WEEKLY E-BULLETIN


CMS Proposals Make Major Changes to HOPDs, ASCs, Physician Payments

CMS last week released proposed rules for Hospital Outpatient Prospective Payment System (OPPS), the Ambulatory Surgical Center (ASC) Payment System and the Physician Fee Schedule (PFS) for 2017. Under the OPPS Rule is a provision that will affect how Medicare pays for certain items and services furnished by off-campus provider-based departments (hospital outpatient departments). The proposal severely limits payments to provider-based departments, under various circumstances.  Click here for our policy team’s summary of the HOPD section of the proposal. Click here for CMS’ OPPS and ASC fact sheet and here for the proposed rule. Click here for the PFS fact sheet and here for the proposed rule.

  • The American Medical Association issued a statement in support of CMS’ proposed HOPD site neutral changes.  Click here.  The American Hospital Association opposes the proposal.  Click here.

CMS Attacks Opioid Crisis in New Rules

Starting in fiscal year 2018, CMS proposes to no longer use the results from three pain management questions in the Hospital Consumer Assessment of Healthcare Providers and Systems survey in determining hospitals’ value-based purchasing program scores, the agency proposed in its CY2017 OPPS rule. CMS would continue to collect and publicly report the results of the HCAHPS pain management questions, however. CMS also is field testing alternative pain management questions, which could be incorporated into the HCAHPS survey through future rulemaking.  Click here for the summary and scroll down to the Hospital Value Based Purchasing section.  In addition, CMS last week issued a final rule that would allow qualified practitioners to request approval to treat up to 275 patients a year with buprenorphine if they have maintained an active waiver to treat up to 100 patients for a year and meet other criteria described in the rule. That’s up from an originally proposed 200 patients a year. Click here for that final rule.

Investigation Finds Physician Sexual Misconduct Widespread

A sweeping investigative report published last week found physician sexual misconduct is widespread in every state across the country.  Reporters from The Atlanta Journal Constitution have identified more than 3,100 physicians who were publicly disciplined for sexual misconduct since 1999, and more than 2,400 of those violations involved patients. The project involved analyzing more than 100,000 disciplinary records. However, according to the AJC investigation, many cases are dealt with secretly by state boards and hospitals, meaning the numbers could be much larger. Click here for this disturbing report.

House Passes Mental Health Bill

The House last week passed 422-2 the Helping Families in Mental Health Crisis Act (H.R. 2646), bipartisan legislation to reform our nation’s mental health system. The Congressional Budget Office estimates that the bill would save Medicaid $5 million over 10 years, with the costs of paying for some services provided by Institutions for Mental Disease offset by savings from an electronic visit verification system for personal care and home health providers. Click here to view the bill.

Addiction and Recovery Bill Almost Law

The House voted 407-5 last week to give final approval to the Comprehensive Addiction and Recovery Act (S. 524). A final Senate vote is expected this week; presidential approval is also expected. The bill approves about $181 million in new funding for opioid programs but would rely on appropriators to deliver the funds later this year. The bill contains policies relating to prevention, treatment, recovery support, criminal justice reform, overdose reversal, and law enforcement and boasts support of 200+ advocacy groups. Click here for the bill text, here for the Joint Explanatory Statement.

House Committee OKs Bill To Delay Physician Supervision Rule for CAHs

The House Ways & Means Committee has unanimously voted to approve the Continuing Access to Hospitals Act (H.R. 5613) that would delay through this year the physician supervision requirement for critical access hospitals in rural areas. Medicare policy requires supervising physicians be present in the department when Medicare beneficiaries receive outpatient therapeutic services. CMS did not enforce the policy through 2014 for critical access hospitals and small and rural hospitals with fewer than 100 beds. Congress extended that enforcement delay through 2015. Click here to view the bill, and here to view the Committee vote and summary of the bill.

