices like private businesses to pay higher wages. Chronic underfunding by the state over the last decade has intensified staffing and operational challenges in the ID/A arenas.
“Services are being reduced and, in some cases, eliminated entirely,” said Patrick DeMico, executive director of The Provider Alliance. “We can’t expect to recruit and retain direct support professionals at below-market wages and with no inflation adjustment for three years.”
AmeriHealth Caritas Pennsylvania and AmeriHealth Caritas Pennsylvania Community HeathChoices received top ranking in the National Committee for Quality Assurance’s Medicaid Health Plan ratings 2022.
AmeriHealth Caritas Family of Companies said the two are the only two Medicaid plans in Pennsylvania and two of only 13 in the nation to receive 4.5 out of 5 rating.
The companies earned the ratings based on results from the Healthcare Effectiveness Data and Information Set (HEDIS), the measurement tool used by the nation’s health plans to evaluate their performance in terms of clinical quality and customer service, as well as the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, which measures members’ satisfaction with their overall health care experience.
AmeriHealth Caritas Pennsylvania serves enrollees in Pennsylvania’s HealthChoices managed care program for most Pennsylvania Medical Assistance (Medicaid) enrollees. AmeriHealth Caritas Pennsylvania Community HealthChoices serves Pennsylvanians ages 21 and older who are eligible for Medicaid and Medicare or qualify to receive long-term services and supports because they need the level of care provided by a nursing facility.
AmeriHealth Caritas Family of Companies has served the HealthChoices and Community HealthChoices programs since their inceptions in 1996 and 2017, respectively.
“This accomplishment is a testament to the effectiveness of our model of care and service in supporting Pennsylvanians most in need,” said AmeriHealth Caritas Family of Companies Executive Vice President and Chief Medical Officer Dr. Karen Amstutz. “From our first day serving Community HealthChoices participants nearly five years ago, we have been committed to providing them with the same quality of service and access to care enjoyed by our other members nationwide. It’s a privilege to partner with the state and help maximize these Pennsylvanians’ independence and quality of life.”
The pandemic had a massive impact on the health care industry’s relationship with telemedicine.
Where it was once reserved for patients with limited mobility or in rural regions with limited medical services, providers and payers had to quickly expand their telemedicine offerings during quarantine.
In the early months of quarantine, providers rolled out telemedicine to most patients and expanded the specialty care they could offer virtually as third-party payers upped the reimbursements they offered for telemedicine.
Highmark Blue Shield’s senior medical director, Dr. Tim Law, spoke to the Journal about how the pandemic impacted Highmark as a payer and what the telemedicine space looks like for payers today.
CPBJ: How would you describe Highmark’s relationship with telemedicine as a payer, prior to the pandemic?
Law: Highmark has recognized the value of telemedicine years before the pandemic. Highmark was an early adopter of telemedicine, offering on demand VUC (virtual urgent care) in partnership with Amwell, Doctor on Demand, and Teladoc prior to the pandemic.
Behavioral health was also offered on the Amwell platform as far back as 2016. Highmark Health was willing to check eligibility and even pay claims on the vendor platforms for Highmark members to receive virtual health services.
This was an early venture across the industry as many payers did not adopt or make room for telemedicine other than as footnote prior to the pandemic.
CPBJ: The pandemic did a lot to change how telemedicine was provided. Particularly thanks to rule changes the Centers for Medicare and Medicaid services made to Medicare reimbursements. What did that quick switch over to telemedicine during the months of quarantine look like for a payer like Highmark?
Law: Highmark immediately stood up an executive level COVID task force for telemedicine to review all the codes available for telemedicine.
We included providers from across Pennsylvania, West Virginia and Delaware. This code list was adjusted to match the rule changes offered by the Centers for Medicare and Medicaid services.
To ensure our members were able to access care in the right setting, at the right time during the COVID-19 outbreak, Highmark was committed to assisting providers to ensure that members had continued access to quality health care despite such challenging circumstances.
During the early part of the pandemic, we were able to ramp up our telemedicine services so quickly. Overall, by the end of 2020 we saw an increase in utilization of telehealth services by more than 3,400 percent over 2019 and more than 3.4 million telehealth services were accessed by our members.
