August 7, 2017

August 7, 2017


2,573 Hospitals Will See Payment Cuts in October Because of Medicare Readmits

CMS will penalize 2,573 hospitals for having too many Medicare patients readmitted within 30 days, according to federal data released last week. Starting in October, the federal government will cut those hospitals’ payments by as much as 3 percent for a year. The $564 million the government projects to save also is roughly the same as it was last year under Obama.  Click here for the hospital-specific data.  Click here to compare Medicare readmissions by state.


Physicians Are Winning Again in Washington…Under Dr. Tom Price

The physician turned congressman turned HHS Secretary, Tom Price, M.D. (an orthopedic surgeon by training), appears to be doing his best to support physician initiatives in the federal health care agency HHS.  Efforts to reduce regulations on physicians are taking effect while the regulatory burden on hospitals seem to be holding fast.  Click here for this interesting perspective.


How Will Trump Administration Enforce the Affordable Care Act Now?

Obamacare, the Affordable Care Act, may be the law of the land following Congress’ unsuccessful attempt at ‘repeal and replace,’ but that doesn’t mean it will be business as usual.  Already the Trump Administration has taken several actions that ACA supporters believe are designed to weaken the effect of the law.  For example, there will a lot less fanfare later this year during the ACA’s open enrollment period because HHS has canceled several major marketing contracts saying they are no longer needed.  Click here for the Washington Post story.

  • Democratic state attorneys general can intervene in a court case over critical Obamacare payments that President Trump has threatened to cut off, a federal appeals court said last week. Click here.

House  Bipartisan ‘Problem Solvers Caucus’ Proposes ACA Fixes

The 43-member bipartisan “House Problem Solvers Caucus,” unveiled last week a proposal aimed at immediately stabilizing the insurance market by funding the cost-sharing reductions, creating a stability fund, eliminating the device tax, weakening the employer mandate, giving states more flexibility, and allowing insurance to be sold across state lines, among other policies. The proposal specifically calls for bringing the ACA’s heavily debated cost-sharing reduction payments under the Congressional appropriations process. The dedicated stability fund would be used to help lower premiums and out-of-pocket costs. The employer mandate would remain, but only apply to firms with 500 or more employees, instead of 50 or more. It would also change the ACA’s definition of a “workweek” to 40 hours, instead of the current 30 hours. Click here to read the proposal.


Senate to Hold Bipartisan Health Hearings to Fix ACA

The Chairman and Ranking Member of the Senate Health, Education, Labor, and Pensions Committee, Lamar Alexander (R-TN) and Patty Murray (D-WA), announced their plan for a series of hearings aimed at crafting bipartisan legislation to shore up insurance markets. Hearings will begin the week of Sept. 4 in a bid to “stabilize and strengthen” the individual health insurance markets. To read the Committee’s statement on the planned hearings, click here.

  • The White House and Senate Republicans are increasingly at odds over health care.  Click here for the report.

Senate OKs Experimental Drug Treatment and Opioid Addiction Bills

The Senate passed several health care bills before leaving for its summer recess on Friday.

  • The Senate sent to the president the $2.1 billion stopgap bill (S. 114) to keep the medical program for veterans running for another six months while another committee works on a broader veterans health care overhaul. Congress is specifically focused on veterans who are having wait-time or distance hardships.Click here for the bill language and summary.
  • The Senate also sent to the president a bill (H.R. 2430) that that funds the FDA’s drug and medical device reviews and have cut the time it takes to approve new treatments. Click here for a bill summary.
  • The upper chamber also passed bills and sent to the House: S.204, (click here) it would would allow seriously ill patients in all 50 states to request access to experimental medicines without FDA approval and a bill (S. 581) to make doctors more aware of patients with opioid addiction by highlighting that information in their medical records. Click here for a summary.

Opioid Addiction Commission Wants President to Declare a National Emergency

The White House’s Commission on Combating Drug Addiction and the Opioid Crisis, chaired by New Jersey Gov. Chris Christie, has sent to President Trump an interim report on proposals for combating the opioid crisis. The report includes a recommendation that FDA help establish opioid prescriber training. The commission also urged the president to “declare a national emergency.” The commission also made numerous other recommendations, including more money for substance abuse treatment, expanding access to medication-assisted treatment and helping states enhance their prescription monitoring programs. Click here for the report.


