WEEKLY E-BULLETIN


GOP To Move Quickly on Obamacare Repeal; Obama Plots Health Care Strategy on the Hill Tomorrow

There were a number of significant developments impacting the future of Federal health policies over the holidays:

– This NY Times story lays out the GOP’s repeal timetable. Click here.

– President Obama is headed to Capitol Hill Wednesday morning to huddle with    Democrats focused on protecting Obamacare.  Click here for more.
– Democratic leaders have already called for a “day of action” to fight health care cuts.  Click here for the letter from Senators Sanders and Schumer and Rep. Pelosi.  Click here for more.
– The nation’s largest senior organization, AARP, is calling on its members to fight changes in Medicare benefits.  Click here.
– Why is the GOP moving so swiftly on repeal?  News reports suggest it may get more difficult as time goes on.  Click here.
– Some in the House GOP are concerned that they might actually win their lawsuit against Obamacare – and remove millions from their coverage immediately and without a replacement plan in place.  Click here for the story.
– However, once sworn in, a President Trump could move quickly to remove the subsidies that help millions of Americans afford their health coverage.  Click here for the Washington Post story.
– President-elect Trump met last week with several well-known hospital system CEOs.  Click here for the story.
– Part of the meeting with CEOs may have focused on allowing more private health care for veterans.  Click here.
– Safety-net hospitals are bracing for the impact of an Obamacare repeal.  Click here for the report.
– The Congressional Budget Office and Joint Taxation Committee are warning they would not consider people with insurance that fails to protect against catastrophic medical events as having coverage.  This could be very problematic for the effort to repeal Obamacare.  Click here.
– Trump’s pick for HHS Secretary, US Rep. Tom Price (R-GA), appears to have divided the nation’s physicians.  Click here.

Study Fingers 50 Hospitals with the Highest Charges to Uninsured

Fifty hospitals in the United States are charging uninsured consumers more than 10 times the actual cost of patient care, according to research published last week. All but one of the facilities are owned by for-profit entities and the largest number of hospitals — 20 — are in Florida. For the most part, researchers said, the hospitals with the highest markups are not in pricey neighborhoods or big cities, where the market might explain the higher prices. Click here for the list.  Click here for the story with a link to the study.

241 Hospitals Have HAC Rate Reductions for 3 Consecutive Years; Readmit Penalty Program Working

241 hospitals have received Medicare payment cuts for 3 consecutive years for high infection rates, according to an analysis released last week.  Earlier this month, CMS announced 769 hospitals are seeing Medicare payments cut in fiscal year 2017 for high rates of hospital-acquired conditions as part of the HAC Reduction Program.  The HAC Reduction Program is in its third year. Click here for the list of 241.
– A new study shows that the hospital readmission penalty program is achieving intended results.  Click here for the study.

Record Number Enrolled in Medicaid, CHIP

More than 74 million individuals were enrolled in Medicaid or CHIP as of October — an increase of nearly 17 million since the start of Obamacare open enrollment in 2013, according to CMS data released last week. The agency’s latest monthly report shows that roughly 68.9 million are Medicaid beneficiaries, with the remaining 5.5 million enrolled in CHIP.  States that expanded Medicaid under Obamacare have accounted for the bulk of the gains, growing enrollment by nearly 40 percent over the last three years. Non-expansion states, by comparison, have seen their collective Medicaid and CHIP population increase by about 18 percent.  Click here for the CMS data report.

  • The former director of the National Economic Council says protecting Medicare is good, but don’t take your eye off of Medicaid.  Click here.

OIG Pushes CMS To Consider Using Observation Towards 3-Day Stay

The HHS Office of Inspector General has recommended to CMS that they look into letting Medicare count all hospital days toward the three-day stay required before Medicare covers nursing home services. CMS agreed with the OIG’s recommendation, but the agency cautioned that it did not have the authority to change the three-day stay requirement without legislation.  Click here for the report.

House Committees blast White House over ACA payments

An addendum to the House Energy and Commerce and Ways and Means Committees’ investigation on the Affordable Care Act’s cost-sharing reduction program concludes that senior administration officials discussed using money appropriated for tax credits to instead fund the CSR program, and they based that decision on a “flawed legal analysis.”  To read the addendum to the investigation, click here.

GOP Lawmakers Suggest States May Be Gaming the System on Medicaid Expansion

Republican lawmakers are pressing CMS on whether Medicaid expansion competes with insurers on the state exchanges, and suggest that states have bent the rules of expansion coverage in order to get the 100 percent federal match rate mandated through the Affordable Care Act. In a letter to CMS, Sen. Orrin Hatch (R-UT) and Reps. Joe Pitts (R-PA) and Tim Murphy (R-PA) say some CMS policies may actually encourage states to push individuals covered on the exchanges to Medicaid.  To read the letter, click here.

Federal Guidelines Updated for Women’s Preventative Services

As one of its last directives, the Obama Administration updated its guidelines describing how women’s preventive services must be covered by most health plans at no charge, including all FDA-approved forms of contraception.  HRSA’s Women’s Preventive Services Guidelines are used to determine which services non-grandfathered plans must cover with no requirement for patient cost-sharing.  The guidelines also address screenings for breast and cervical cancer, preventive care visits and counseling for sexually transmitted infections, among other areas.  Click here to read the update.

New Cardiac Bundles and Expansion of Ortho Bundles Finalized

CMS has published final regulations on mandatory bundled pay demonstrations for cardiac and joint-replacement services, even though the incoming Republican administration and many Republicans in Congress oppose requiring providers to participate in demonstrations that test changes to Medicare reimbursement.  Additionally, the agency finished writing policy for the accountable care organization Track 1 +, which aims to get more physicians to accept the risk of penalties for poor performance.  CMS anticipates the ACO Track 1 + will attract 70,000 doctors, which means that by 2018 about 200,000 doctors would be in risk-bearing alternative pay models that receive a 5 percent pay bump under the new physician pay scheme.  Click here for the final rule and here for the CMS fact sheet.  For the Strategic Health Care memo on the new mandatory bundles click here, and for the memo on ACO Track 1+ click here.

HHS Picks Eight States for Mental Health Care Demonstrations

HHS has announced that it has picked eight states — Minnesota, Missouri, New York, New Jersey, Nevada, Oklahoma, Oregon and Pennsylvania — for a two-year behavioral health demonstration authorized by the 2014 Protecting Access to Medicare Act.  The two-year demonstration program is part of the effort to integrate behavioral and physical health care while improving access to better-quality care.  The states will develop care for seriously mentally ill adults, children with severe emotional disturbances and serious drug addicts, and they must launch their programs by July 1, 2017.  Click here for more from HHS.

Diabetes Care Still Tops Chronic Spend List

A new study published in the Journal of the American Medical Association reveals what patients and their insurers are spending their money on, $3.2 trillion in 2015.  Chronic — and often preventable — diseases are a huge driver of personal health spending. The three most expensive diseases in 2013: diabetes ($101 billion), the most common form of heart disease ($88 billion) and back and neck pain ($88 billion).  Click here for more.
– Click here to the see 5 most expensive drugs in 2016.

Hospitalized Medicare Patients Better-Off with a Female Physician

Hospitalized patients who are treated by female doctors show lower mortality and readmission rates, according to a new Harvard public health report.  The study included data from more than 1 million Medicare beneficiaries who were hospitalized with a medical condition and treated by internists between 2011 and 2014.  If treated by a female physician, the patients had a 4 percent lower risk of dying prematurely and a 5 percent lower risk of being readmitted to a hospital within 30 days.  Click here to read the study.