April 9, 2018

MedPAC Targets Urban Stand-Alone EDs for Payment Cuts, Wants Changes To Hospital Value Programs

The Medicare Payment Advisory Committee voted last week to cut payment to some stand-alone emergency departments, saving Medicare up to $250 million annually if enacted into law.  Specifically, MedPAC called for Congress to reduce Type A emergency department rates — rates for those emergency room open all day, every day — by 30 percent for off-campus stand-alone emergency departments that are within six miles of an on-campus hospital emergency department. There are concerns that the number of stand-alone emergency rooms is growing in several urban markets, and they tend to be located in high-income areas. MedPAC staff said Medicare payments are misaligned with relative costs, and those off-campus facilities have lower patient severity and standby costs than on-campus emergency departments, even though they are paid the same. Click here for the staff presentation.

  • MedPAC voted in favor of a separate recommendation that Congress allow isolated rural stand-alone emergency departments — those that are more than 35 miles from another emergency room — to bill standard outpatient prospective payment system fees and that Congress provide such departments annual payments to assist with fixed costs.
  • Medicare payment advisers are eyeing a recommendation that would fold the four current value-based payment programs into a single initiative. The new hospital value incentive program, as MedPAC called it, would judge hospitals on readmissions, mortality, spending and how patients’ rate their stay. Two percent of a hospital’s Medicare payments would be withheld — and earned back depending on how well they do. Click here for the MedPAC presentation.

Health Care Mega-Mergers Are Changing the Face of Medicine

People are flocking to retail clinics and urgent care centers in strip malls or shopping centers, where simple health needs can usually be tended to by health professionals like nurse practitioners or physician assistants much more cheaply than in a doctor’s office. Some 12,000 are already scattered across the country, according to Merchant Medicine, a consulting firm. On the other side, office visits to primary care doctors declined 18 percent from 2012 to 2016, even as visits to specialists increased, insurance data analyzed by the Health Care Cost Institute shows. There’s little doubt that the front line of medicine — the traditional family or primary care doctor — has been under siege for years. Click here for an excellent NYTimes report.

  • JPMorgan Chase & Co. CEO Jamie Dimon, in his annual letter to investors, said he expects to update them in the “coming years” about the bank’s health care partnership with Inc. and Berkshire Hathaway Inc., suggesting a long timeline for the closely watched venture. Dimon also laid out some of his ambitions for the partnership, including aligning incentives among doctors, insurers and patients and reducing fraud and waste in the health care system. Click here for details.
  • Shareholders of Kindred Healthcare Inc. approved the home-health provider’s deal to be acquired by health insurance giant Humana Inc. and private equity firms TPG Capital and Welsh Carson Anderson & Stowe. The $4.1 billion sale, announced in December, is expected to close in the summer. Click here.
  • CVS Health said it plans to start treating patients with chronic kidney disease, as the drugstore chain continues its expansion into monitoring and providing care. The company said it would start offering home dialysis through its infusion provider unit Coram, and is working with another unspecified company to develop a new device for that service. Click here.

Senate Committee Releases Draft Opioid Bill

The Senate Health Committee unveiled bipartisan draft opioid legislation last week that would grant new authorities to several federal departments and agencies to address the opioid crisis, “including the ripple effects of the crisis on children, families, and communities, help states implement updates to their plans of safe care, and improve data sharing between states.” The Committee plans a hearing on April 11th. Click here for the draft legislation, here for the summary, and here for the hearing information.

  • The House Energy and Commerce Committee will hold its third legislative hearing on the opioid crisis this week. The long list of bills look to make improvements in Medicaid, Medicare Part B, and Medicare Part C. To read the full list and see the hearing details, click here.

Congress intends to pass comprehensive opioid legislation by Memorial Day.

Surgeon General Endorses Naloxone To Fight Opioid Crisis

Surgeon General Jerome Adams is endorsing naloxone as a key component to fighting the opioid crisis, calling on more Americans to carry the overdose antidote. In a rare advisory posted last week, Adams endorsed naloxone products as safe and effective, while warning that “too few community members are aware of the important role they can play to save lives.” The advisory is the first from the surgeon general’s office in more than a decade, and it comes as the Trump administration rolls out policies combating the opioid epidemic. Adams also wrote a JAMA op-ed on how health care providers can raise awareness of naloxone.  Click here for the op-ed.

2018 ACA Marketplace Enrollment: 11.8 Million Lives

The final report released by CMS shows that overall enrollment this year for the ACA exchanges was 11.8 million, which is just 4 percent lower than the previous year. The report also shows that premiums went up by more than 30 percent from on average from $476 to $621, a direct effect of the discontinuation of the cost-sharing reduction payments. However, CMS states that about 83 percent of customers received some sort of subsidy to allow for protection from the increases, leaving monthly average payments at $89, down from $106 last year. One troublesome issue for the insurance pools: under-age-35 shoppers fell to 26 percent of the pool, the first decline since the ACA exchanges launched. To see the CMS report, click here.  For a more detailed analysis from Health Affairs, click here.


Medicare Advantage Plan Get big Payment Boost; New Benefits Are Also Included

CMS will boost payments to Medicare Advantage plans by 3.4 percent next year, nearly double the 1.8 percent increase it proposed two months ago, click here for the final payment policy and here for the fact sheet.  In a major development,

air conditioners for people with asthma, healthy groceries, rides to medical appointments and home-delivered meals may be among the new benefits offered to Medicare beneficiaries who choose private sector health plans, when new federal rules take effect next year.  CMS expanded how it defines the “primarily health-related” benefits that private insurers are allowed to include in their Medicare Advantage policies. And insurers would include these extras on top of providing the benefits traditional Medicare provides. Click here for details.

