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02/08/2016

Weekly E-Bulletin


673 Rural Hospitals Vulnerable To Closure: Analysis

673 rural hospitals across 42 states are vulnerable to closure, according to a report released last week from iVantage Health Analytics. Southern states have especially high rates of vulnerability when compared to their total number of rural facilities. States in this region with high rates of vulnerability include Mississippi (79 percent), Louisiana (58 percent) and Georgia (53 percent). 63 percent of the hospitals vulnerable to closure are located in states that have not expanded Medicaid. 68 percent of the hospitals vulnerable to closure are critical access hospitals. More than 60 rural hospitals have closed since 2010 and another.  Click here for the complete report.

House GOP Leaders Want Provider Input on HOPD Site-Neutral Issue

Republicans on the House Energy and Commerce Committee last week said they are jumping into a hospital payment issue that has been a priority for the Ways and Means Committee. Chairman Fred Upton (R-MI) and health subcommittee leader Joe Pitts (R-PA) last week sent a letter to health care groups asking for input on policy changes related to site-neutral payments, after last year’s budget deal included a cut to Medicare payments for services provided in hospital outpatient departments.  This is a big issue for many hospitals that had plans to expand their off-campus HOPD sites but were cut short by the legislation that passed with little discussion.  Click here to read the leaders’ letter.

MACPAC Suggests Targeting DSH Payments to Deserving Hospitals

Medicaid and CHIP Payment and Access Commission (MACPAC) last week recommended CMS direct Medicaid Disproportionate Share Hospital (DSH) payments to those hospitals that deserve them, in their annual report to Congress on DSH. The Commission states that “DSH allotments and payments should be better targeted toward states and hospitals that serve a disproportionate share of Medicaid and low-income patients and that have higher levels of uncompensated care, consistent with the original statutory intent.” To read the report, click here.

Government Investigating Pain Relief Cream Fraud, Veterans May Be Biggest Victim

The Justice Department is investigating what authorities suspect is half a billion dollars in health-care fraud linked to specialty creams used to treat pain and other ailments, and believe an insurance program for veterans may have been the biggest victim. Sales of these so-called compounding creams have surged recently thanks in part to a marketing blitz, including pitches by retired NFL quarterback  Brett Favre, that has promoted them to the elderly, athletes and others. Click here for the Wall Street Journal report.

The Push Is On for a Telehealth Payment Expansion

The push is on for Congress and CMS to expand Medicare payments for telehealth and remote patient monitoring.  In a study released last week, three proposed policy changes to expand Medicare reimbursement of telehealth and remote patient monitoring (RPM) are estimated to collectively decrease federal spending by $1.8 billion between FY2017 and FY2026.  Click here for the Avalere Health report.  The report supports new legislation introduced last week in the House and Senate.  Click here for that report.

CDC Issues New Zika Guidelines

The CDC issued guidelines Friday detailing how to prevent the sexual transmission of Zika, and offered recommendations for health care providers preparing to treat patients infected with the virus.  The agency recommends that men who have a pregnant partner and have traveled to outbreak regions abstain from sexual activity or use condoms for the duration of the pregnancy. CDC says Zika virus testing for men is only recommended to determine if their pregnant partners have been infected. At this time, testing men for the purpose of assessing risk for sexual transmission is not recommended. Click here for the guidelines.

Study: State Medical Boards Fall Short Protecting Against Sexual Misconduct

Some U.S. state medical boards are not doing enough to protect the public from doctors who have engaged in sexual misconduct, consumer watchdog Public Citizen said last week.  Between 2003 and 2013, reports of 1,039 physicians having engaged in one or more cases of sexual misconduct were filed in the United States, of which 786 doctors were disciplined by a state medical board, according to a study by Public Citizen. However, 177 of the remaining 253 entirely escaped sanctions from a state medical board, such as the revocation or restriction of a medical license. Click here for the study.

CMS Initiative To Reduce Hospitalizations from Nursing Home Residents “Promising”

Early results of CMS’ initiative to reduce hospitalizations among nursing home residents indicates a promising start to the program, CMS officials reported last week.  The results for 2014 showed that Medicare expenditures were generally reduced at all seven testing sites, relative to a comparison group. Two sites showed “statistically significant” reductions in expenditures. All testing sites showed a decline in all-cause and potentially avoidable hospitalization, with four sites showing significant reductions in at least one hospitalization measure. Click here for details from CMS.  Here’s more from CMS’ CMO.

