05 Aug August 5, 2019

• Healthgrades has released its 2019 Women’s Care Award Recipients, to recognize hospitals nationwide that provide exceptional care and outcomes in women’s healthcare services. For the award recipients, click here.

CMS Rules Would Require Disclosure of Private Hospital/Insurer Contracts, Continue 340B and Site Neutral Cuts
CMS has released proposed rules impating 340B, site neutral payment policy and end-stage renal disease and changes to payments for physician services.  There are also new policies proposed, such as mandated price transparency for all hospitals and blending evaluation and management codes.  Once finalized, these rules will  take effect January 1.  Public comments are due by late October.

• Outpatient Proposed Rule – In addition to regular payment update under the outpatient prospective payment system – an increase of 2.7-percent – CMS loaded the proposed rule with a number of other policies.  Included in the proposal are several proposals to implement President’s Executive Order on Improving Price and Quality Transparency such as updates to requirements that hospitals make standard charges available in a machine-readable format and requirements for hospitals to make public standard charge data available for at least 300 “shoppable services” that can be scheduled in advance. CMS also continues the current cut to payments on 340B drugs and asks for comments on a proposal to reimburse qualifying 340B claims at a rate of ASP +3% would be an acceptable remedy for 2020 as well as an “appropriate” retrospective remedy for 2018 and 2019 should the ongoing litigation go in favor of hospitals. Additionally, the rule proposes to move hip replacement surgeries off the inpatient only list, continue the two-year phase in of site-neutral payments for clinical visits, and a request for information on organ transplant quality. Click here for the CMS fact sheet, and here for the rule.
• Physician Fee Schedule – CMS proposes to update the physician fee schedule conversion factor by 0.20% leading to an actual conversion factor for 2020 of $36.09, a slight increase over $36.04 the previous year. Additionally, CMS proposes to walk back its previous year proposal to collapse E/M level codes 2 through 5 and instead reimburse a blended rate for levels 2 through 4.  CMS also, in order to implement the SUPPORT Act [Public Law 115-271], proposes to create a monthly bundled payment arrangement for the management, care coordination and behavioral health counseling in treating patients with an opioid use disorder.  The proposal would also include adding three new telehealth Healthcare Common Procedure Coding System (HCPCS) codes to help improve care for these patients. CMS proposes changes to Merit-Based Incentive Payment System (MIPS) as well as Alternative Payment Models (APMs) and proposes updates to care management services, click here for the CMS fact sheet, and here for the rule.
• End Stage Renal Disease – The CMS 2020 End State Renal Disease (ESRD) and Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS) proposed rule would update the ESRD base rate to $240.27 in CY 2020, an increase of $5.00 to the current base rate of $235.27 and proposes to reduce the Transitional Drug Add-on Payment Adjustment (TDAPA) for calcimimetics from ASP +6 to 100% of the ASP. CMS is also proposing changes to how Medicare pricing is determined for new DMEPOS items and  to simplify their DMEPOS payment requirements for practitioners. Click here for the CMS fact sheet, and here for the rule.

SNFs, IRFs and Psych Facilities To Receive Payment Increases
It was a busy week for rules at CMS, the agency also released final rules for inpatient psychiatric facilities, inpatient rehabilitation facilities, and skilled nursing facilities.

• Psych facilities will see a 1.5-percent pay bump in fiscal 2020 and will be subject to a new quality measure intended to assess whether patients fill their prescriptions soon after being discharged, click here for the CMS fact sheet, and here for the final rule.
• IRF payments will increase by 2.5-percent or $210 million for FY 2020, amend regulations to clarify that the determination as to whether a physician qualifies as a rehabilitation physician is to be determined by the IRF, as well as adopts two new quality measures that satisfy the IMPACT Act, click here for the fact sheet, and here for the final rule.
• SNFs will see a 2.4-percent payment increase for 2020, have set definitions on therapy sessions, and get two new quality measures as required under the IMPACT Act, click here for the fact sheet, and here for the rule.

GAO Finds Four States’ DSH Payments Exceeded Hospital Uncompensated-Care Costs
A recent Government Accountability Office report sheds light on the big differences between federal disproportionate share hospital payment spending by showing that California, Illinois, Maryland and Missouri exceeded uncompensated-care costs, as well as how Tennessee’s DSH payments represented 0.7-percent of its Medicaid funding and Maine’s payments represented nearly 97-percent of Medicaid funding. This report comes just as Congress to looking at how to tackle the looming cuts to DSH payments starting in October. The report also shows that in 40 states, DSH payments make up less than 20-percent of hospital Medicaid payments and eight states exceed 20-percent. To read the full report, click here.