CPBJ: How has the company’s relationship with telemedicine services changed in the last two years?
Law: In the past few years Highmark Health’s strategy shifted. Rising care costs and changing consumer preferences mean that the need for an evolved approach for virtual care delivery across the industry has never been more pressing.
Recent trends have made virtual health an essential approach to serve our members. COVID most likely had a part in that towards providing a more robust virtual care strategy.
In 2021 we signed the enterprise agreement with Amwell, we now offer a white-labeled virtual health platform offered exclusively to our members for virtual urgent care visits and behavioral health and plan to add other multispecialty practices.
Highmark will continue to reimburse providers for virtual visits at parity if the services meet certain criteria.
CPBJ: Have patient expectations regarding telemedicine changed because of the pandemic?
Law: Yes, patients have a new sense of comfort with technology as a result of the pandemic.
They expect a seamless, user-friendly process that will accommodate their needs.
Highmark’s data also showed that women were more likely to utilize telehealth, and that members aged 30-39 were the most likely to access telehealth services, with 350 per 1,000 members in this age group utilizing telehealth services.
We also saw the largest number of telehealth claims among members aged 19 or younger. This shows that children and teens are getting regular care during the pandemic, which is really important for their growth and health.
Our members have used telemedicine services for conditions such as depression, anxiety, flu, pink eye, rashes, strep throat and sinus infections through board-certified doctors 24 hours a day via phone, tablet or computer. The important thing is that our members are able to get the care they need, whether it is in person or virtually.
CPBJ: What did this shift mean for Highmark’s online offerings? Did you see any change among your telemedicine vendors?
Law: Yes, there was a drastic increased utilization of virtual health visits during the pandemic.
In FY 2019 there were 95K virtual health visits and in FY 2020 there were over 3.5M visits to include both vendors and providers.
In 2021, we have seen a larger increase in vendor virtual health usage and more people going back to their physician in person.
We have kept all online offerings in place to include vendor and opened up our whole code set availability to telemedicine. That is to say, we have no list of what is available by way of telemedicine.
If the provider can perform the basic functions of the exam and document that as per normal means they can submit the code for use as telemedicine. This allows out physicians to participate as much or as little as they wish in the virtual health platform.
CPBJ: How does Highmark and Penn State Health’s strategic partnership fit into this?
Law: Penn State Health is a valued partner to our overall care strategy. We utilized input from across their system to help hone our strategy during the pandemic and beyond.
With the large majority of patients seeking care with primary care doctors, even or telemedicine that meant most of the care was still occurring at the local level.
As a result, Highmark paid local doctors nearly $300 million for telehealth services in 2020, an increase of more than 8,000 percent over 2019.
Non-profit senior care facility The Campus of the Jewish Home of Greater Harrisburg will be sold to New Jersey-based real estate investment firm, Tryko Partners.
The board of The Campus of the Jewish Home of Greater Harrisburg announced the sale this week, citing a “persistent and increasing” gap between Medicaid reimbursement rates and the cost of caring for residents—challenges that were exacerbated by the pandemic.
The Jewish Home also pointed to persistent staffing shortages, which have limited the number of residents the home has been able to accept.
The sale includes the organization’s campus at 4000 Linglestown Road, Lower Paxton Township, consisting of the Jewish Home’s 138-bed skilled nursing facility and 58-unit personal care home, known as The Residence.
“This was a very difficult decision,” said Richard Spiegelman, president of the Jewish Home Board. “Because of the significant fiscal challenges we have faced as a stand-alone facility, we decided the best option for residents of the Jewish Home and Residence and the staff was to sell the facility to an organization with the scale and resources to uphold the high standards we have followed for 40 years.”
Tryko, which expects to complete the purchase of the property by March, currently owns 6,000 skilled nursing/assisted living beds across the country. The facilities are supported by Marquis Health Consulting Services, a nursing home consulting company.
“The Jewish Home and Residence provides outstanding care for the Jewish community and larger population,” said Uri Kahanow, director of acquisitions at Tryko. “Our mission is to carry that forward and quickly earn the trust of residents, their families and the dedicated care team at the Jewish Home and Residence.”