  • More hospital-level patients are being treated at home but Medicare just isn’t paying for it as hospital-level care.  Click here for more.

HHS Recovered $1.8 Billion in Fraud Prevention Efforts

HHS’ Office of Inspector General released a report last week stating that in fiscal year 2017 the department recovered $1.8 billion from entities engaged in fraudulent health activities – or $6 for every $1 spent on the enforcement activities. This all stemmed from 1,528 convictions  which included 1,157 convictions of fraud and 371 convictions of patient abuse or neglect – an 88.6 percent conviction rate. Additionally, there were 961 civil settlements and judgments of which 426 (44 percent) involved pharmaceutical manufacturers. Click here for the report.

Employment with Ambulatory Health Care Services Continues To Grow 

The health care sector added 22,000 jobs last month — about 1 in 5 jobs created across the entire economy, according to latest report. That’s roughly in line with the monthly average for health care jobs created over the last year. The biggest gain was in ambulatory health care services, which added 16,000 workers in March.  Residential mental health facilities lost 4,100 jobs, the largest employment decline in the health care sector, after those facilities made 700 new hires in February. Click here to review the report.

CMS Names New Innovation Center Director

The Trump administration installed a permanent director to lead the Center for Medicare and Medicaid Innovation, an office that could be at the center of efforts to reform the health care system. CMS Administrator Seema Verma said in an email to staff that Adam Boehler, the former CEO of home-health care company Landmark Health will start as the director of the office next week. Click here for more.

Most Physicians Favor Medicaid Work Requirements: Survey

According to a survey conducted by the physician-recruiting firm Merritt Hawkins, a large majority of physicians support adding work requirements as a condition for Medicaid coverage. The single-question survey found that 56.6 percent of doctors are very favorable to work requirements and 17.8 percent are somewhat favorable. Conversely, 9.2 percent reported feeling very unfavorable, and 8.4 percent said they feel somewhat unfavorable.  Click here for the press release on the survey.

GAO Recommends Increased Data Security at CMS

The Government Accountability Office last week called for greater oversight by CMS over the data security of its beneficiaries’ information. GAO found that CMS has created an oversight program for Medicare Administrative Contractors (MAC) data, but that the agency has not established a similar program to monitor security implementation by other entities, such as researchers. Data breaches have become more common in recent months and years, particularly in the health care sector. GAO recommended CMS provide additional guidance on required security controls, and that they more routinely track their oversight efforts. Click here for the report.

New Report Reviews Heath Care Reform Efforts in Maryland, Massachusetts, Oregon and Arkansas

A new report reviews the results to date of major payment and delivery system reforms in Maryland, Massachusetts, Oregon, and Arkansas. Over the past few years, these states have launched ambitious reforms in an attempt to reduce health care costs while maintaining or improving health care quality, in stark contrast to recent waiver proposals by some states to roll back Medicaid eligibility and benefits through policies such as work requirements and lock-out periods. Click here for the analysis.

Maryland’s Global Budget System May Not Be Reducing Hospital Stays: Study

Maryland’s unique plan to cap hospital expenditures has saved hundreds of millions of dollars since its enactment in 2010, but a new study published last week raises questions about whether the state’s all-payer global budget is encouraging the reduction of expensive hospital stays in the state, one aim of the program. Under the plan, hospitals receive a fixed budget each year to incentivize them to spend less because they get to keep the difference in funds as long as they improve care and reduce hospital stays. The program was first enacted in eight rural hospitals in 2010, followed by statewide expansion in 2014. Click here for the analysis in Health Affairs.


CDC: ‘Nightmare’ Bacteria Found in 27 States
The bad news is that the CDC has found new and highly resistant germs in hospitals and nursing homes.  The good news is that have yet to spread widely. CDC tested 5,776 isolates of antibiotic-resistant germs from hospitals and nursing homes and found 221 contained a rare resistance gene. The 221 rare genes were found in isolates gathered in 27 states from infection samples that included pneumonia, bloodstream infections and urinary tract infections. However, the new CDC protocol for these types of bacteria — which calls for facilities to quickly isolate patients and begin aggressive infection control and screening actions to discover, reduce, and stop transmission to others — can be very effective. For more from the CDC, click here.

Report Shows Increased Diabetes-Related Hospital Deaths in Rural America
A new report released last week found a higher likelihood of diabetes-related hospital deaths in the Midwest and South regions of the United States, according to data analyzed from 2009 through 2014. “Despite innovations and more widespread availability of diabetes self management programs over the years, substantive differences in the odds of diabetes-related hospital mortality between rural and urban areas still persist,” said the report. To read more, click here.

  • 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.

Rural Hospital Closures Are Putting Farmers Out of Business
Farmers and many manual laborers tend to have high rates of injury and repetitive stress injuries and they are also more likely to be uninsured. In fact, a 2015 study found that 65 percent of commercial farmers identified health insurance costs as the most serious threat to their farms. Beyond insurance, other barriers exist for rural farmers to obtain medical care, such as transportation issues and shortage of providers. Medical deserts are forming in rural America, putting manual laborers such as farmers at risk. For more, click here.

Medications Linked to a Higher Risk of Allergies in Children
Children prescribed acid-suppressive medication and antibiotics during infancy developed allergic reactions throughout their childhood, according to researchers with TRICARE. They analyzed 792,130 children through a database, born between October 2001 and September 2013 that were prescribed outpatient acid-suppressive medications or antibiotics, such as penicillin, at any time within their first six months of life. After studying the database, researchers analyzed particular children in the data were diagnosed with an allergic reaction, such as a food allergy or asthma, from 6 months of age and older. Click here for the study, JAMA Pediatrics.

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