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The Health of Safety-Net Hospitals: How are They Faring? What’s the Outlook?

Monday, June 04, 2012

Safety-net hospitals play a critical role in providing care to vulnerable populations, especially at a time when employer-sponsored coverage has declined and the demand for safety-net services has gone up.

While the Patient Protection and Affordable Care Act (PPACA) creates some opportunities for safety-net providers, it also presents significant challenges. Medicaid is the single largest revenue source for most safety-net hospitals. Under PPACA, approximately 16 million additional people are anticipated to enroll in the Medicaid program. But many states are cutting Medicaid rates paid to hospitals and other providers in order to balance their budgets. Additionally, under the health reform law, the Department of Health and Human Services is to develop a new method to reduce disproportionate share hospital (DSH) payments, another stream of funding which safety-net hospitals have counted on.

Who does the safety-net system currently serve and how will this patient mix change as the health reform law plays out? How are safety-net hospitals faring in the current economic environment and how are they altering the way they provide care? How are states and safety-net systems planning for the challenges and opportunities presented under PPACA when its major provisions become effective, starting in 2014 ? What are some policy options for sustaining financial viability of safety-net hospitals in the short-term and long-term?

To answer these important questions and related ones, the Alliance for Health Reform and The Commonwealth Fund sponsored a June 4 briefing. Speakers were: Patrick Conway, Centers for Medicare and Medicaid Services; Billy Millwee, Texas Medicaid Director; Arthur Gianelli, NuHealth System, Nassau County, NY; and Deborah Bachrach, Manatt, Phelps & Phillips. Ed Howard of the Alliance and Pamela Riley of Commonwealth co-moderated.


 Q and A, , Moderator
 Ed Howard, Alliance for Health Reform, Moderator
 Pamela Riley, The Commonwealth Fund, Moderator
 Patrick Conway, Centers for Medicare and Medicaid Services, Speaker
 Billy Millwee, Texas Medicaid Director, Speaker
 Arthur Gianelli, NuHealth System, Nassau County, NY, Speaker
 Deborah Bachrach, Manatt, Phelps & Phillips, Speaker
(Click on the camera icon to see a video of the speaker's presentation.)

Transcript, Event Summary and/or Webcast and Podcast

Transcript: Briefing Transcript (Adobe Acrobat PDF), 6/4/2012
Event Summary: Safety Net Hospitals Event Summary (Adobe Acrobat PDF), 6/18/2012
Full Webcast/Podcast: Click Here

The full webcast and podcast for this briefing, as well as videos of individual speakers' presentations, are provided by Kaiser Family Foundation.

Speaker Presentations

Arthur A. Gianelli's Presentation - NuHealth Systems (PowerPoint), 6/4/2012
Deborah Bachrach's Presentation - Manatt Health Solutions (PowerPoint), 6/4/2012
Billy Millwee's Presentation - Texas Medicaid Director (PowerPoint), 6/4/2012
Pamela Riley's Presentation - The Commonwealth Fund (PowerPoint), 6/4/2012

(If you want to download one or more slides from these presentations, contact us at info@allhealth or click here for instructions.)

Source Materials

Speaker Biographies (Adobe Acrobat PDF), , 6/1/2012
Agenda (Adobe Acrobat PDF), , 6/1/2012
Source List (Adobe Acrobat PDF), , 6/1/2012
Materials List (Adobe Acrobat PDF), , 6/1/2012
Safety Net Hospitals Event Summary (Adobe Acrobat PDF), , 6/18/2012

Offsite Materials (briefing documents saved on other websites)

Aetna Foundation Grant to Help Safety-Net Hospitals Improve Care Coordination, Healthcare Finance News, 1/5/2012
- Anderson, Chris
Toward a High Performance Health Care System for Vulnerable Populations: Funding for Safety-Net Hospitals, The Commonwealth Fund, 3/8/2012
- Bachrach, Deborah, Laura Braslow, and Anne Karl
Federal Mediacid Disproportionate Share Hospital (DSH) Allotments: FY2011, Henry J. Kaiser Family Foundation: State Health Facts, 10/1/2011
- Map and Figures of Medicaid DSH Payments
The Basics: Medicaid Disproprotionate Share Hospital Payments (Adobe Acrobat PDF),National Health Policy Forum, 6/15/2009
- Peters, Christie P.
Health Reform: Uncompensated Care Costs and Reductions in Medicaid DSH Payments, Health Affairs Blog, 10/15/2010
- Burke, Courtney and Erika Martin
The Potential Impact of Affordable Care Act-Mandated Medicare DSH Cuts on Urban Safety-Net Hospitals, National Association of Urban Hospitals , 1/1/2011
How the Affordable Care Act Supports a High-Performance Safety Net, The Commonwealth Fund Blog, 1/16/2012
- Riley, Pamela, Julia Berenson, and Cara Dermody
Toward Meeting the Needs of Vulnerable Populations: Issues for Policymakers' Consideration in Integrating a Safety Net into Health Care Reform Implementation (Adobe Acrobat PDF),National Academy for State Health Policy, 1/1/2012
- Grossman, Laura, Katharine Witger, and Catherine Hess
The Impact of the Affordable Care Act on the Safety Net (Adobe Acrobat PDF),Academy Health, 4/1/2011
Will We Need the Safety Net After Reform?, The Commonwealth Fund Blog, 8/8/2011
- Gabow, Patricia
Funding for State Safety Net Hospitals Approved, Boston Globe, 5/23/2012
- Conaboy, Chelsea
Are Feds Giving a Safety Net to Massachusetts's Hospitals?, The Heritage Foundation: The Foundry, 10/24/2010
- Archambault, Josh
Health Reform Holds Both Risks and Rewards For Safety-Net Providers and Racially And Ethnically Diverse Patients, Health Affairs, 10/1/2012
- Andrulis, Dennis and Nadia Siddiqui
Improving Health Care Access For Low-Income People: Lessons From Ascension Health's Community Collaboratives, Health Affairs, 7/1/2011
- Felland, Laurie, Paul Ginsburg, and Gretchen Kishbauch
The Costs and Adequacy of Safety Net Access for the Uninsured: Bexar County, Texas (Adobe Acrobat PDF),Robert Wood Johnson Foundation, 6/1/2010
- Hall, Mark
The New York City Health and Hospitals Corporation: Transforming A Public Safety Net Delivery System to Achieve Higher Performance, The Commonwealth Fund, 10/1/2008
- McCarthy, Douglas, and Kimberly Mueller
Ensuring Equity: A Post-Reform Framework to Achieve High Performance Health Care for Vulnerable Populations, The Commonwealth Fund, 10/1/2011
- Schor, Edward L., Julia Berenson, Anthony Shih, Sara R. Collins, Cathy Schoen, Pamela Riley, and Cara Dermody
Advancing the Capabilities of Safety Net Accountable Care Organizations (ACOs) (Adobe Acrobat PDF),UC Berkley School of Public Health, 3/1/2012
- Shortell, Stephen
America's Public Hospitals and Health Systems, 2010: Findings from the Annual NAPH Member Hospital Characteristics Survey, National Association of Public Hospitals, 6/11/2012


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