August 20, 2018

U.S. News Releases Best Hospitals Rankings for 2018-19

U.S. News lat week released its 2018-19 Best Hospitals rankings. The 29th annual rankings are designed to assist patients and their doctors in making informed decisions about where to receive care. The rankings compared more than 4,500 medical centers nationwide across 25 specialties, procedures and conditions. This year, a total of 158 hospitals were nationally ranked in at least one specialty. More than 1,100 hospitals were rated high performing in at least one common procedure or condition, and 29 received a high performing rating in all nine procedures and conditions evaluated.  Click here for the complete report.

  • Click here for all specialty rankings.
  • Click here to see the top hospitals by state.
  • Click here for the top children’s hospitals.

“Surprise Bills” Affect 18% of Patients with Large Employer Health Insurance: Analysis

About one in six hospital stays for patients with large employer health insurance includes a bill that isn’t covered by the plan, according to a new analysis that provides new details on the extent of the “surprise bill” problem.  The analysis, published by the research firm Kaiser Family Foundation, could help shape the push for legislation to counter surprise medical bills expected in Congress later this year.  A surprise medical bill occurs when someone goes to an in-network hospital for care but some of the services, such as a lab test, are out of the insurance network. Those out-of-network services can be much more expensive.  In 2016, almost 18 percent of inpatient admissions to a hospital or surgical center have a claim for an out-of-network provider. Click here for the analysis.

  • The U.S. health insurance industry’s premium composition is increasingly shifting toward government-sponsored business, which exposes carriers to additional risks as the business is generally low-margin and results in a greater reliance on state and federal funding, according to a new A.M. Best report, click here.

House Asks CMS for Red Tape Relief in Medicare
The House Ways and Means Committee has released a report detailing the work they have done asking CMS to reduce the regulatory burden on providers from Medicare. The Committee requested feedback on policies which place an undue burden on providers, held roundtables with members of Congress and providers, and met with CMS to discuss the needed relief. The Committee says that they will continue to work towards reducing the burden, but the committee has sent letters to CMS regarding enforcement of conditions of participation, reforming hospital star ratings, and standardizing reporting and billing authorization requirements. To read more, click here.

  • The Critical Access Hospital Coalition advocates for reduced regulatory burden on CAHs. To read more about the CAH Coalition, click here.

Hospitals Battling Over Access To Heart Procedure TAVR

When Medicare in 2011 agreed to pay for a new procedure to replace leaky heart valves by snaking a synthetic replacement up through blood vessels, the goal was to offer relief to the tens of thousands of patients too frail to endure open-heart surgery.  To help ensure good results, federal officials limited Medicare payment only to hospitals that serve large numbers of cardiac patients. In the past seven years, more than 135,000 mostly elderly patients have undergone transcatheter aortic valve replacement, known as TAVR. And TAVR’s in-hospital mortality rate has dropped by two-thirds, to 1.5 percent. Now more hospitals want to provide the service.  Click here for the Kaiser Health News report.


HHS Committee To Vote on New Emergency Physician Payment Model

An Advanced Alternative Payment Model proposal from the American College of Emergency Physicians will be the focus of the next meeting of the HHS group responsible for reviewing and recommending new APMs.  However, despite previous recommendations from the Physician-Focused Technical Advisory Committee (PTAC), HHS has yet to agree to implement any of them.  The PTAC will review and likely vote on ACEP’s proposal on Thursday, September 6 in Washington, D.C.  Click here for details.

  • Beginning in January, Medicare will pay for certain care management home visits under the Next Generation Accountable Care Organization Model, according to a CMS memo sent last week.  Next Generation participants and preferred providers who have initiated a care treatment plan for aligned beneficiaries will be eligible to receive up to two care management home visits within 90 days of seeing that participant or provider. Click here for the CMS memo.

Arkansas Sued Over Medicaid Work Requirements; Gov’t Managed Care Programs Reviewed
A lawsuit has be filed in the US District Court for the District of Colombia challenging Arkansas’ new work requirement for recipients of Medicaid. The suit brought by the National Health Law Program and the Southern Poverty Law Center challenges both the HHS and the CMS recent waivers that allow states to issue work requirements for recipients. Arkansas is the first state to implement work requirements last June. Federal officials have not yet commented on the case. Click here for more detail on the case.

  • Medicaid managed care continues to grow across the country and the Congressional Budget Office is out with a new report taking a closer look.  Click here.
  • How are Medicare Advantage plans stacking up in their government ratings?  McKinsey & Company has released an analysis.  Click here.

$125 Million in QI Grants Awarded by HHS
HHS has awarded $125 million Quality Improvement grants to 1,353 health centers across the country. Coming from the Health Resources and Services Administration the grants will be used for improving care quality and outcomes, increasing access to care, and improving health information technologies among other goals. 27 million people rely on community health systems and these grants by HRSA aim according to the agency. For more news from HHS on QI grants click here.

Progress Seen in Stroke Patient Readmission Rate: Study

The 30-day hospital readmission rate for stroke patients declined by an annual average of 3.3% from 2010 to 2014, national data on more than 2 million stroke hospital discharges indicated. About one in eight adult stroke patients were readmitted within 30 days of hospital discharge in that period, but stroke patients discharged from high-volume non-teaching hospitals were more likely to return than patients treated at high-volume academic centers, according to a  JAMA Network Open report.  To read the study, click here.

On-Line Health Data Focus of New Tech Commitment

Major tech companies committed last week to removing technological barriers that have hindered patient and provider access to health-care data online. At a Trump administration event focused on developing more health-care apps, companies including Inc., Alphabet Inc. unit Google and Microsoft Corp. said they would “share the common quest to unlock the potential in health care data, to deliver better outcomes at lower costs.”  That promise would help accelerate what many regard as a coming data-driven revolution in health care, as patients, providers and researchers gain more access to records. Click here for the company announcement. Click here for news reports.

