February 18, 2019.

50 Best Hospitals Named by Healthgrades
Healthgrades last week published their list of the 50 best hospitals in the country based solely on clinical quality outcomes for 32 conditions and procedures. Also released were the top 100 and 250 hospitals in America, eight states did not have hospitals on any list.  The top 5 percent of hospitals in the nation are represented by those named among the 250 best hospitals. Healthgrades states that patients are “more likely to have a successful treatment without major complications—and have a lower chance of dying—at America’s Best Hospitals.” Click here for the state-by-state list.

Hospitals Main Cause of Health Care Inflation 
Hospital prices are the main driver of health care inflation growing substantially faster than physician prices, according to a new study. Researchers analyzed claims data on people who had employer-sponsored health coverage between 2007 and 2014, from hospitals, and from a market intelligence database finding that prices for inpatient care increased by 42 percent while physician prices increased by 18 percent. Additionally, the data showed that hospital prices for outpatient care increased by 25 percent while physician prices increased by 6 percent. Ultimately finding that a “majority of the growth in payments for inpatient and hospital-based outpatient care was driven by growth in hospital prices, not physician prices.” Leading the researchers to suggest that policymakers focus on cutting spending in hospitals rather than physicians. To view the study in Health Affairs, click here.

CMS May Propose New Radiation Therapy Payment Model
CMS last week issued a transmittal to Medicare Administrative Contractors related to the implementation of a radiation oncology alternative payment model (RO-APM).  This is the surest indication that a RO-APM is on the way, as suggested last fall in comments from HHS Secretary Alex Azar. The transmittal, posted briefly by mistake and then pulled down, included just a few details. According to the transmittal, the RO-APM will be applicable in both hospital-based and freestanding settings, so it effectively replaces the Medicare Physician Fee Schedule and Hospital Outpatient Prospective Payment System for practices participating in the model. The model provides prospective payment for a 90-day episode of care that includes separate PC/TC payments for radiation oncology services.  Click here to read the transmittal.  Click here for Azar’s comments about the move to value-based care.

CMS’ Innovation Center Announces New Emergency Treatment and Transport Model
The Center for Medicare and Medicaid Innovation last week announced a new voluntary new payment model for emergency triage, treatment and transportation (ET3) following a 911 call. The model will allow ambulance suppliers and providers to partner with other health care providers to deliver treatment in place (either on-the-scene or through telehealth) and with alternative destination sites (such as primary care doctors’ offices or urgent-care clinics) to provide services to  beneficiaries following a call to 911. CMS plans to release a Request for Applications in Summer 2019 to solicit Medicare-enrolled ambulance suppliers and providers and implement the triage lines for low-acuity 911 calls by the Fall of 2019. Click here for the CMS Fact Sheet on the ET3 model.

Medicare-For-All Proposal has Over 90 Co-Sponsors So Far
Before even being introduced, the Medicare-For-All proposal authored by Reps. Pramila Jayapal (D-WA) and Debbie Dingell (D-MI) has gathered at least 93 cosponsors, according to a letter seeking additional co-sponsors. The letter states that the draft legislation builds upon bills introduced by former Rep. John Conyers (D-MI) and Sen. Bernie Sanders (I-VT) as well as adding “updates critical to our country’s future health care system.” The draft legislation would add benefits including – dental, vision, prescription drugs, women’s reproductive health services, maternity and newborn care, and long-term services, however it does not provide any detailed information related to the tax increases likely necessary for funding a single-payer health system. To view the letter, click here.

CMS Proposes to Cover CAR-T Cancer Treatments
CMS on Friday proposed nationwide coverage of FDA-approved CAR T-cell therapy, a new form of cancer therapy that uses a patient’s own immune system to fight the disease and that can cost as much as $500,000. Medicare programs would be required to offer the therapies under “Coverage with Evidence Development” where patients can only receive treatment in a CMS-approved registry or clinical study over a two-year period. CMS stated that reviewing the therapy in this manner will help determine future decisions by the agency about the types of patients and cases that Medicare will cover. For the CMS Fact Sheet, click here.

  • In a speech to doctors at the American Medical Association, HHS Secretary Alex Azar defended prior authorization and step therapy to cut drug costs, click here for the speech.

