April 30, 2018

Latest Hospital Patient Safety Scores Released by Leapfrog
The majority of urban hospitals don’t perform well on patient safety measures, according to the latest Hospital Safety Grade report released last week by the Leapfrog Group. Of the 11 hospitals in New York City included in the report, only one—NYC Health & Hospitals/Metropolitan—received an “A” grade from the Leapfrog Group in its spring 2018 report. Additionally, just three of Los Angeles’ 12 hospitals got an “A” while only six of Chicago’s 18 hospitals did. Of the approximately 2,500 hospitals graded, 30% earned an “A,” 28% earned a “B,” 35% a “C,” 6% a “D” and 1% an “F”. Click here for Leapfrog’s latest scores by state and by facility.


Top 15 Health Systems Announced by IBM Watson Health
IBM Watson Health has revealed its 15 Top Health Systems based on overall organizational performance. Formerly known as the Truven Health Analytics 15 Top Health Systems, the rankings have been conducted annually since 2008.
Top systems earned the ranking at least in part through more consistent care across member hospitals, finding a “small but discernible difference” in the level of individual hospital alignment within the top-performing health systems as well as 1.9 percent lower volatility, the group said. Click here to see the top 15.

  • The group’s top 100 hospitals was announced last month. Click here to see the list (on Page 7 of the report).

CMS Issues FY19 Payment, Policy Changes for IRFs, SNFs, Hospice, Psych
CMS late Friday issued new payment and policy regulations for inpatient rehab, skilled nursing, hospice and inpatient psych. Earlier in the week, new rules were issued for hospitals and LTCHs.

  • For IRFs, net payments would increase by 0.9% ($75 million) relative to FY 2018 payments, including a 2.9% market-basket update, offset by statutorily mandated cuts of 0.8 percentage points for productivity and an additional cut of 0.75%, and a 0.4% decrease in outlier payments. Click here for details.
  • SNF payments would increase by 2.4% over FY 2018 levels an $850 million increase. As follow-up to the SNF reform model released by CMS in May 2017, the agency proposes for FY 2019 an overhaul of the SNF payment system that would replace the current unit of payment known as “RUGs.” Click here.
  • For FY 2019, aggregate hospice payments and the statutory annual cap would both increase by 1.8% ($340 million) from FY 2018 levels, which is based on a hospital market-basket update of 2.9%, minus the statutorily mandated cuts of 0.8 percentage points for productivity and an additional 0.3 percentage point cut. Click here.
  • For inpatient psych facilities, CMS proposes a net payment increase of 0.98% or $50 million. This includes a 2.8% market-basket update, offset by cuts of 0.8% for productivity and a further Affordable Care Act-mandated cut of 0.75%, as well as a decrease of 0.27% due to updating the for high-cost outlier threshold. CMS also proposes to remove eight measures from the IPF Quality Reporting program. Click here.

CMS Proposes Payment Bump for Hospitals, Changes to Meaningful Use, Eliminate 25% LTCH Rule
In its annual proposed rule for the inpatient and long-term care hospital payment systems, CMS proposed to bump up payments to acute-care hospitals by 3.4 percent and LTCHs by 1.15 percent. Additionally, CMS proposed to overhaul the meaningful use program by giving hospitals more flexibility in how they use electronic health records, and also require hospitals to post the prices of their services online. CMS is also considering paying for gene therapy drugs that treat cancer separately for inpatient stays, currently these drugs, such CAR-T, are bundled with other billings. Finally, to delight of the LTCH community, CMS proposed to eliminate the 25 percent rule. Click here for the CMS fact sheet, and here for the 1,883 page-proposed rule.

Another 340B Bill Introduced, Increases Reporting Requirements
U.S. Rep. Buddy Carter (R-GA) introduced legislation last week that would require 340B hospitals to report on low-income utilization rates of outpatient hospital services. The 340B Optimization Act, co-sponsored by Rep. Chris Collins (R-NY), is another in a series of bills expected to change the program that provides discounted drugs to high disproportionate share hospitals. The bill would require hospitals to report their low-income utilization rate for outpatient services in addition to their low-income utilization rate for inpatient services in both the main hospital and all ‘child-site’ settings. This bill comes about a week and a half before hospitals are set for oral arguments in the case against the CMS outpatient rule that dramatically dropped the reimbursement rate for 340B drugs. Click here for the bill, and here for a summary.