Five Percent of Americans Misuse Opioids: Survey

According to a new study, over one-third of all American adults admit to using prescription opioids, and nearly 5 percent report they misused painkillers. The 2015 National Survey on Drug Use and Health found that 91.8 million U.S. adults used prescription opioids in 2015. About 11.5 million adults, or 4.6 percent, reported misusing them, and 1.9 million, or 0.8 percent, said they were addicted. To read the full report, click here.

  • Opioid users are filling jails.  Why are so few being treated?  Click here.


CMS Bumps Payments to Hospitals, LTCHs, SNFs, IRFs, Psych and Hospice

CMS has finalized its final rule for inpatient acute care hospitals and will, on average, increase payments by 1.3 percent in FY 2018. The proposal incorporate uncompensated care cost data from Worksheet S-10 of the Medicare cost report for distributing disproportionate share hospital payments was finalized as well.  CMS abandoned its proposal to make accrediting surveys available to the public.  Click here for a summary of the inpatient and LTCH rule.

  • SNFs, IRFs, Inpatient Psych and Hospice are all getting a one-percent payment increase.  Click here for the SNF rule, here for the IRF rule, Inpatient Psych here and here for the hospice rule.

FDA to Host a Work Shop on Real-World Evidence for Regulatory Reviews

The Food and Drug Administration announced last week that it will host a public workshop in September on how it can use real-world evidence gathered outside of traditional clinical trials in its regulatory review process. The 21st Century Cures Act required the FDA to evaluate different sources of evidence, gaps in data collection, and standards for analysis of new drugs. Such evidence, which includes data on a patient’s health status routinely gathered in ongoing medical care, has been used to review treatments for some rare diseases in the past, but the FDA has not standardized what information it will use. In announcing the Sept. 13 workshop, the FDA states that it is especially interested in how such evidence could be used to support a new indication for an already approved drug, and how it could be used for post-approval study requirements. Click here for the announcement in the Federal Register.


Medicaid Satisfaction Highest in Arizona, Colorado, Iowa, Utah and Virginia: Survey

Medicaid enrollees are more satisfied with their coverage than individuals enrolled in commercial health plans, according to a new survey.  Beneficiaries still site cost as an issue, as 42 percent of Medicaid managed care enrollees put off medical care and 40 percent avoided buying prescription drugs because of the expense. The report shows that states with the highest levels of satisfaction among Medicaid enrollees are Utah, Iowa, Colorado, Arizona and Virginia. The states with the lowest scores in the study were Kansas, Mississippi, Delaware, New Jersey and California. To read the study, click here.


VA, Trump Tout New Telehealth Program Targeting Rural Areas

The Veterans Administration last week announced a new initiative designed to get care to veterans in rural areas through telehealth.  Click here for the report.  Rural veterans face particularly difficult hardships in health care.  Click here to see some of the innovative ways being used to address these issues.


Excluding More Docs, Clinicians from MIPS Creates New Problems: Analysis

Under a proposed CMS rule that would take effect in January, even more doctors and other clinicians will be excluded from participating in the Medicare payment system created under MACRA.  While that may be good news for doctors who don’t have to meet the requirements of participation in MACRA’s Merit-Based Incentive Payment System (MIPS), the policy decision creates problems, according to a researcher writing in Health Affairs. The proposed rule would exempt more than 585,000 eligible clinicians from the program and its reporting requirements. Click here for the report.


CMS Announces Plan for Technical Expert Panel on Quality Measures

CMS has announced its plan to form a technical expert panel titled, “Quality Measure Development: Supporting Efficiency and Innovation in the Process of Developing CMS Quality Measures.” The panel will be made up of CMS MIDS Measure Developer contractors, non-CMS measure developers, EHR vendors, hospital/clinician system representatives, and patient advocacy group representatives. In the announcement, CMS called for applications from individuals representing patients, patient advocates, consumers and/or purchaser perspectives. Applications are due by August 11th.  Click here for more from CMS.


CMS Opens Application Process for MACRA Hardship Exception

CMS has announced that its will now except applications for the Quality Payment Program Hardship Exceptions for the 2017 transition year. Under the law, MIPS eligible clinicians and groups may qualify for a re-weighting of their Advancing Care Information performance category score to 0% of the final score, and can submit a hardship exception application, for one of the following specified reasons:

  • Insufficient internet connectivity
  • Extreme and uncontrollable circumstances
  • Lack of control over the availability of Certified EHR Technology (CEHRT)

Click here for more on the application and process




No Comments

Post A Comment