WEEKLY E-BULLETIN


CMS Proposes New Quality and Anti-Discrimination Measures for Hospitals

CMS last week released proposed rules outlining new quality, anti-discrimination measures for hospitals. The new Conditions of Participation require nearly all U.S. hospitals to meet new standards to reduce antibiotic overuse and improve health equity, among other changes. The 6,228 hospitals that participate in Medicare or Medicaid must designate a qualified leader to lead antibiotic overuse reduction efforts, and they must also establish policies that prohibit discrimination on the basis of race, gender, sexual orientation and more. Critical access hospitals would be required to have a Quality Assessment and Performance Improvement (QAPI) program. Click here to view the rule, and here for the CMS fact sheet.

House Committee Unanimously Approves Mental Health Legislation

The House Energy and Commerce Committee last week approved, 53-0, mental health care legislation that is budget neutral. The bill (HR 2646) would, among other provisions, strengthen a federal mental health parity law that requires insurers that cover mental health services to provide mental health coverage that equals the benefits for physical health care. The bill would create a new assistant secretary role in the HHS to oversee mental health and substance abuse programs. The bill also includes measures such as grants for innovative programs that are intended to make initiatives more effective and authorizes grants for areas such as preventing suicide and early intervention for children with mental illnesses. Click here to view the markup, and here for the section-by-section of the bill.

MedPAC’s Report To Congress Recommends Major Changes

The Medicare Payment Advisory Commission late last week released its June 2016 report on Medicare payment policy to Congress. Some of the highlights include –

• MedPAC presented basic principles for CMS to follow on the new physician payment system payment models. Among them are that the eligible alternative payment entities should be at financial risk for total Part A and Part B spending, that CMS should give eligible alternative payment entities certain regulatory relief, and that each eligible alternative payment entity should take on financial risk and enroll clinicians.

• MedPAC found that it is feasible to develop a common unit of payment for post-acute care services, with patient and stay characteristics forming the basis of risk adjustment. The commission concluded that because of differences in Medicare’s coverage policies across the PAC settings, separate models will be needed to establish payments for non-therapy ancillary services and for the combination of routine and therapy services.

• MedPAC discussed giving isolated rural hospitals the option of converting to an outpatient-only model that it believes may be more sustainable in communities with declining inpatient volumes.

• The report examines CMS’s proposed Part B demonstration. MedPAC suggests that Medicare overpays for Part B drugs and could lower the add-on payments to doctors. CMS has proposed doing that for high cost medicines in the experiment.
Click here for the full report and here for the fact sheet from MedPAC.

Senate Moving Bill To Stop Cuts To DME

A bill to delay durable medical equipment supplier cuts in rural and non-competitive bid areas is being expedited through the Senate using the “hotline” process. The American Association for Homecare is urging its members to focus on getting support for a companion House bill in what the group calls its last chance to push back the cuts before they are implemented. CMS was required to adjust Medicare fee schedule amounts for non-competitive bid areas by Jan. 1. The agency decided to phase in changes to the DME fee schedule rates during the first half of 2016 so that the rates in all areas would be based on a 50/50 blend of current rates and adjusted rates. Click here for more about the legislation.

OIG Renews Call for Eliminating Provider-Based Designation

A new report from the HHS Inspector General supports eliminating the provider-based designation for hospital outpatient departments or equalize payment for the same physician services provided in different settings. If CMS does not seek authority to implement these measures, the OIG recommends that CMS (1) implement systems and methods to monitor billing by all provider-based facilities, (2) require hospitals to submit attestations for all their provider-based facilities, (3) ensure that regional offices and MACs apply provider-based requirements appropriately when conducting attestation reviews, and (4) take appropriate action against hospitals and their off-campus provider-based facilities that we identified as not meeting requirements. Click here for the OIG’s report.

HHS Awards $156 Million To 420 Health Centers for Oral Health

HHS last week announced nearly $156 million in funding to support 420 health centers in 47 states, the District of Columbia and Puerto Rico to increase access to integrated oral health care services and improve oral health outcomes for Health Center Program patients. This funding enables health centers to expand integrated oral health care services and increase the number of patients served. Health centers will increase their oral health service capacity by hiring approximately 1,600 new dentists, dental hygienists, assistants, aides, and technicians to treat nearly 785,000 new patients. Click here to see how the funds are distributed.

ED Docs have Most Complex Schedules

New research on physician shift scheduling trends shows that emergency medicine departments in the U.S. have the most complex sets of staffing rules and monthly requests of any specialty in medicine. The report, 2016 Physician Scheduling Complexity by Specialty, analyzed rules and requests used in 5,547 department schedules across 57 medical specialties. This report includes analysis of rules and request trends as well as commentary from physician and department administrators on the factors involved. Click here for the report.

AMA Adopts New Code of Ethics

The AMA last week adopted a modernized code of ethics after an eight-year effort to adapt the ethical guidance, first created in 1847, to contemporary medicine. Among other things, the updated code provides new ethical guidance on telehealth that says physicians’ ethical responsibilities do not change as new technologies and new models of care are created. The modernization is aimed at improving the code’s relevance, clarity and consistency. Click here to view AMA’s new code.

