WEEKLY E-BULLETIN


New Bill Would Halt Hospital Star Ratings Program

U.S. Reps. Renacci (R-OH) and Rice (D-NY) have introduced a bill to delay for at least one year the hospital star ratings program. The legislation would require CMS to take down the newly published ratings until at least July 31st, 2017 and require the methodology to be vetted by a third party. Given the broad, bipartisan support in Congress for the delay, this issue is likely to be debated when Congress returns in September. Click here to review the 3-page bill.

On July 27th, CMS posted the overall hospital quality star rating on the Hospital Compare website. Despite the urging of the hospital community and lawmakers, it appears that CMS has not made any adjustments to its methodology to develop the star rating system, which summarizes 64 existing quality measures for each hospital into a single rating. CMS also posted a table that shows how individual hospitals perform compared to all hospitals across the country. Of the 4,600+ hospitals, 102 hospitals earned five stars, 934 four stars, 1,770 three stars, 723 two stars and 133 will only get one star. CMS won’t rate 937 hospitals due to factors such as failure to report or insufficient available data. Click here to go to the hospital compare website and here for the CMS fact sheet.

Healthgrades Announces 2016 Hospital Awards for Women’s Care

Healthgrades last week announced the recipients of three awards for women’s care: the 2016 Healthgrades Gynecologic Surgery Excellence Award™ (click here for list); the 2016 Healthgrades Labor and Delivery Excellence Award™ (click here); and the 2016 Healthgrades Obstetrics and Gynecology Excellence Award™ (click here). These awards recognize hospitals across the country that have demonstrated superior outcomes in important components of women’s healthcare services.  Click here for more.

CMS To Increase SNF Payments 2.7%

CMS late Friday issued a final rule outlining FY2017 Medicare payment policies and rates for the Skilled Nursing Facility Prospective Payment System.  The policies in the final rule continue to shift Medicare payments from volume to value. CMS projects that aggregate payments to SNFs will increase in FY17 by $920 million, or 2.4 percent, from payments in FY16. This estimated increase is attributable to a 2.7 percent market basket increase reduced by 0.3 percentage points, in accordance with the multifactor productivity adjustment required by law.  Click here for the CMS fact sheet.

Inpatient Psych Payments to Increase 2.2%

CMS also issued a notice updating fiscal year FY17 Medicare payment policies and rates for the Inpatient Psychiatric Facilities Prospective Payment System.  CMS estimates IPF payments to increase by 2.2 percent or $100 million in FY 2017.  This amount reflects a 2.8 percent IPF market basket update less the productivity adjustment of 0.3 percentage point and less the 0.2 percentage point reduction required by law, for a net market basket update of 2.3 percent.  Additionally, estimated payments to IPFs are reduced by 0.1 percentage point due to updating the outlier fixed-dollar loss threshold amount. Click here.

Hospice Medicare Payments To Increase 2.1%

CMS also issued a final rule outlining FY17 Medicare payment rates and wage index and the Hospice Quality Reporting Program for hospices serving Medicare beneficiaries. The final rule also describes a potential future enhanced data collection instrument, as well as plans to publicly display quality measures and other hospice data beginning in calendar year 2017. As finalized, hospices would see a 2.1 percent ($350 million) increase in their payments for FY17 (reflecting an estimated 2.7 percent inpatient hospital market basket update, reduced by a 0.3 percentage point productivity adjustment and a 0.3 percentage point adjustment required by law). Click here for more.

Inpatient Rehab Payments To Increase 1.9% in 2017

CMS also issued a final rule outlining FY17 Medicare payment policies and rates for the Inpatient Rehabilitation Facility Prospective Payment System and the IRF Quality Reporting Program. CMS is updating payments for FY17 an overall estimated update of approximately 1.9 percent (or $145 million), relative to payments in FY16. Click here.