Taxpayers Paying Much More for Medicare Part D Program

In 2007, Part D cost taxpayers $46 billion. By 2016, the figure reached $79 billion, a 72 percent increase. It’s a surprising statistic for a program that is often praised for establishing a competitive insurance market that keeps costs low, and that is singled out as an example of the good that can come from strong competition in a private market.
Much of this increase is a result of growing enrollment — it has doubled in the past decade to 43 million — and higher drug prices. But there is also a subtle way in which the program’s structure promotes cost growth. Click here for details.

PBMs Fighting Back Against Claims They Are Causing High Drug Prices

The pharmacy benefit manager association released a report last week to counter the Trump administration’s assertion that drug rebates are a key driver of high drug prices. A drug maker and PBM, which oversees drug plans for employer and union-sponsored health plans, negotiate rebates with drug makers to lower the cost of prices. The report looked at brand name drugs sold on Medicare Part D, the program’s prescription drug plan, and Medicare Part B which reimburses for drugs administered in a doctor’s office like a vaccine or chemotherapy. It said that a large number of prescription drugs that have “extraordinary” drug prices are in Medicare Part B, where private plans and PBMs don’t negotiate for rebates. Click here for the report.

New Bill Would Eliminate Caps on Medicaid Rebates

House Energy & Commerce Health subcommittee Chair Michael Burgess (R-TX) has quietly introduced a bill that would eliminate the cap on Medicaid rebates that Obamacare created. The idea, included in the Trump administration’s drug-pricing blueprint, has been criticized by the drug industry. The Affordable Care Act capped the amount of rebates drug makers must pay to Medicaid at 100 percent of Average Manufacturer Price. The administration’s blueprint proposes eliminating that cap, saying it “allows for excessive price increases to be taken without manufacturers facing the full effect of the price inflationary penalty established by Congress.” Burgess’ two-page bill, introduced July 31, would sunset the cap on rebates effective Jan. 1, 2019. Click here to see the bill.

Senior Senate Democrat Says CMS Must Change How It Regulates Nursing Homes

The Trump administration needs to change how it regulates nursing homes in light of a report that found most homes overstated their staff numbers, a senior Democratic senator said last week. Ron Wyden (D-OR) sent a letter (click here) to CMS Administrator Seema Verma calling for reform of the star rating used to judge nursing homes as a response to the New York Times report published last month (click here). Wyden, the top Democrat on the Senate Finance Committee, said that the New York Times story calls into question how CMS gets data for quality measures, which is self-reported by nursing homes.

Drug Overdose Deaths Reach New Record in 2017: CDC

More than 72,000 people died from drug overdoses in 2017, the CDC reported last week. That’s a new record, and an increase of just under 10% from 2016. The biggest problem is still synthetic opioids like fentanyl. Roughly 30,000 people fatally overdosed on synthetic opioids last year — about the same number as heroin and prescription opioids combined. Some people are counted multiple times because multiple drugs were in their systems when they died. Click here for the CDC report.

  • Some hospital emergency departments are giving people medicine for withdrawal, plugging a hole in a system that too often fails to provide immediate treatment.  Click here for the New York Times report.

Measles Outbreak to Exceed 2017 Outbreak
A measles outbreak has infected 107 people in 21 states according to the Center for Diseases Control. The outbreak is expected to outpace last year’s total of 108 cases and only within 15 states. The CDC notes that the majority of those affected are not vaccinated. The disease carries with it the chance of death and health complications from it as well for those affected. Click here for the most up-to-date reporting on the measles outbreak.

Insurers Paying Rent To Improve Health of Patients; Social Determinants Focus of Coalition Efforts

Solutions addressing social determinants of health are gaining traction across the country.  Forbes has a report about some insurers that are paying the rent for some patients as part of their health care plan.  Click here.

  • The Root Cause Coalition, a non-profit, member-driven organization established to achieve health equity through cross-sector collaboration, will host its third annual National Summit on the Social Determinants of Health on October 7-9 at the Sheraton New Orleans Hotel. Click here to register.

FDA Touts Success of Anti-Smoking Campaign

The FDA’s campaign to educate at-risk teens about the harmful effects of tobacco use, has proven to be successful by preventing nearly 350,000 youth nationwide from initiating smoking from 2014 to 2016 and has resulted in savings of more than $31 billion for youth, their families and society at large by reducing smoking-related costs like early loss of life, costly medical care, lost wages, lower productivity and increased disability – that’s $181,000 saved for each of the 175,000 youth that would likely have become an established smoker. Click here for more from the FDA.

Elephants May Carry Gene that Resists Cancer 
Scientists have discovered that elephants have a unique DNA gene that protects them from cancers. The discovery comes after observation that elephants are not more prone and may be less prone, to tumors than smaller animals. The gene looked at is the p53 gene, that targets and destroys damaged DNA. The uniqueness of this gene comes from the fact that elephants have 20 copies of the gene whilst other animals have one copy. The discovery may lead to better targeting of cancer and tumors in the future for humans and a better understanding of how the body reacts to cancerous cells. For the full report, click here.

Full Tuition Scholarships Offered to NYU School of Medicine Students
New York University School of Medicine has announced that it is offering full-tuition scholarships to all current and future students. The decisions comes as the cost of medical school continues to rise while the institution still wishes to attract the best and brightest. Current tuition is $55,000 with the median current debt being $202,000. The decision is also based on getting more graduates into less specialized fields that offer higher salaries to pay off the debt than more general practices. Click here for the press release regarding the scholarships offered to students.

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