Weekly E-bulletin

President, Some GOP Senators Not Giving Up on ACA Repeal and Replace
President Trump turned to Twitter over the weekend to cajole, push and threaten GOP senators to immediately pass a repeal and place bill before starting work on any other issue.  Read the story here in the NY Times.  Several GOP senators huddled with Trump after the senate voted 51-49 to kill the “skinny” ACA repeal bill Friday morning.  Their aim was to resurrect a bill that could pass.  Click here.  House Freedom Caucus leader Rep. Mark Meadows (R-NC) also urged his senate colleagues not to give up.  Click here.
• One immediate problem is that the government subsidies for individuals on the insurance exchanges end this month. President Trump has not said whether he would allow them to continue in August and beyond. Click here.

• The American Association of Actuaries last week urged support for the insurance subsidies and issued a very good report on how they work and why they’re needed.  Click here.
• Calls for a bipartisan solution are also growing, but can that be accomplished.  Click here.
• The House “Problem Solvers” caucus of about 40 bipartisan members have been meeting to find solutions.  Click here to read what one of its GOP members, Charlie Dent (PA), has to say about it.
• Hundreds of counties may not have exchange coverage in 2018 unless there is a fix.  Click here.
• 2,000 people showed up for a free clinic in Virginia’s Appalachian area 10 days ago as a reminder that there is still much to be done for the uninsured and under-insured.  Click here for the compelling story.

CMS Proposes Billions in Hospital DSH Cuts
Starting this October, CMS could begin cutting billions in disproportionate-share hospital payments. The ACA mandated that Medicaid DSH funds be cut by $43 billion between fiscal years 2018 and 2025. On July 27th, CMS proposed to move forward with the mandated cuts beginning on Oct. 1st. The cuts would build year over year, starting at $2 billion in fiscal 2018, and growing to $8 billion by fiscal 2025. In an attempt to lower the impact, CMS states in the proposal that the formula used for these cuts would be geared toward ensuring that DSH funds reach those providers with the greatest need for financial support. Among other things, the rule would impose a smaller cut in low DSH states. Larger cuts would be felt in states that have the lowest percentage of uninsured, states that do not target DSH payments for hospitals with high Medicaid volumes, and states that do not target DSH payments on hospitals with high levels of uncompensated care. Click here for the rule.

EmCare Practices Are Focus of Out-of-Network Billing Analysis
A study by Yale researchers found that the rate of out-of-network doctor’s bills for customers of a big insurer jumped when EmCare entered a hospital. EmCare is now one of the nation’s largest physician-staffing companies for emergency rooms and is coming under increasing scrutiny. Click here for the NY Times report. Click here for the Yale study.

House Leader Moves To Cut Provider Regulations and Mandates
Ways & Means Health Subcommittee Chair Pat Tiberi (R-OH) is asking providers to submit ideas for cutting back Medicare regulations and laws. Specifically, Tiberi is seeking ways to provide relief from the regulations and mandates that, “impede innovation, drive up costs, and ultimately stand in the way of delivering better care for Medicare beneficiaries.” Specifically, the Subcommittee is looking for feedback on how Congress can deliver statutory relief from the mandates established in law through legislative authority.  He is also seeking input how Congress can work with the HHS and CMS to deliver regulatory relief through Administrative action. Feedback is due to the Subcommittee by Aug. 25th.  Click here for more from the Subcommittee and instructions for submission.

CMS Releases Market Saturation and Utilization Data Tool
CMS has released an interactive tool that includes maps and data-sets that shows national, state, and county level provider services and utilization for selected health service areas. The Market Saturation and Utilization Data Tool, is based on Medicare claims data and shows the density of providers of particular services within defined geographic areas relative to the number of the beneficiaries receiving that service in those areas. The tool includes an interactive map that is color-coded and can be adjusted according to the data sets chosen by a user. To view and use the tool, click here.

Over 100 Million Americans Have Diabetes or Pre-diabetes
According to new CDC statistics, more than 100 million U.S. adults are now living with diabetes or pre-diabetes. The National Diabetes Statistics Report finds that as of 2015, 30.3 million Americans, or 9.4 percent of the U.S. population, have diabetes. Additionally, another 84.1 million have pre-diabetes, a condition that if not treated often leads to type 2 diabetes within five years. The report also includes information on risk factors for complications, acute and long-term complications, deaths, and costs of the disease. Click here for the report.

CMS’ Proposed Home Health Cuts Amount to Nearly $1 Billion
A new CMS proposal would reduce Medicare home health payments by 0.4 percent for 2018, saving the government an estimated $80 million. Additionally, CMS is proposing a series of changes to the payment methodology beginning in 2019 that could result in a pay cut of up to 4.3 percent or possibly as much as $950 million in reduced payments. This includes changing the home health payment case-mix adjustment methodology and changing the unit of payment from 60-day episodes of care to 30-day periods of care, that would be implemented beginning after January 1, 2019. For the CMS fact sheet, click here, and for the proposed rule, click here.