Pennsylvania organizations offering independent living services to people with disabilities are not receiving enough Medicaid reimbursements from the state to keep their employees, say advocates for the state’s Centers for Independent Living, known as CILs.
Earlier this month, a group of CILs, individuals with disabilities, caregivers and legislators met on the steps of the capital to ask the legislature to increase reimbursements for independent living.
The organizations say staffing was an issue among CILs because of low reimbursements before the pandemic and is now in a full-blown workforce crisis because employees left the industry for better paying work.
Reimbursement rates for CILs vary across the state with some receiving $17.88 to $19.88 an hour. Reimbursement in neighboring states, such as Ohio and Delaware, are at least $4 higher, said Shona Eakin, CEO of Erie-based Voices for Independence, one of the state’s largest in-home care providers for individuals with disabilities.
Low reimbursements mean that CILs can’t offer employees more than $8 to $12 an hour for homecare work.
“In order for there to be a sustainable market with wages, and maybe even for the first time ever a little bit of health insurance, we need to see a $5 increase,” said Eakin. “We need to see some investment in these rates of reimbursement.”
The last increase in reimbursements was 40 cents in early 2020, which allowed Eakin to increase her employees hourly wage by 70 cents.
“Getting a 40-cent increase after five years of no increases is great but it puts a Band-Aid on a gaping wound,” she said.
Following the rally, Gov. Tom Wolf committed some of his staff to work with the CILs to find solutions to the problems the CILs have posed, but according to the administration, an effort to improve the workforce problem for CILs is already underway.
The state Department of Human Services is awaiting approval from the federal Centers for Medicare and Medicaid Services to allow the state to fund a number of initiatives that would target direct care recruitment and retention, said Brandon Cwalina, press secretary for the department.
The initiatives will be funded through the American Rescue Plan Act, which allows states to leverage a temporary 10% increase in Medicaid reimbursements for home and community-based services.
“This work is essential and life-sustaining, and we are committed to helping recruit and retain dedicated individuals to these positions, as the Wolf Administration has been prior to the pandemic,” said Cwalina. “We are currently awaiting our conditional approval from the Centers for Medicare and Medicaid Serivces, and once that is received, we’ll be able to move forward with implementation.”
The rally, titled the “Rally for Our Lives,” highlighted another problem CILs are seeing: people with disabilities are reassessed annually by the state and given the number of hours that they can receive services from a CIL weekly. Those hours have been cut drastically for many Pennsylvanians, said Pam Auer, director of advocacy and community engagement at the Center for Independent Living of Central PA.
“People with disabilities receiving services are getting reassessed and that means the services they are receiving are getting reduced,” she said. “Some are saying that the state is going out of order, and they don’t understand why they are being assessed.”
Auer went on to say that some individuals’ hours have been cut so dramatically that they have gone from 126 hours a week with a CIL to 40 seemingly arbitrarily.
“If you had 126 hours and you were cut to 40, how could your needs be met adequately?” said Eakin. “Everyone says that they understand that people want to live at home and not in institutions, but they don’t understand the nuances that are causing the problem.”
Part of the problem is that the state relies too much on informal support, such as someone’s family or friends and not enough on CILs, said Auer.
WellSpan Health is partnering with Pittsburgh-based managed care organization Gateway Health Plan in a move the two organizations say will lower health care costs for Gateway’s 24,000 Medicaid members living in South Central Pennsylvania.
Gateway and York-based WellSpan announced this week that they entered a value-based partnership agreement that will allow the two entities to utilize data insights to improve the health outcomes for WellSpan patients with Medicaid through Gateway.
The agreement will also let WellSpan lower health care costs for Gateway’s Medicaid members through value-based programs where it will receive incentives for meeting health care quality and cost-reduction targets.
“Gateway Health is proud to partner with WellSpan to provide our Medicaid members with enhanced value-based care that they can really count on,” said Ellen Duffield, COO at Gateway Health. “We are committed to connecting our members to the type of care they need to live healthier lives and achieve not just physical health, but whole life health.”
The two organizations intend to proactively contact Gateway’s Medicaid members without a primary care provider and address their barriers to care to help avoid costly emergency department visits in the future, WellSpan wrote in a press release on Thursday.