White House Announces $200 Million Investment To Increase Organ Donations, Transplants

Following an Organ Transplant Summit at the White House last week, the Administration announced new public and private efforts to reduce the organ transplant 120,000 patient waiting list, including a $200 million investment in research and development to enable more transplants. The White House estimates these steps could increase the number of transplants by almost 2,000 each year and improve patient outcomes. The Department of Defense will dedicate $160 million of the funding toward developing techniques to repair and replace cells and tissues that may one day lead to organ replacement. Additionally, NIH will work with Johns Hopkins University to study organ donations among HIV-positive donors and recipients. The government is also working with private groups to close the gap between the 95 percent of Americans who support organ donation and the 50 percent who are actually registered as donors. Click here for the fact sheet from the White House.

Bills to Revise the Affordable Care Act Approved by House Committee

The House Ways and Means Committee approved a series of bills last week that would revise the Affordable Care Act. The eight bills, included measures to expand health savings accounts, update the foster care system, exempt different groups from the insurance mandates in the health law, repeal part of the law dealing with tax deductions for high medical expenses, and revoke a regulation discouraging small businesses from providing certain health reimbursement arrangements. The following eight bills were approved:

• H.R. 5456, “Family First Prevention Services Act of 2016.” Click here
• H.R. 5447, “Small Business Health Care Relief Act.” Click here
• H.R. 5458, “Veterans TRICARE Choice Act.” Click here
• H.R. 5452, “To amend the Internal Revenue Code of 1986 to permit individuals eligible for Indian Health Service assistance to qualify for health savings accounts.” Click here
• H.R. 5445, “To amend the Internal Revenue Code of 1986 to improve the rules with respect to health savings accounts.” Click here
• H.R. 3080, “Tribal Employment and Jobs Protection Act.” Click here
• H.R. 210, “Student Worker Exemption Act of 2015.” Click here
• H.R. 3590, “Halt Tax Increases on the Middle Class and Seniors Act.” Click here
Click here to view the markup and read other supporting documents from the Committee.

CMS Delays New Lab Payment System

CMS late last week released a final rule delaying a new system for paying for lab tests until 2018. The new system, which will base payments for clinical diagnostic laboratory developed tests based on a weighted median of what private plans pay for them, was slated to take effect in January 2017. CMS stated that it made the date change to give laboratories enough time to develop the information technology systems to meet the new requirements. The change in lab payments was mandated by the Protecting Access to Medicare Act of 2014. Click here for the rule, and here for the CMS fact sheet.

Hospitals Feel the Squeeze of Rising Rx Prices

The high cost of pharmaceuticals are beginning to put a serious squeeze on the bottom lines of hospitals, which do not see much wiggle room for negotiation at this point, according to reports last week. Total prescription spending on drugs increased at a 12.2 percent clip last year, up from a 2.4 percent increase in 2014, according to Crain’s, which cited data from the Centers for Medicare & Medicaid Services. Pharma giants such as Amgen, Allergan and Pfizer have imposed double-digit percentage price increases on dozens of their branded drugs since late last year. Click here for the story.

• Drug companies are using marketing strategies normally aimed at physicians to target patients, particularly children, and the practices could be pushing more patients into prescriptions for costlier medicines, according to a new analysis. The study’s authors say their paper is the first known documentation of drug companies using these methods – including gifts, financial support and one-on-one marketing – to target patients as opposed to doctors. Click here for the report.

Confidence in the American Medical System Holds Steady

According to a new poll by Gallop, Americans’ confidence in the medical system has stayed pretty constant over the past 10 years. Roughly 39 percent of Americans this month professed that they had a “great deal” of confidence in the health care system, compared to 38 percent in 2006. Interestingly, the same survey showed Americans’ falling confidence in other institutions such as big banks, organized religion, the media and Congress, which has the confidence of only 9 percent of Americans. Click here to view the poll data.

Medicaid Plans See Huge Revenue Increase

Over the last five years, increased enrollment within Medicaid managed care plans has led to a 132 percent spike in revenue for insurers, according to a financial analysis released by Milliman. Managed care plans saw particularly large gains within the last year because provisions of the Affordable Care Act that expanded Medicaid and fueled growth within the managed care market. Between 2014 and 2015, the average profit for Medicaid managed care plans increased from 2.1 percent to 2.6 percent. Enrollment increased 25 percent over that same time period and overall revenues grew to 30 percent, reaching $144.1 billion. Click here for the analysis.

Most Employers Plan to Keep Coverage But Still Have Concerns

Few employers have plans to stop offering health benefits to employees, although many worry about price increases and wish workers had more information on pricing, according to a new report by the American Health Policy Institute. Employers also are concerned about federal policies including the Cadillac tax and the potential efforts under a new administration to chip away at the ACA could add complexity and spark frustration among employers. Click here for the report.