• In another report, GAO found that CMS’ Medicare Plan Finder misses the mark on actually helping Medicare beneficiaries find plans citing that it was “difficult for beneficiaries to use and provides incomplete information,” click here.

Congress, President Avert Government Shutdown Drill
Before leaving for the August recess, the Senate sent the President a two-year $2.7 trillion budget deal to stop looming budget cuts and to prevent the nation from defaulting on the debt. The Bipartisan Budget Act of 2019 (H.R. 3877) sets new budget limits for appropriators work from when they return in September for all 12 appropriations bills that need to pass before the 30th of the month. Under the budget agreement, the defense spending limit will increase by $22 billion over current levels for fiscal 2020 and the non-defense funding cap will be raised by $27 billion during that time. In fiscal year 2021, the bill will increase each of the budget limits by another $2.5 billion. The President is expected sign the bill as he tweeted shortly after passage, “Budget Deal is phenomenal for our Great Military, our Vets, and Jobs, Jobs, Jobs!” To view the bill and a summary, click here.

House Passes Short-Term Funding Fix for Mental Health Clinics
Under a “pro-forma” session last week, the House sent the Senate-passed bill to the President that will provide funding to a Medicaid pilot providing mental health and addiction services running through mid-September – the third short-term funding extension in four months. The Sustaining Excellence in Medicaid Act of 2019 (H.R. 3253) provides about $60 million in funds to continue services while champions of the program push for a longer-term extension. The program was launched in 2017 to provide enhanced Medicaid funding to nearly 80 clinics across eight states that are designated as “certified community behavioral health centers.” If the funding ends, the clinics will stay open but will lose their enhanced match. Click here to view the bill and a summary.

Treasury Department Giving Greater Flexibility to High Deductible Plans
Under new guidance released by the Treasury Department, high deductible health plans (HDHPs) will have greater flexibility to cover additional medications and services used to treat chronic disease before the enrollee meets the plan deductible. Under current law, an HDHP may not provide benefits for any year until the minimum deductible is satisfied however, the law also provides a safe harbor for preventive care allowing qualifying items and services not subject to the deductible. The new guidance will significantly expand the list of items and services qualifying for safe harbor treatment to address pervasive chronic diseases such as heart disease, hypertension, diabetes, asthma, and depression. Click here to read notice 2019-45.

Clinical Labs Win Court Review of Case Filed To Stop Payment Cuts
The US Court of Appeals for the District of Columbia sent the lawsuit from the American Clinical Laboratory Association over lab reporting policies that have driven down payments from CMS for clinical lab services. The lower court said the lab reporting could not be challenged since it was tied to the final payment rates, which Congress shielded from the courts; however the appeals court states the two statutory provisions are separate. The judge said that the final rule on data collection is not a setting of pay rates, but rather a blueprint for which laboratories need to report private payer data to CMS. To view the full opinion, click here.

HHS Moves Forward with Drug Import Plan; Canada Fights Back
HHS last week unveiled a proposal to allow importation of certain drugs intended for foreign markets into the U.S. with a goal of lowering drug prices. The two-part plan would include regulations to authorize pilot projects for states, wholesalers, and/or pharmacists to import certain versions of FDA-approved drugs from Canada as well as FDA guidance to drug manufacturers to allow them to import certain foreign versions of FDA-approved drugs. Canadian Prime Minister Justin Trudeau immediately vowed to protect his country’s medical supply, saying the HHS proposal will potentially lead to drug shortages in Canada. To read the HHS proposal, click here. And for Trudeau’s response to the plan, click here.

Government Agency Focuses Telehealth Program on Rural America
The FCC voted to adopt a report and order for its Rural Health Care Program. This program focuses on telehealth among other things and seeks to improve access to care via telehealth. To view the fact sheet, click here.

Key House Members Weigh-In on Air Ambulance Surprise Billing Debate
In a letter to Transportation Secretary, Elaine Chao, House Ways and Means Committee Chairman and Ranking Member – Reps. Richard Neal (D-MA) and Kevin Brady (R-TX) – urged her to comply with the Congressionally mandated requirements to convene the Air Ambulance and Patient Billing Advisory Committee. Congress directed DOT to establish this task force within 60 days of enactment of the FAA Reauthorization Act of 2018 which was signed into law 10 months ago. Under the current movement to curb surprise billing, Neal and Brady suggest that this Committee must move quickly to advise Congress. Click here for the letter.