  • President Trump’s speech on drug prices rescheduled for May 8th, expected to contain policies from his 2019 proposed Budget, click here, including changes to 340B.

Committees Vote on Opioid Legislation
The Senate Health Committee passed its bi-partisan Opioid Crisis Response Act of 2018. The bill is compiled from 40 provisions from 38 different Senators aimed at stopping fentanyl at the border, reducing inappropriate prescribing, and accelerating research on non-addictive pain medicines. The Senate Finance Committee is also expected to put together a package to combat the opioid crisis that will be combined with the HELP Committee bill and head to the floor later this summer. On the other side of Capitol Hill, the House Energy and Commerce Health Subcommittee advanced 57 bills – 48 by voice vote – to the full Committee focused on the ongoing crisis. For information on the Senate markup and bill information, click here. For House bills and markup information, click here.


Appropriators Boost Veterans Funding for 2019 Without New Choice Program Funds
The House Military Construction-VA Appropriations Subcommittee last week approved a $97 billion fiscal 2019 spending package – a 5 percent boost in discretionary funds above the current fiscal year. However, the bill does not include $1.9 billion requested by the VA to avert a funding shortfall in the Veterans Choice Program. The White House requested to move Veterans Choice funding into a discretionary stream of money, but Appropriators are skeptical about pulling the funds away from other programs. Rather, Committee Members are looking at the Authorizing Committee to shore up the health program that allows veterans to receive care outside the VA, which could happen in May. Click herefor the Appropriations bill, and here for a summary.

  • A new study finds that the VA’s health systems are competitive with non-VA ones. Click here for the study.

CMS Wants Input on Direct-to-Provider Contracting
The CMS Innovation Center put out a request for information last week for assistance in developing a program that allows providers to contract directly with patients for care, taking insurers out of the equation. Under one scenario, CMS outlines in the RFI a medical practice could receive a lump sum payment from Medicare for each patient to cover basic primary care services, with a chance to earn bonuses from CMS for additional care or quality. The Direct Provider Contracting Model is similar to many other pilots that involve aspects of direct provider contracting, including ACOs, the Comprehensive Primary Care Plus Model that involves capitation arrangements between primary care providers and commercial insurers, and arrangements between providers and Medicare Advantage plans. The new program would apply to fee-for-service Medicare, Medicare Advantage, Medicaid and the Children’s Health Insurance Program. Responses are due May 25. Click here for the RFI.

  • A GAO analysis of the CMS Innovation Center shows that the number of initiatives has dropped significantly as CMMI refocuses its mission under the Trump Administration — With a significant move away from mandatory to voluntary programs. Click here.

CMS To Release New Medicare Data
CMS administrator Verma has announced plans to make new Medicare Advantage encounter data available to researchers. This would supplement information researchers already have about the fee-for-service beneficiaries with provider identifiers, diagnoses, and data on the date and type of service. The agency will start with a preliminary version of 2015 Medicare Advantage encounter data, and prepare the final version by the end of the calendar year. CMS also plans to encourage Medicare Advantage programs to use release platforms that meet the capabilities of CMS’s Blue Button 2.0 feature, which allows patients to access their own claims data. Click here for Verma’s speech making the announcement – it’s a quick and enlightening read.

  • The No. 2 official at the Department of Health and Human Services said the Trump administration isn’t afraid of causing “disruption” in the healthcare system in order to make care better. Click here.

Major Acquisition Positions Health System in New Direction
Not-for-profit health system ProMedica, based in Toledo, is taking a giant step outside of the traditional hospital space with its plan to acquire bankrupt nursing home provider HCR ManorCare for about $1.4 billion through a complex proposed deal. Click here for all the details about the deal that creates a $7 billion health care company.


Major Coverage Gaps Found in Short-Term Plans
According to a new report by the Kaiser Family Foundation, short-term insurance products sold through two major national online brokers tend to not cover maternity care, prescription drugs and substance abuse treatment. The report looked at online insurance websites eHealth or Agile Health Insurance in 24 distinct products marketed in 45 states and the District of Columbia. The analysis found that coverage of maternity care was the biggest problem as none of the plans offering benefits in that category. Also, almost 75 percent don’t cover prescriptions, 62 percent don’t cover substance abuse treatment, and 43 percent don’t cover mental health services. To read the Kaiser report, click here.


