April 8, 2019

MedPAC Wants to Create National ED Coding Guidelines, Boost Payments for Rural Dialysis, Boost MA Data Accuracy 
The Medicare Payment Advisory Commission has voted to approve a set of recommendations aimed at boosting the accuracy of Medicare Advantage encounter data. The recommendations included a broader set of performance metrics, a payment withhold to push compliance and a mandate that noncompliant plans collect data through Medicare Administrative Contractors. Additionally, MedPAC suggests that HHS create a national guideline for coding all emergency department visits by 2022 saying that hospitals currently make their own guidelines that lead to a lack of consistency. MedPAC also discussed an analysis that shows Medicare’s payment adjustment to rural and low-volume dialysis facilities needs to be updated to better target facilities that are struggling. Currently Medicare offers a payment adjustment for low-volume facilities and a separate adjustment for rural facilities. This analysis suggests the two current adjustments should be replaced with a single adjustment. Click here for the MA presentation, here for the ED coding guidelines and here for the rural dialysis facilities.

MedPAC Wants To Phase Out Fee-for-Service Medicare
MedPAC commissioners plan to continue to work on recommendations that would phase out Medicare fee-for-service.  They identified four scenarios (click here for their slide presentation):  1) Continuing traditional fee-for-service Medicare with changes in payment policies and incentives to cut costs. 2) Requiring all traditional Medicare providers to join accountable care organizations, or ACOs—groups of doctors, hospitals, and other providers who work together to coordinate care for Medicare beneficiaries and receive financial benefits for meeting quality and cost measures. 3) Discontinuing Medicare’s practice of paying providers directly, leaving that task to ACOs and the private Medicare Advantage plans that some 20 million beneficiaries have opted for. The Medicare program, however, would continue to set fees for medical services under this option. 4) Discontinue the government’s role in setting fees for medical services, leaving that to providers whose market power could elicit higher payments.

CMS OKs More Telehealth Benefits for Medicare Advantage
CMS has finalized changes that would allow Medicare Advantage beneficiaries to access additional telehealth benefits, starting in plan year 2020. Under this final rule, MA enrollees may have opportunities to receive healthcare services from places like their homes, rather than being required to go to a healthcare facility. MA plans will now have broader flexibility than is currently available in how they pay for coverage of telehealth benefits to meet the needs of their enrollees. Click here.