Legislation Introduced in House and Senate to Allow Medicare Buy-In at Age 50
Democratic Sens. Debbie Stabenow (MI) and Tammy Baldwin (WI), along with Democratic Reps. Brian Higgins (NY) and Joe Courtney (CT), introduced legislation last week that would allow people between the ages of 50 and 64 buy into Medicare, and use existing ACA tax credits and federal contributions to pay for the program. The legislation would provide the new enrollees the same benefits given to anyone enrolled in Medicare, including Parts A, B, and D, as well as the ability to enroll in a Medicare Advantage plan. While patient advocacy groups were quick to voice their support, industry groups, including hospitals and insurers, warned that it could negatively affect physician payments and the Medicare trust fund. Click here for more from the Senate sponsors and here from the House sponsors.

Medicare Advantage Plans Accused of Denying LTCH Services
Medicare Advantage Plans are coming  under increasing scrutiny for denying transfers of patients to long-term care hospital services, according to a new analysis. With Medicare Advantage plans having historically low administrative overhead costs over private insurance, MA Plans are under fire, accused of cutting costs by denying transfers of high acuity patients into long-term care settings. Why? With a move from per-diem payments to DRG payments systems, insurers are no longer incented to move a patient from their bed to another facility, because hospitals will often keep some patients longer without additional pay. On top of this, the MA plans themselves benefit by paying for one DRG to one facility rather than paying two facilities. To read the analysis, click here.

Senior Living Groups Turn to New Medicare Advantage Deal
In a bold move that could give senior housing operators a template for increasing their revenue and power within the care continuum, four companies are teaming up for a big bet on Medicare Advantage. Operators Christian Living Communities (of Englewood, CO), Juniper Communities (Bloomfield, NJ) and Ohio Living (Columbus, OH) are working together with a new Medicare Advantage company to help senior living organizations better manage their patients. For more details, click here.

E-Cigarettes Drive Higher Tobacco Use Among Youth
According to a new report released by the CDC, the number of young people using tobacco products is climbing, mainly due to the growing popularity of e-cigarettes among teenagers. The report states that about 4.9 million middle and high school students reported using a tobacco product in the past month in 2018, up from the 3.6 million that reported the same in 2017. Additionally, e-cigarettes were the only type of tobacco product that saw an increase in use. Even more troubling, over 20 percent of high school kids and 5 percent of middle school kids confessed to vaping in the past month. To read the full report, click here.

Grants Opportunities for Rural Residency Programs
HRSA is offering grants for providers to develop new rural residency programs or Rural Training Tracks (RTT) in family medicine, internal medicine, and psychiatry, to support expansion of the physician workforce in rural areas. Rural residency programs are allopathic and osteopathic physician residency training programs that primarily train in rural communities and are intended to be sustainable through separate public or private funding beyond the grant period of performance. Eligible applicants are: 1) rural hospitals, 2) rural community-based ambulatory patient care centers, including FQHCs, community mental health centers, or RHCs; 3) health centers operated by the Indian Health service; 4) schools of allopathic medicine or osteopathic medicine; 5) public or private non-profit graduate medical education consortiums; and 6) faith-based and community-based organizations. Applications are due by March 25th. Click here for the opportunity.

  • The Critical Access Hospital Coalition is a consortium of innovative health care leaders representing CAH facilities across the country working to improve payment models in rural America. Click here for details.

Breast Cancer Screening Age Should Be Lowered to 35
A trial recently conducted by the University of Manchester, found that by changing the breast cancer screening eligibility age to 35, almost 86,000 women in the UK would receive screenings every year. Researchers looked at women aged 35-39, and was able to detect 50 breast cancers where 80% of the tumors were detected at a size of 2 cm or smaller. When compared with a group of unscreened women, only 45% of the tumors were detected at such a small size, indicating the need to change the screening eligibility age. To read more about this issue, click here.

Medical Cannabis May Treat Autism Spectrum Disorder
According to researchers in Israel, medical cannabis may be an effective treatment for autism. The study analyzed data collected as part of the treatment program of 188 patients who were treated with medical cannabis between 2015 and 2017 and found that symptoms were significantly improved in 6 months for a majority of the patients. The use of cannabis oil has become a common practice for kids with seizures, autism, and other disorders. More research on the long-term effects needs to be done to understand the safety of this treatment however, before full implementation, the researchers caution. To read the full study, click here.

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