Medical School Enrollment Is Up, But New Residencies Go Unfunded
With medical school enrollment up 31 percent since 2013, and by 52 percent including osteopathic schools and first-year matriculation, it seems a physician shortage has been adverted. However, Atul Grover, MD, PhD, executive vice president of the AAMC says increased residencies are needed. “We’ve done everything we can on the medical school front to reduce the physician shortage. The federal government needs to resume covering its fair share of the costs.” That share is typically about 21 percent, and largely has been frozen for 22 years. The Resident Physician Shortage Reduction Act of 2019 (H.R. 1763) would add up to 15,000 Medicare-funded residency positions over five years, which have only grown by about 1 percent annually since 1997. For more information from AAMC and the study results, click here.

Infant Mortality Rates No Longer Increasing; Teen Birth Rate Drops Again 
In new data released by the CDC from 2017, the infant mortality has more or less leveled off since 2013. On average, infant mortality is at 6 deaths per 1000 births. Maternal age as well as race and ethnicity continue to play a role in outcomes, with infant mortality 90 percent less in women aged 30-34 than in women under 20. Asian women had the lowest mortality rate at 4 deaths per 1000, whereas black women had significantly higher rates of nearly 11 deaths per 1000. For the entire study, click here.

• A new report from Pew Research Center shows the U.S. teen birth rate continues to go down to just 18 births per 1,000 teens last year, less than half the rate from 2008, click here.

Too Many Americans Still Misuse Antibiotics: Study
Use of non-prescribed anti-biotics is dangerous for public health. Overuse of anti-biotics can be harmful both for the individual who takes them and for the population because it has the potential to cause anti-biotic resistant bacteria, or “superbugs.”  A study published in the medical journal Annals of Internal Medicine reveals that the number of Americans who do so is dangerously high. For the full study, click here.

The Root Cause Coalition and RWJ Foundation Launch “Learning Cohorts” on Food and Housing Insecurity
The Root Cause Coalition, a national non-profit dedicated to addressing health equity through cross-sector collaboration, and the Robert Wood Johnson Foundation launched Learning Cohorts, a cross-sector initiative where participants will learn and share best practices to address food and housing insecurity. The Learning Cohorts will meet “virtually” throughout the 10 months that follow the Coalition’s National Summit in October where participants develop a deeper understanding of how to design, implement and evaluate social determinant interventions. To apply to lead or assist in the design the curriculum, click here to complete the expert application. To sign up to attend the Cohorts, click here.

$42 Million Awarded to 49 Health Center Controlled Networks
HHS has awarded nearly $42 million to HCCNs in an effort to help grow and support health IT expansion. A total of 1,183 health centers will receive federal funding with the goal of increasing data access for continuity of care for patients and providers alike. For more from HHS, click here.

CMS Announces ET3 Model Application Portal and Tutorial Webinar 
The Emergency Triage, Treat, and Transport (ET3) Model Application Portal and Tutorial Webinar will be open for registration August 5, 2019 and the Webinar will be held on August 8, 2018 from 12:00-1:30 EST. For more information on ET3 click here, and to register, click here.

Study Finds More Americans than Ever Are Sedentary 
A recently published study in JAMA, based on 27,343 participants, found that on average Americans are sedentary for almost an hour longer, a 0.7 weighted average increase, from 2008 to 2016. Additionally, the study found that individuals who reported sedentary time of more than six hours and who did not adhere to the Physical Activity Guidelines for Americans for aerobic activity rose from 16.1% to 18.8% during that same time. For the full study click here.

Anemia May Contribute to Increased Dementia Risk
A new study from the Heart Brain Connection Collaborative Research Group found that anemia, along with having high hemoglobin levels, increases the risk for dementia. The study conducted in the Netherlands looked at 12,305 and over the course of the study, 1,520 developed dementia. The study concluded that anemia was associated with a 34% increased risk of dementia. Click herefor the study. Click here for a New York Times article on the study.

Some of the Most Deadly Cancers Receive Less Funding than Other, Less Deadly, Cancers
A study from Northwestern University analyzed funding of different types of cancer, showing that colon, endometrial, liver, cervical, ovarian, pancreatic, and lung cancers received significantly less funding than other cancers such as breast and pediatric cancers, leukemia, and lymphoma. The researchers hope this report will bring attention to deadly cancers with insufficient funding. For the full study published in the Journal of the National Comprehensive Cancer Network, click here.

Genetic-Testing Scams Have Targeted Seniors to Bill Medicare
A new wave of scammers have looked to capitalize on the newfound popularity of genetic testing. By focusing on less educated and older Americans, these scammers have been able to receive personal information in exchange for cheek swabs that would theoretically give them information on health risks. The scammers use this information to bill Medicare for a “Genetic Test” and get payouts from about $6,000-$9,000. Participants are found in low-income housing complexes, senior centers, and of course through Facebook ads. Click here for details.