A Disproportionate Share: A Complex Patchwork of Supplemental Payments

This is a special publication of the first season of the new Health Affairs podcast, Research and Justice For All. The first season, "Private Sector Solutions," is sponsored by CVS Health. The six-episode season will publish Wednesdays.

Guest: Thomas Sequist, Chief Medical Officer at Massachusetts General Brigham

In the first episode of Research and Justice For All, CVS Health’s Sree Chaguturu and Joneigh Khaldun interview Thomas Sequist from Massachusetts General Brigham on the important role of health and hospital systems in driving health equity in the US.

This season is sponsored by CVS Health.

Related Links:  

• Beyond Research, Taking Action Against Racism (Health Affairs Forefront)  
• United Against Racism 2-Year Anniversary: A Reflection from Mass General Brigham’s Chief Community Health & Health Equity Officer (Massachusetts General Brigham)  
• Mass General Community Health (Massachusetts General Hospital)

Explore the CVS Health-sponsored Health Affairs Forefront short series, “Private Sector Solutions for Health Equity.”

Health Affairs' Jeff Byers interviews Tracy Fasolino about her experience with creating the podcast series No One Gets Out of Here Alive for the Health Affairs Podcast Fellowship.

In the final episode of No One Gets Out of Here Alive, Clemson University’s Tracy Fasolino addresses the four challenges facing palliative care and hospice services and highlights some of the legislative bills that may fill the needs for patients and caregivers dealing with serious illness. 

Guests on this episode include Edo Banach, Dr. Betty Ferrell from City of Hope, Dr. Wayne Hollinger, Mr. Pat Coyne from Medical University of South Carolina, and Ginger Marshal, CEO of Hospice & Palliative Nurses Association. 

No One Gets Out of Here Alive was produced by Tracy Fasolino for Health Affairs Podcast Fellowship Program.

Music by Elias Workman.

Related Links:

• The Hospice Paradox: How Medicare Fails Americans At The End Of Life (Health Affairs Forefront)
• A National Strategy For Palliative Care (Health Affairs)
• The Hidden Curriculum Of Hospice: Die Fast, Not Slow (Health Affairs Narrative Matters)
• Understanding The Use Of Medicare Procedure Codes For Advance Care Planning: A National Qualitative Study (Health Affairs)

Welcome back to No One Gets Out of Here Alive, where we spend time talking about various legislation that impacts delivery of palliative care and hospice services right now. In this episode, we hear from one family as they share their story in dealing with the serious illness of chronic obstructive pulmonary disease. 

Host Tracy Fasolino of Clemson University presents four challenges facing palliative care and hospice services right now. 

No One Gets Out of Here Alive was produced by Tracy Fasolino for Health Affairs Podcast Fellowship Program.
 
Music by Elias Workman. 

This episode is dedicated to Al & Wendy for their amazing bravery and exemplary love. 

Related Links:

• Live hospice discharge: Experiences of families, and hospice staff (National Library of Medicine)
• Live discharge from hospice for people living with dementia isn't “graduating”—It's getting expelled (Journal of the American Geriatrics Society)
• Subjects Sentenced in $150 Million Hospice Fraud Case (Compliance Resource Center)
• The Forgotten and Misdiagnosed Care Transition: Live Discharge From Hospice Care (National Library of Medicine)

Welcome to No One Gets Out of Here Alive, the fifth series from Health Affairs Pathways. In this series, Clemson University's Tracy Fasolino unpacks some of the legislative and policy issues associated with palliative care and hospice services through the lens of a nurse. 
 
To start, Tracy peers into the past and tells the history of hospice legislation and the evolution of palliative care. She highlights the key players in the creation of the hospice benefit and shares insights on the growth of palliative care in the US.

Guests on this episode include Edo Banach, Dr. Betty Ferrell from City of Hope, and Dr. Wayne Hollinger.

Music by Elias Workman.

Related Links:

• Dr. Elisabeth Kübler-Ross Interview
• President Nixon Signs the National Cancer Act (Richard Nixon Foundation)
• National Hospice Study: Patient and Facility Data, [1980-1983]
• Policy and the Reformation of Hospice (Journal of Hospice & Palliative Nursing)

Health Affairs' Jeff Byers interviews Dr. Michael Shen about his experience with creating the podcast series A Disproportionate Share for the Health Affairs Podcast Fellowship.