Senate Committee Examines MACRA This Week

The Senate Finance Committee announced that they will hold a hearing this Wednesday on implementation of the new Medicare physician payment system, MACRA. CMS acting administrator Andy Slavitt is expected to testify at the hearing entitled, “Medicare Access and CHIP Reauthorization Act of 2015: Ensuring Successful Implementation of Physician Payment Reforms.” Click here for the hearing notice, and here for the hearing website.

  • The American Association of Physicians and Surgeons has called on physicians to leave the Medicare program in response to MACRA.  Click here.

Senate Committee to Hold Hearing on Stark Law

The Senate Finance Committee has announced a hearing entitled, Examining the Stark Law: Current Issues and Opportunities, to be held Tuesday. The hearing will examine ways to improve and reform the Stark Law and follows a white paper issued by Chairman Orrin Hatch detailing suggestions from stakeholders on ways to improve the law. Click here for more details form the Committee, and here for the white paper.

  • The American Hospital Association is recommending a series of changes to Stark.  Click here for their report.

Report Identifies Factors for Rural Hospital Closures

A new analysis released last week sites aging, poor, and shrinking populations, high uninsured rates and a payer mix dominated by Medicare and Medicaid, economic challenges in the community, aging facilities, outdated payment and delivery system models, and business decisions by corporate owners/operators as reasons for increased rural hospital closures. The report states that the closures will have the biggest impact on emergency services and for elderly. They suggest that many communities are attempting to adapt with new models of care; however, without federal support, they will not be able to proceed. Click here to read the report from the Kaiser Foundation.

Commission Calls for “Wholesale Overhaul” of VA Medical System

A congressionally mandated commission, the Commission on Care, offered two views of health care provided by the Department of Veterans Affairs in a report released last week. Care for veterans is “in many ways comparable or better in clinical quality to that generally available in the private sector.” At the same time, VA health care needs “fundamental, dramatic change — change that requires new direction, new investment, and profound reengineering.” The report recommended that the system should get a wholesale overhaul that includes shuttering some facilities and making permanent a system that lets the nation’s 22 million veterans get care from private doctors. Click here for the Commission’s website, and here for the report.

Ongoing Drug Shortages Remains High: GAO

The number of ongoing drug shortages remains high, according to a new report by the Government Accountability Office. The report.  According to the report, there were 136 new drug shortages in 2015, down from 257 in 2011, while the number of ongoing drug shortages increased to 291 from 184 over the period. Click here for the GAO report.

Community Health Workers Growing in Numbers, Success

Thanks in part to federal grants awarded under the Affordable Care Act, the number of community health workers is growing. In 2015, there were 48,000 of them working in the U.S., up from 38,000 three years earlier, a 27 percent increase, according to the U.S. Department of Labor.  But many insurers still don’t cover their services, limiting their potential impact.  However, the three quarters of Medicaid beneficiaries who are in managed care plans can receive services from community health workers, since under managed care providers receive a lump sum each month to cover all the expenses incurred by the beneficiary, including for community health workers. Click here for the report.

Too Many Suncreens Don’t Meet Derm Guidelines: Analysis

About 40 percent of sunscreens commonly purchased on Amazon don’t actually meet sunscreen guidelines set forth by the American Academy of Dermatology. Researchers reviewed the top 1 percent of nearly 6,500 sunscreens available by sales numbers on the site. The most common failings? A lack of water or sweat resistance. The analysis found that shoppers purchased products offering similar levels of sun protection ranged from 68 cents an ounce to $24 an ounce. Click here for the analysis.

364 Organizations on Newest “Most Wired” List

Hospitals & Health Networks has released its 2016 Health Care’s Most Wired list, recognizing hospitals and health systems using advanced technology to support patient care. Hospitals and health systems must meet specific requirements in the following four focus areas to earn the Most Wired designation: infrastructure, business and administrative management, clinical quality and safety, and clinical integration. 364 organizations demonstrated that they met or exceeded “core” development of the four focus areas to receive the awards this year. Click here for the list.