CMS Proposes New Cardiac Bundled Payment Models

CMS last week released a proposed rule to create new mandatory cardiac bundled payment models and an extension of the existing bundled payment model for hip replacements to other hip surgeries. The bundled payment models proposed in the proposed rule – as well as the CJR model which began this year – could qualify as Advanced Alternative Payment Models beginning in 2018. This proposed rule would:

  • Create the Advancing Care Coordination Through Episode Payment Models (EPMs), two new 90-day post hospitalization bundled payment programs for acute myocardial infarction (AMI) and coronary artery bypass graft (CABG);

 

  • Build upon the existing Comprehensive Care for Joint Replacement model (CJR) to create a new model, the Surgical Hip/Femur Fracture Treatment (SHFFT) model, that compliments the CJR by adding additional hip and femur fracture surgeries;

 

  • Create a track in each of these models that could qualify for the Advanced Alternative Payment Model bonus under MACRA, the new physician payment system; and

 

  • Create the Cardiac Rehabilitation Incentive Payment Model, which would provide incentive payments to hospitals to coordinate rehabilitation services for beneficiaries who are hospitalized for a heart attack or bypass surgery.

To view the proposed rule click here and for the CMS fact sheet click here. For the CMS webpage on the Cardiac Care Models, click here.

CMS Announces Extension of New Provider Ban in Six States

CMS announced it is extending for six months and expanding statewide the temporary provider enrollment moratoria on new Medicare Part B non?emergency ground ambulance suppliers in New Jersey, Pennsylvania, and Texas and home health agencies in Florida, Texas, Illinois, and Michigan.  Additionally, the statewide expansion also applies to Medicaid and CHIP.CMS also announced it is immediately lifting the current temporary moratoria on all Medicare Part B, Medicaid, and Children’s Health Insurance Program emergency ground ambulance suppliers.  Click here for details.

Rural Health Clinics Generate $1 Million Each to Local Economies

The annual economic impact of Rural Health Clinics is 12.6 local jobs and $1,009,299 in wages, salaries and benefits. This is according to a new estimate from the National Center for Rural Health Works. The Center looked at CMS cost reports for 1,261 RHCs and found that an RHC with a full-time physician can generate about 10 jobs and income of more than $800,000 for people directly employed by the clinic. Click here to read the study.

Major Progress on Using the Immune System to Fight Cancer

Harnessing the immune system to fight cancer, long a medical dream, is becoming a reality. Remarkable stories of tumors melting away and terminal illnesses going into remissions that last years — backed by solid data — have led to an explosion of interest and billions of dollars of investments in the rapidly growing field of immunotherapy. Pharmaceutical companies, philanthropists and the federal government’s “cancer moonshot” program are pouring money into developing treatments. Medical conferences on the topic are packed.  All this has brought new optimism to cancer doctors.  Click here for this great NYTimes report.

New Guidelines for Treating Cancer Patients Pain – Opioids Played Down

New America Society of Clinical Oncology guidelines for cancer survivors place opioids far down the list of pain treatment options – below the use of medical cannabis where permitted – and urge clinicians to carefully assess the risks before prescribing narcotics. The guidelines state that clinicians may prescribe a trial of opioids “in carefully selected cancer survivors” who have chronic pain that did not respond to more conservative treatment management. The ASCO guidelines were developed largely through the review of more than 60 studies. Click here for the guidelines.

Seniors Getting Switched to Medicare Advantage with Little Warning: Report

With Medicare’s specific approval, a health insurance company can enroll a member of its marketplace or other commercial plan into its Medicare Advantage coverage when that individual becomes eligible for Medicare. Called “seamless conversion,” the process requires the insurer to send a letter explaining the new coverage, which takes effect unless the member opts out within 60 days. Medicare officials refused recently to name the companies that have sought or received such approval or even to say how long CMS has allowed the practice. Click here for the story.

30 Percent of Pediatric Readmissions May Be Preventable: Study

Nearly 30 percent of pediatric readmissions may be preventable, according to a new study published in Pediatrics. Researchers reviewed medical records for 305 patients who were readmitted within 30 days to Boston Children’s Hospital from December 2012 to February 2013. They also interviewed clinicians and parents of the children in the study. Planned readmissions for treatments like chemotherapy were also included. Click here for the study.