“A key driver in growing our relationship with Gateway Health is learning more about the most effective ways to provide care to patients that promotes lifelong wellness,” said Dr. Geoff Nicholson, Jr., senior vice president of population health at WellSpan. “Together, we can keep patients healthier and strive for a shared vision of higher quality care at lower costs.”
Pennsylvania hospitals saw a 33% loss in operating income as a result of the COVID-19 pandemic, according to a new fiscal report by the Pennsylvania Health Care Cost Containment Council (PHC4).
In a new report documenting the margins of hospitals throughout the state, PHC4 reported a decrease in operating income from $2.8 billion in fiscal year 2019 to $1.9 billion in fiscal year 2020, a decrease of 33% statewide.
PHC4’s annual report on the financial health of Pennsylvania hospitals, titled Financial Analysis 2020, used hospital data from 164 general acute-care hospitals licensed in the Commonwealth.
The report found that the total margin realized by Pennsylvania’s hospitals decreased by 2.7 percentage points, from 6.63% in fiscal year 2019 to 3.93% in fiscal year 2020. The statewide operating margin decreased 1.89 points from 5.61% to 3.73%, according to the report.
“This significant change in operating and total margins reflects the financial impact on hospitals due to the pandemic COVID 19 crisis,” said Joe Martin, executive director for PHC4. “Many hospitals will face serious financial challenges as Pennsylvania works to mitigate the fiscal impact of the epidemic.”
The number of hospitals that posted low or negative margins is a troubling indicator for hospitals moving forward, according to Martin.
“In fiscal year 2020, 38% of Pennsylvania hospitals posted a negative operating margin, and 18% of Pennsylvania hospitals posted an operating margin between 0% and 4%,” he said. “38% of Pennsylvania hospitals posted a negative total margin and 17% of Pennsylvania hospitals posted a total margin between 0% and 4%.”
Throughout the midstate, acute care hospitals saw either a decrease in net patient revenue (NPR) or an increase in operating expenses in fiscal year 2019 to 2020. NPR includes Medicare, Medicaid, commercial insurance and private pay.
Lancaster General Hospital saw a decrease in NPR from $1.07 billion in 2019 to $1.06 billion in 2020. Its operating expenses rose from $1.002 billion to $1.080 billion.
Across its many hospitals in the region, UPMC saw its NPR decrease from $1.54 billion in 2019 to $1.53 in 2020. Operating expenses increased from $1.42 billion to $1.43 billion.
WellSpan Health’s NPR increased from $1.816 billion in 2019 to $1.91 billion in 2020, throughout its hospitals. The York-based system’s operating expenses rose from $1.63 billion to $1.83 billion.
Penn State Health Milton S. Hershey Medical Center’s NPR also increased from $1.645 billion in 2019 to $1.668 in 2020. Its operating expenses increased from $1.54 billion to $1.68 billion
A dramatic increase to Medicare reimbursements for telemedicine services that allowed health care providers to receive payment for services they provide online, could continue after the public health emergency is over.
In the country’s first weeks of the pandemic, the Centers for Medicare & Medicaid Services (CMS), a federal agency that oversees Medicare and Medicaid programs across the country, rolled out a series of rule changes that opened the door to reimbursements of telemedicine that were much closer to what a provider would make during an in-person meeting.
To promote social distancing and to protect at-risk patients from contacting COVID-19, the agency also introduced leniencies on HIPAA requirements that allowed providers to use a variety of video software while conferencing with patients.
Prior to the changes, approximately 14,000 Medicare beneficiaries across the country received telehealth services in any given week. Thanks to the changes in reimbursements, CMS reported that 10 million beneficiaries received a Medicare telehealth service from mid-March through early-July.
This month, CMS announced it will propose expanding telehealth reimbursements permanently after President Donald Trump signed an executive order on Improving Rural and Telehealth Access on Aug. 3. The order outlines CMS’ recent rule changes and the impact they’ve had on Medicare beneficiaries. In the order, Trump directs Secretary of Health and Human Services Alex Azar to review the temporary measures and propose an extension to them as appropriate within the next 60 days.
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