“Secret” Super-Germ Is Spreading; CDC Says It’s an Urgent Threat; Measles, E. coli Also Spreading
A germ, a fungus called Candida auris, preys on people with weakened immune systems, and it is quietly spreading across the globe. Over the last five years, it has hit a neonatal unit in Venezuela, swept through a hospital in Spain, forced a prestigious British medical center to shut down its intensive care unit, and taken root in India, Pakistan and South Africa. Recently C. auris reached New York, New Jersey and Illinois, leading the federal Centers for Disease Control and Prevention to add it to a list of germs deemed “urgent threats.”  Click here for the report.
  • From January 1 to March 28, 2019, 387** individual cases of measles have been confirmed in 15 states.  This is the second-greatest number of cases reported in the U.S. since measles was eliminated in 2000. The states that have reported cases to CDC are Arizona, California, Colorado, Connecticut, Georgia, Illinois, Kentucky, Michigan, Missouri, New Hampshire, New Jersey, New York, Oregon, Texas, and Washington. Click here for the CDC report.
  • As of April 4, 2019, 72 people infected with the outbreak strain of E. coli O103 have been reported from five states. Eight people have been hospitalized. No cases of hemolytic uremic syndrome (HUS) or deaths have been reported. Click here for the CDC report.
Hospitals Offer Their Own Solution on Surprise Billing
In a bid to gain federal support in the continued fight on Surprised billing, the American Hospital Association, American Medical Association, an Federation of American Hospitals, co-authored a letter to the Committee on Energy and Commerce. This letter supports “a federal legislative solution to protect patients in these scenarios that limits patients’ cost-sharing obligations to the in-network amount, and prohibits balance billing when the opportunity for health plans and providers to arrive at a fair payment rate is ensured” and strongly opposes the hospital bundled billing solution that has been thrown into the continued surprise billing dialogue. For the letter sent to Energy and Commerce, click here.
  • 25 states have already passed laws that help to protect patients from surprise billing, with PEW reporting 20 more considering legislation for this year, click here.
HOPDs See Poorer, Sicker Patients than ASCs: Study
A new study reveals that Medicare patients who receive care in a hospital outpatient department clinic are more likely to be poorer, have severe chronic conditions, and have been previously hospitalized, than Medicare patients treated in an ambulatory surgical center (ASC).  The findings of this new study underscore the unsoundness of compensating hospitals and health systems under Medicare the same amount as ASCs and other locations of care. Proposals under consideration by policymakers to do so fail to recognize the legitimate differences in the types of services hospitals provide, as well as the types of patients hospitals serve. Click here for the American Hospital Association study.
Drug Company’s Report Says 340B is Driving Physician-Administered Drugs to Hospital Settings
PhMRA, the pharmaceutical manufacturer interest group, continues its lobbying efforts against the 340B drug discount program with the release of a study last week that shows that is may be driving care from physician offices to the more expensive hospital outpatient setting for doctor-administered drugs. Based on analysis of all Medicare Part B reimbursement for physician-administered medicines by the Berkley Research Group, the study found that more than 30 percent of reimbursements were at 340B hospital settings in 2017, up from less than 10 percent in 2008. To view the study, click here.
Hospitals are Not Prepared for Cyberthreats: Study
According to a new study, most hospitals and doctors aren’t prepared for the increasing dangerous cyberattacks levied against health care providers. As health care technology is increasingly connected to the internet, the sector overall lags behind others in the way that it protects its information technology infrastructure, leading them open for attacks. Most hospitals don’t have the resources or the awareness to monitor cybersecurity threats, and data security is often focused more on patient privacy. Additionally, the study found that hospitals are much more vulnerable than individual physician offices. To read the full article, click here.
Pelosi Speaks Out on Medicare-for-All 
In her weekly press conference last week, Speaker Nancy Pelosi (D-CA) questioned the affordability of the “Medicare-for all” idea being embraced by several Democratic presidential candidates. Pelosi urged cation as she spoke of how “Medicare-for-all” is being used as a catchall phrase for “healthcare-for-all” rather than an actual plan of action. “I’m agnostic. Show me how you think you can get there,” Pelosi said in an interview with The Washington Post. “We all share the value of health care for all Americans — quality, affordable health care for all Americans. What is the path to that? I think it’s the Affordable Care Act, and if that leads to Medicare-for-all, that may be the path.” Click here to view the article in its entirety.
House Committee Advances Six Drug Pricing Bills
The House Energy and Commerce Committee has voted favorable on six bills aimed at lowering prescription drug prices, among other legislation. Most notable of the six moving to the House Floor is the CREATES Act, H.R. 965 (116), which would penalize brand-name drug manufacturers that withhold sample products from generic makers by citing safety concerns. The other 5 bills include: H.R. 1499 (116), which bans brand manufacturers from striking deals with generic rivals to keep their products off the market; H.R. 938, which limits first-approved generic makers’ ability to delay other rivals; H.R. 1520 and H.R. 1503, which provides generic and biosimilar makers more information through FDA databases about the patents on branded products; and H.R. 1781, which boosts congressional advisory committees’ access to pricing and rebate data. Click here to watch the Markup and review the legislation.
Study Shows More Ties Between Housing and Health Care
A new study has found that 92% of patients who were also renters delayed getting health care treatment due to financial difficulty. The survey found that healthcare and housing were at the top of the list in priority, and with increasing rent burden, the study reports that housing wins out. Brian Rahmer, Enterprise Community Partners VP of health and housing, had this to say about housing as a social determinant of health: “We can’t just focus on stability, and we can’t just focus on affordability, and we can’t just focus on quality and safety on the home itself, the kind of solutions we need to bring to the table are solutions that tackle multiple pathways to health and wellness at the regional or local level.” For the article, click here, and for more from Enterprise Community Partners, click here.
  • A study from Northwestern University found that poverty and socioeconomic status is not only a strong determinant of human health, it also may have an impact on the human genome, click here.
Online Prescription Services Running Amuck
Prescription delivery services have been growing in popularity, and have become increasingly available to patients, allowing for convenience in the form less trips to the doctor and pharmacy alike. What if you could cut out the visit to the doctor altogether? That is a question that drug prescribing sites like Roman, Kick, Hims, and Hers have tried to answer. Marketing everything from Viagra, to contraceptives, the sites claim they connect doctors to patients and are not subject to federal drug marketing or regulatory agencies that regulate drug manufacturers and drug distributors. These sites use prescribing algorithms and interactive patient health questionnaires that limit doctor interaction, making high volume requests easy to maintain, turning profits to the tun of $23 Million, $41 Million, and investments of over $100 million. Click here to view the New York Times investigation.
Violence Against Older Americans on the Rise
According to the Centers for Disease Control and Prevention, violence against Americans over the age of 60, especially men, has dramatically increased over the last 15 years. From 2002 to 2016, the nonfatal assault rate rose 75.4-percent among older men while it rose by 35.4-percent among older women. Sadly, the study found that 58-percent of assault cases among elderly Americans involved perpetrators who had a relationship with the victim. To read the full study, click here.
Poor Diet Linked to 20-Percent of Deaths Worldwide
A new study found consuming vegetables, fruits, fish, and whole grains to be associated with a longer life. Researchers looked at a large survey of 195 countries, tracking eating habits and consumption from 1990 to 2017. Results suggested that poor diets were associated with 20-percent of all deaths that occur worldwide, and the U.S. ranked 43rd out of 195 for rates of diet-related deaths. High consumption of sodium, which can lead to heart conditions, was analyzed as being the largest cause of diet-related death. Scientists suggest increasing the intake of healthy food, instead of reducing the intake of fats and sugars. To read the study, click here.
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