43 States Graded “F” for Price Transparency in New Report

The Catalyst for Payment Reform and the Health Care Incentives Improvement Institute released their report card on price transparency laws, and the report shows little progress from the year prior. Based on the rating criteria, Colorado, Maine and New Hampshire were the only states to receive an “A” grade this year. Oregon received a “B” grade, two states — Virginia and Vermont — received a “C” grade and Arkansas received a “D.” The remaining 43 states earned an “F” in this year’s report. Last year, 45 states earned an “F.”  Click here for the report.

CMS: Some Drug Companies have Incorrectly Reported Best Price

CMS stated last week that some drug manufacturers are incorrectly reporting their quarterly “best price” as higher than the Average Manufacturer Price (AMP) for products. In a recently released guidance document, CMS asked companies to verify the accuracy of their best price before submitting that information to the Drug Data Reporting for Medicaid system. The Medicaid best-price policy requires drug companies to sell drugs at the lowest price available during each rebate period. CMS says in a July 21st manufacturer notice that because of the way the best price is computed, “the reported Best Price is generally lower than AMP; however, we continue to see labelers reporting Best Price greater than AMP.” Click here to read the guidance.

Foundations Launch Project on Chronically Ill

The Commonwealth Fund, the John A. Hartford Foundation, Robert Wood Johnson Foundation, the Peterson Center on Healthcare, and the SCAN Foundation will launch an initiative later this year that will focus on chronically ill patients because they have costly and complex health care needs and are disproportionately affected by poor quality care. The project has three main goals: to better understand the needs of chronically ill patients, to identify ways to deliver high-quality, integrated care at lower costs, and to expand those practices across the country. To view the announcement, click here.

Part D Rx Premiums in 2017 Expected To Remain Stable

CMS last week announced that the average basic premium for a Medicare Part D prescription drug plan in 2017 is projected to remain relatively stable at an estimated $34 per month. This represents an increase of approximately $1.50 over the actual average premium of $32.56 in 2016. The stability in average basic Medicare Part D premiums for enrollees comes despite the fact that Part D costs continue to increase faster than other parts of Medicare, largely driven by high-cost specialty drugs and their effect on spending in the catastrophic benefit phase. Click here for details.

Zika Transmitted Locally in Florida

Florida health officials said on Friday the state has four cases of locally transmitted Zika, potentially marking the U.S. arrival of the mosquito-borne virus responsible for serious birth defects. The Florida Department of Health said it believes three men and one woman were infected by a virus-carrying mosquito in the state. The CDC has reported nearly 1,650 people in the continental U.S. have been infected after traveling abroad to Zika-infested areas or having sexual contact with someone who had returned from one. Click here for more.

HHS Teams with Groups to Speed-up Antibiotic Development

HHS announced last week it is teaming with U.S. and other international groups to help speed the development of new antibiotics. The public-private partnership aims to make antibiotic development a more attractive space for private investment. HHS’s Biomedical Advanced Research and Development Authority will provide up to $250 million over five years for the project. NIH will provide in-kind research and technical support. The U.K.’s ARM Centre, a public-private group that works on antibiotics and diagnostics, will provide up to $100 million and the Wellcome Trust, a global charitable foundation that works on medical challenges, will also provide funding. Click here for the HHS announcement.

88 Percent of Ransomware Attacks Are on Hospitals

The healthcare industry is hit significantly harder by ransomware than any other — 88 percent of attacks hit hospitals – according to a report released last week. Hospitals and health systems data is worth more than other sectors when it comes to hacks as patient data sells for higher prices than any other kind of information on the black market. Of the 88 percent of the attacks that occurred in healthcare organizations, 94 percent were linked to a specific variant of software called Cryptowall, according to Solutionary’s Security Engineering Research Team Quarterly Threat Report for Q2 2016. To read the report, click here.

HHS Announces Grants To Battle Cyber-Threats

HHS has announced “cooperative agreement funding opportunities” for the creation of an information sharing and analysis organization, or ISAO, that would share cyber-threat intelligence with the department. The funding offer could amount to $250,000 in the first year with the possibility of being extended for five years. HHS is inviting existing ISAO or sector-specific information sharing and analysis centers, or ISACs, to apply for the grant. Click here for more information from HHS.