House Passes Stopgap Funding for VA Health Care Access Program
The House has unanimously passed a $2.1 billion extension for the private medical care access program for veterans, VA Choice, sending the measure to the Senate for action before the funding runs out. The House passage of the bill (S. 114) includes renewals of 28 major medical facility leases that have been sought by lawmakers for years. Click here for a summary and bill language.

MedPAC Releases Data on Health Care Spending
The Medicare Payment Advisory Commission released its 2017 data book on health care spending and the Medicare program. The book provides data on Medicare spending, demographics of the Medicare population, beneficiaries’ access to care, and quality of care in the program, among other information. In the report, the data shows that Medicare is the largest single purchaser of health care in the United States at 22 percent or $605 billion in 2015. A combined 35-percent of spending was financed through various private health insurance payers, and 13 percent was from consumer out-of-pocket spending. To read the report, click here.

House Passes Bill to Allow Private Accreditors to Certify Dialysis Centers
The House unanimously passed a bill that would allow private accreditation organizations to certify dialysis facilities. Currently, around 90% of providers, including hospitals, are certified by private accreditors, but dialysis centers have been excluded from this. CMS provides funding to state agencies to survey, certify, and inspect dialysis centers, however they’re currently a “lower priority” on the certification tier system established by the agency. More than 600,000 Americans are being treated for kidney failure and 468,000 patients are on dialysis, according to the latest data from the National Kidney Foundation. To view the bill language and summary, click here.

Telehealth Important Rural Residents: GAO
With the rising cost of health care and closing of rural hospitals, telehealth plays an important role in providing preventative and specialized patient care to rural residents. The Center for Telehealth at the University of Mississippi Medical Center in Jackson estimates that if just 20 percent of all diabetes patients in Mississippi participated in a telehealth program, Mississippi could save up to $180 million per year. However issues with telehealth still exist, with Medicare patients often not qualifying for services due to federal restrictions, according to the GAO. Rural residents are, on average, older, sicker, and poorer than their urban counterparts. Click here for GAO’s congressional testimony.

Senator Targets Pharma Companies as She Deepens Probe into Opioid Epidemic
Senator Claire McCaskill (D-MO) is expanding her investigation into the causes of the opioid epidemic to four additional drug companies and three opioid distributors. McCaskill sent letters to opioid manufacturers Mallinckrodt, Endo, Teva and Allergan and opioid distributors McKesson Corporation, AmerisourceBergen Corporation and Cardinal Health. McCaskill asked drug manufacturers for documentation of suspicious order notifications provided to the Drug Enforcement Agency originating from Missouri. Click here for her letters.

Democrats Unveil New Anti-Price-Gouging Plan for Drugs
Democrats last week laid out a three-pronged approach to lower the cost of prescription drugs in the United States that aims to stop large price increases and give the federal government more power to influence pricing in Medicare Part D. The plan would create an independent, Senate-confirmed “price gouging,” enforcer to identify medicines with “unconscionable” price increases and impose fines on manufacturers that are proportional to the size of the price hike. Click here for details.

Medicaid Covered Hospital Stays Jump, While Commercial and Uninsured Fall: AHRQ
From 2005 to 2014, the number of Medicaid-insured hospital stays increased nearly 16 percent, while privately insured and uninsured hospital stays both decreased nearly 13 percent. Medicare-insured stays remained essentially unchanged. During the same time period, the inflation-adjusted mean cost per inpatient stay increased by 12.7 percent, from $9,500 to $10,900.  Click here to read this new data report from the Agency for Healthcare Research and Quality.

FDA Delays E-Cigarette Guidelines, Seeks Nicotine Reduction in Tobacco
The FDA is delaying the enforcement of marketing guidelines for electronic cigarettes for several years, allowing more time to establish comprehensive standards for the newer tobacco products and examine whether e-cigarettes have positive health effects, the agency announced Friday. At the same time, FDA said it will examine whether to lower the amount of nicotine in traditional cigarettes to less addictive levels.  Click here for the FDA announcement.  Click here for the Washington Post story.

“Slug Slime” Inspires New Stitches
Inspired by slug slime, scientists have developed a flexible adhesive that sticks to wet surfaces. This stretchy glue can be attached to a beating, bleeding heart and could someday replace stitches in wound repair. Other commercially available glues create strong but inflexible bonds or stretchy but weak connections. The slug-inspired glue cements tightly and it is held together by a stretchy matrix. Click here for details.

Cows May Be Key to Helping with HIV
Scientists at Scripps Research Institute have found that while cows don’t contract HIV, they can produce anti-HIV antibodies when injected with proteins like those on the surface of the virus. After injecting four cows with the proteins, the researchers harvested antibodies that blocked the fast-mutating virus. The cow’s ability to respond, which is much faster than humans, to viral mutations “was kind of mind-blowing,” lead author Devin Sok in an interview with STAT. Click here for the report, and here for the interview in STAT.

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