Related Links:

• A Disproportion Share - Episode 1
• A Disproportion Share - Episode 2

In A Disproportionate Share, NYC Health + Hospitals's Michael Shen, a primary care doctor and Chief Creative Officer for the medical education podcast Core IM, explores the role of safety net hospitals in caring for America's vulnerable populations.

In the final episode, Shen discusses why supplemental payments for safety net hospitals might be at risk and look at policy approach that could bolster the safety net. He interviews individuals from NYC Health + Hospitals, America's Essential Hospitals, and University of Pennsylvania.

Related Links:

• Michael Shen
• Disproportionate Share Hospital (Centers for Medicare & Medicaid Services)
• Variation and Changes in the Targeting of Medicaid Disproportionate Share Hospital Payments (Health Affairs)
• Annual Analysis of Disproportionate Share Hospital Allotment to States - 2022 (MACPAC)
• For Disproportionate-Share Hospitals, Taxes and Fees Curtail Medicaid Payments (Health Affairs)

In A Disproportionate Share, NYC Health + Hospitals's Michael Shen, a primary care doctor and Chief Creative Officer for the medical education podcast Core IM, explores the role of safety net hospitals in caring for America's vulnerable populations.

In this episode, Shen discusses how we pay for essential care for low income patients delivered through our safety net hospitals and the complex patchwork of supplemental payments for such care. He interviews individuals from America's Essential Hospitals and NYC Health + Hospitals to explain cost-shifting, uncompensated care, payer mixes, cash on-hand, and more.

Related Links:

• Michael Shen
• What Types of Hospitals Form the Safety Net? (Health Affairs)
• Podcast: Understanding Private Equity Investment in Hospitals (A Health Podyssey)
• Can Safety-Net Hospital Systems Redesign Themselves To Achieve Financial Viability? (Health Affairs Forefront)
• Safety-Net Hospitals More Likely Than Other Hospitals To Fare Poorly Under Medicare's Value-Based Purchasing (Health Affairs)

Welcome back to Health Affairs Pathways, the podcast fellowship program from Health Affairs.

In 2023, we have two exciting seasons for listeners, one on safety net hospitals and another on palliative and hospice care.

In A Disproportionate Share, NYC Health + Hospitals's Michael Shen, a primary care doctor and Chief Creative Officer for the medical education podcast Core IM, explores safety net hospitals and how we pay for them.

In this first episode, Shen looks at the closure of Hahnemann University Hospital, a large urban hospital affiliated with a major academic medical center, to ask how safety net hospitals sustain themselves on thin financial margins. He shares what safety net hospitals are and their role in caring for America's vulnerable populations.

Related Links:

• Michael Shen
• Graduate Medical Education Should Not Be A Commodity (Health Affairs)
• Podcast: Graduate Medical Education Should Not Be A Commodity (Health Affairs Narrative Matters)
• The Death of Hahnemann Hospital (The New Yorker)
• To Protect America's Safety-Net Hospitals, Establish a New Federal Designation (Health Affairs Forefront)

In the fourth and final episode of The Earth Disease, journalist Jared Downing explores the carrots and sticks that the federal government can use to curb climate change.

Jared produced this series in 2021 as part of the Health Affairs Podcast Fellowship Program.

Guests on this episode include Dr. Ashish Jha, Howard Frumkin from the University of Washington School of Public Health, and Arsenio Mataka from the Office of Climate Change and Health Equity at the Department of Health and Human Services.

At the time of this recording, Dr. Jha was the Dean of the Brown University School of Public Health. He is currently the White House COVID-19 Response Coordinator and Counselor to the President. The views represented in this podcast are his own.

Works Cited:

• Department of Health and Human Services FY 2021 Budget in Brief (HHS)
• HHS Climate Adaption Plan - 2014 (HHS)
• Low Income Home Energy Assistance Program (Office of Community Services)

Music produced by Seth Kennedy.