Rural OB Closure Leaves 80-Mile Drives to Care
A profile in the Sioux City Journal follows a Western Iowa woman’s story as she navigated the difficulty of finding emergent OB care after the critical access hospital in her community had stopped providing OB services. This closure left mothers and families in the community with an 80-mile drive through farmland in order to reach care. Click here for more.

  • The CAH Coalition is actively working with Congress and federal agencies to best support the unique needs of Critical Access Hospitals. Click here to learn more about their work.

Anthem Profits Increase 30% to $1.3 Billion; Hospital Plans See Big Boost in MA Enrollees
Health insurer Anthem saw a boost in profits during the first quarter after it decided to sell fewer Obamacare plans and instead focus on Medicare Advantage. The company’s profits increased 30 percent, to $1.3 billion, from the first quarter of 2017, according to its latest earnings report. In an earnings call Wednesday morning Anthem said the company plans to focus more in its Medicare Advantage business, which offers a private option to beneficiaries, who are 65 and older or have disabilities. Enrollment in those Anthem plans grew by 237,000 during the first quarter. Click here for more.

  • More than 3 million people are enrolled in a Medicare Advantage plan that is owned by a hospital system or physician group, which is up more than 20% from 2015, according to an analysis of federal data. Click here for details.

FDA to Crack Down on E-Cig Advertising to Children
The FDA announced last week that it will clamp down on manufacturers targeting e-cigarettes to kids and those who sell them to minors. In total, the agency issued 40 warning letters to brick-and-mortar stores selling e-cigarettes to minors, after performing a “large-scale, undercover nationwide blitz” focused on Juul products. The FDA also announced that the online auction site eBay has removed all Juul products from its listings. Additionally, FDA requested Juul and other manufacturers to provide documents regarding youth marketing, research on youth initiation and use, and product design targeting young people or they will be found in violation the law and subject to enforcement. For more from the FDA, click here.
Autism Incidence is Higher than Previously Reported: CDC
According to a new report from Centers for Disease Control and Prevention, about 1 in 59 children have autism spectrum disorder, an increase from a 2016 report that found 1 in 68 children have the condition. The Autism and Developmental Disabilities Monitoring Network – an active surveillance system that provides estimates of the prevalence of autism spectrum disorder among children aged 8 in 11 communities – also found that males were four times more likely than females to have the disorder. Additionally, overall estimated prevalence of autism was highest in New Jersey compared to each of the other ten sites. To view the entire study, click here.


Premature Deaths for Black Adults Declined Significantly: Study
Premature deaths among black adults living in the U.S. have significantly declined since 1990, largely due to falling death rates from heart disease, cancer and HIV, according to a new analysis from University of Pittsburgh researchers.
The study, which researchers called the first of its kind to examine racial disparities in premature deaths between 1990 and 2014, shows that longstanding differences among racial groups are shrinking. Overall, blacks saw a 28 percent reduction in premature deaths during this time, while whites saw a decline of 4 percent. Click here for the study.
HHS, Nephrologists Announce Partnership
HHS last week announced a partnership with the American Society of Nephrology to launch the Kidney Innovation Accelerator (KidneyX), KidneyX will engage a community of researchers, innovators, and investors to enable and accelerate the commercialization of therapies to benefit people with and at risk for kidney diseases through a series of prize competitions and coordination among federal agencies and the private sector. More than 40 million Americans live with kidney diseases and 703,243 experience kidney failure. Click here for details.


SWEET! Dark Chocolate Enhances Health
Are you having difficulty cutting sweets like chocolate out of your diet? No worries – dark chocolate can reduce stress levels, as well as boost mood, memory and immunity. Researchers from Loma Linda University focused on the impact of dark chocolate on human gene expression, including immune response, neural signaling and sensory perception. Researchers tested the electroencephalography (EEG) response to consuming 48 grams of dark chocolate (70 percent cacao). These findings showed that 70 percent cacao enhances neuroplasticity in human’s brain. The results revealed that the flavonoids found in cacao are extremely potent antioxidants and anti-inflammatory agents, which is beneficial to brain and cardiovascular health. Click here for more healthy facts about dark chocolate.

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