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February 12, 2018

February 12, 2018

White House Targets 340B in FY19 Budget

The Trump administration on Monday is officially moving ahead to fiscal 2019. Expected to be included in the the FY19 budget proposal are changes to the 340B pharmaceutical discount program, as well as other changes designed to lower drug prices. The plan would allow 340B hospitals that deliver a minimum amount of charity care (expected to be 3.6%) to keep savings, otherwise savings go the government. It is unclear how charity care would be defined. The White House Council of Economic Advisers released a report late last week detailing how the government could reduce drug prices while simultaneously increasing innovation. The report includes possible changes to nearly all government health programs. 340B issues are addressed on pages 15-17 of the 30 page report. Its recommendations are expected to be included in the White House budget. Click here for the report.  Click here for more on the Administration’s plans to tackle drug costs.

Hospitals Win in 2-Year Budget Deal

In an era when any health care “win” in Congress is rare, hospitals were given billions of dollars in new spending and spending-cut delays.  Passing both chambers by healthy bipartisan margins, the budget deal keeps the government operating on another temporary funding patch until March 23.  Among the “wins”:

  • Postpones for two years Medicaid Disproportionate Share Hospital pay cuts.
  • Repeals the Medicare-pay cap for therapy services.
  • Repeals the Independent Payment Advisory Board
  • Makes Special Needs Plans in Medicare Advantage permanent.
  • Funds community health centers for two years.
  • Extends add-on pay for Medicare-dependent hospitals for two years.
  • Extends add-on pay (under a new formula) for hospitals with low volumes of patients for two years.
  • Funds teaching health center graduate medical education for two years.
  • Extends home health rural add-on pay for five years.
  • Extends ground ambulance add-on pay for five years.

Click here for the legislation that was signed into law, and here for the 25-page summary of all the health care provisions.  Lawmakers in charge of spending on Capitol Hill are now entering a six-week scramble to figure out how to dole out the $500 billion in new funding.  The first step is divvying up that pot of funding across all corners of the federal government. (The budget deal only decided the size of the pie, not the size of the slices.) All the health care provisions added in the two-year deal are expected to be included in the legislation to be voted on by march 23. The bill also raises the government’s borrowing capacity through March 2019. That will prevent a fight over the debt limit from occurring before the midterm elections.

  • The new Secretary of Health and Human Services, Alex Azar, will answer questions on the HHS budget this week. The first hearing will be with House Ways and Means Committee on February 14th (click here), followed by Senate Finance (click here) in the morning of the 15th and the House Energy and Commerce Committee in the afternoon (click here).
  • Physicians Assistants will now be allowed to act as attending physicians to patients in Hospice, under a provision in the new budget bill.  Click here for details.
  • The new law would eliminate Part B drug costs from MIPS scores and eliminate physician-improvement from the cost performance category for the second through the fifth years of MIPS. CMS would be allowed to determine the weight of the cost performance category to between 10 percent and 30 percent for years two through five of MIPS.

20,000 Clinicians Will Receive Medicare Pay Increase This Year

CMS announced last week the results of the 2018 Value Modifier and the adjustment factor that will be applied to clinicians receiving an upward payment adjustment. In 2018, over 20,000 clinicians will receive an increase of 6.6% to 19.9% on their Medicare physician fee schedule payments as a result of their high performance on quality and cost measures in 2016. The Value Modifier payment adjustment ends in 2018 as the Merit-based Incentive Payment System (MIPS) under the new Quality Payment Program is replacing the Value Modifier. The 2018 Value Modifier results and the payment adjustment factor are available on the 2016 QRUR and 2018 Value Modifier webpage, click here. For questions about the 2018 Value Modifier, contact the Physician Value Help Desk at 888-734-6433 (select option 3) or pvhelpdesk@cms.hhs.gov.

Flu Is at Pandemic Level

Hospitalizations  for the flu are now significantly higher than what officials have normally seen this time of year since CDC began using this tracking system in 2010. In particular, officials are seeing unusually high levels of hospitalizations in non-elderly adults, with the rates for 50-to-64-year-olds significantly higher than what they were at the same period in the severe 2014-2015 season with the same predominant flu strain. The latest weekly report (click here) shows 1 out of every 13 doctor visits last week was for fever, cough and other symptoms of the flu, matching the peak levels during the 2009 swine flu pandemic. It was higher than any other seasonal flu season since 2003, when officials changed the way flu is tracked.  Click here for the latest CDC national flu map.  Click here for the summary from the Washington Post.

Health Experts Tell House Committee Medicare Changes Could Aid Opioid Fight Health care leaders urged lawmakers last week during a House Ways and Means Health Subcommittee hearing to consider changes to Medicare policy that would help address the nation’s ongoing opioid epidemic. Among the recommendations addressed were paying for outpatient opioid abuse treatment and giving health plans more flexibility to limit prescriptions of pain killers and reimbursing for support services, such as counseling and drug screening. Click here to view the hearing and read the prepared testimonies.