  • Potentially preventable hospital stays – those that might be prevented with good outpatient care — decreased at a faster rate (19 percent) than overall hospital stays (8 percent) between 2005 and 2012.  This is according to a report released last week by the Agency for Healthcare Research and Quality.  Click here for the report.

United HealthCare Files Suit Over Medicare Advantage Overpayment Rule

United Healthcare and its plans last week sued CMS over a Medicare Advantage rule that requires plans to report and return risk adjustment overpayments for diagnoses that aren’t backed up by a beneficiary’s medical record. At issue is a rule finalized by CMS in 2014 that requires plans to return overpayments for beneficiary diagnoses that they knew — or should have known — were not backed up in medical records. To read the complaint, click here.

FDA, White House, CMS Announce Plans To Fight Opioid Epidemic

The FDA will give more weight to the the public health risks of painkillers in approving new drugs, one of several steps announced last week as part of the agency’s response to growing concern over the opioid epidemic. The new action plan follows the White House announcement on Tuesday of a $1.1 billion initiative to fight the epidemic, focused mainly on expanding access to medication assisted treatment. The announcement also follows the news that three Senate Democrats – Bernie Sanders, Joe Manchin and Ed Markey – planned to hold up Califf’s nomination, citing concerns over the agency’s controversial new painkiller approvals. Click here for the FDA action plan.  Click here for the White House action plan.

  • CMS has issued a detailed bulletin to state Medicaid programs on the oversight of opioids. CMS recommends more prescriber education, and highlights efforts in some states to require prior authorization for certain uses of the drugs and state mandates that doctors check drug databases before prescribing. It also recommends removing methadone – when it’s being used to treat pain – from Medicaid preferred drug lists. To read the bulletin, click here.

Pharma:  If Uninsured Rate Is Dropping, Why Is 340B Increasing?

Pharma was out last week with a new attack on the 340B Rx discount pricing program.  Currently about 45 percent of all Medicare acute care hospitals in the U.S. participate in the 340B program. It is projected that as more individuals become eligible for Medicaid under the Affordable Care Act, more hospitals will become eligible for 340B because hospital eligibility is partly based on the number of Medicaid and low-income Medicare patients treated on an inpatient basis.  Pharma says this new data raises questions about whether the growth in hospital eligibility for 340B is justified. Click here for more.

  • The uninsured rate for low-wage workers dropped significantly in states that expanded Medicaid compared to states that did not, according to a new study from Families USA. The report found that states that expanded Medicaid in 2014, on average, saw a 25 percent reduction in the number of uninsured workers. States that did not expand Medicaid saw a 13 percent drop. Click here for the report.

 Residents Can Work Longer Shifts According to New Study

A study in the New England Journal of Medicine suggests that patients didn’t suffer additional harm when surgeons-in-training were allowed to work longer shifts. The analysis “of data from 138,691 patients, flexible, less-restrictive duty-hour policies were not associated with an increased rate of death or serious complications.” To read the study, click here.

Employers Should Offer Long-Term Care Insurance: Report

The Bipartisan Policy Center released a report last week proposing a plan that includes encouraging employers to offer long-term care insurance with fewer benefits to keep the policies affordable. The group’s recommendations include increasing the availability of private long-term care insurance, expanding options for home and community care in Medicaid, creating options for working individuals with disabilities and creating a federal catastrophic program. To view the report, click here.

Uninsured Rate Drops Rapidly for Low-Wage Workers in Medicaid Expansion States

The uninsured rate for low-wage workers dropped about twice as fast in states that expanded Medicaid compared to states that didn’t, according to a new study by Families USA. The study used data from the Census Bureau’s American Community Survey. It considered expansion states as the 26 states that had expanded Medicaid in 2014. The report found that states that expanded Medicaid in 2014, on average, saw a 25 percent reduction in the number of uninsured workers. States that did not expand Medicaid saw a 13 percent drop. To read the study, click here.

12.7 Million Sign Up for Obamacare: HHS

About 12.7 million people signed up for 2016 health plans during the most recent Obamacare enrollment period, the Obama administration announced late last week. That’s a modest increase from last year’s sign-up figure and within the administration’s targets – but far short of the 21 million customers nonpartisan scorekeepers at the Congressional Budget Office originally predicted before scaling back estimates last month. Click here for details from HHS.

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