  • Several health care groups aligned last week to create the Allied Against Opioid Abuse to promote guidelines for the safe use of opioids, as well as how to dispose of unused medications, click here.

New High-Paid Employees Tax Will Impact Not-for-Profit Hospitals Differently

How not-for-profit hospitals structure themselves is likely to determine how hard they are hit by the new tax on their highest paid employees, according to a new Wall Street Journal report. Under the new law, a nonprofit will owe a 21% tax on pay exceeding $1 million. But it will owe the tax only on the five highest-paid employees at each tax-exempt entity the nonprofit has registered with the Internal Revenue Service, excluding some doctors. Click here for the story.

Health System Releases Best Practices in Rural Health Care

The Compendium of Best Practices in Rural Health Hospital-Community Partnerships was published last week by Bryan Health, a Nebraska nonprofit health system. The publication details 12 case studies that tell the stories of rural Nebraska hospitals partnering with local businesses, schools, community centers and other organizations to improve the health of everyone in their communities. Bryan Health states the intention of the compendium is to provide, “potential ideas for health care leaders in rural areas and across the country as they develop strategies to improve access to quality health care.” Click here for more.

  • The CAH Coalition is also actively advocating health policies that provide support to Critical Access Hospitals nationwide.  Click here for details.

CHIME Urges FCC To Double Rural Funding

The College of Healthcare Information Management Executives asked the FCC last week to consider doubling funding for rural health care and to focus on areas affected by the opioid crisis. The FCC had requested comment on a proposed rule – Promoting Telehealth in Rural America. Among CHIME’s other recommendations were that the FCC “work collaboratively with other agencies” including the Substance Abuse and Mental Health Services Administration, CMS and ONC on telemedicine; that it establish a national broadband strategy and that it remain vendor agnostic. Click herefor the CHIME letter.

Presenters Sought for Third Annual Summit on Social Determinant of Health

The Root Cause Coalition, a national non-profit dedicated to addressing the root causes of health disparities through cross-sector collaboration, is seeking proposals for presentations at its Third Annual National Summit on the Social Determinants of Health, October 8-9, 2018 in New Orleans. The Coalition wants presentations that address the “how” versus the “why”, regarding a broad range of health inequities and social determinants. The robust two-day agenda will bring together representatives from healthcare, the non-profit sector, the faith community, researchers, clinicians, government leaders, educators and businesses to share best practices, offer community connections and resources and engage in the crucial discussion of how to best address the social determinants of health. Completed applications are due on or before February 15, 2018.  Click here.

ACA Enrollment Steady for 2018 Plan Year

ACA marketplace enrollment for the 2018 plan year remained generally stable despite political uncertainty stoked by the repeal debate, according to new data from the National Academy for State Health Policy released last week. About 11.8 million consumers selected plans, accounting for a 3.7 percent drop-off from the 12.2 million consumers who signed up a year earlier. States that operated their own marketplaces showed an increase of 0.2 percent over last year, while states that relied solely on HealthCare.gov registered a 5.3 percent decrease in enrollment. To read the study, click here.  Click here for more from the Washington Post.

Employer-Sponsored Insurance Spending Growth Jumps

After several years of slower growth post-recession and post-Affordable Care Act, employer-sponsored insurance health spending increased by 4.6 percent between 2015 and 2016, according to a new report posted in Health Affairs. This annual spending growth ranged from a high of 6.1 percent for hospital outpatient services to a low of 3.5 percent for professional services. In general, growth rates have been trending up across all health care sectors, with the exception of prescription drugs, which declined from a growth rate of 10.4 percent in 2015 to 5.1 percent in 2016. Click here for the summary.

CDC: Asthma attack rates declining for children About 8.3% of U.S. children had asthma in 2016, down from 9.4% in 2010, the CDC reported last week. In 2013, Asthma hospitalizations for children with asthma declined from 9.6 percent in 2003 to only 4.7 percent. The percentage of children who reported asthma-related missed school days also was lower in 2013 than it was in 2003. There are several asthma action plans to teach children how to recognize symptoms such as inhalers, nebulizers, air pollution and avoiding dust. Click here for details.

Pets Can Lower Blood Pressure and Stress: NIH

Interacting with animals has been shown to decrease levels of cortisol (a stress-related hormone) and lower blood pressure, according to the NIH. Additionally, studies have found that animals can reduce loneliness, increase feelings of social support, and boost your mood. Over the past 10 years, NIH has partnered with the Mars Corporation’s WALTHAM Centre for Pet Nutrition to look at the effects that pets have on the health benefits – from fish to guinea pigs to dogs and cats. Click here for more.

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