19 Feb February 19, 2018

February 19, 2018

HHS Secretary Says MIPS Could Be Eliminated

The new HHS Secretary, Alex Azar, said last week the agency is looking into whether the MIPS reporting requirements can be eliminated altogether.  Click here. Just a few weeks ago, the Medicare Payment Advisory Commission voted to replace the Merit-based Incentive Payment System with a voluntary program.  Azar testified before three committees about the President’s budget. When asked about the deep cuts to the Medicare program, Azar said the cuts wouldn’t hit beneficiaries and amount to a small reduction of the entitlement program’s overall budget. The Secretary also pushed for the Graham-Cassidy legislative plan to repeal and replace Obamacare that includes a market-based health care grant program. Click here for the Senate Finance hearing, here for Ways and Means, and here for Energy and Commerce. Click here for the HHS budget.

Key Senators Want IRS Review of Hospitals’ Non-Profit Status

The Chairman of the Senate Finance Committee, Orrin Hatch (R-UT), and Sen. Chuck Grassley (R-IA) sent a letter last week to acting IRS Commissioner David Kautter requesting information on how the agency reviews information hospitals submit on their charitable giving and what guidance the IRS has given hospitals on their obligation to aid their communities. Annually, not-for-profit hospitals receive an estimated $25 billion in tax breaks with the understanding they return the investment to their communities in the form of “community benefit,” such as free or low cost care for the underserved. The Senators state, “Given the importance of these institutions to their communities, and the forgone federal revenue associated with their tax-exempt status, it is important that both Congress and the IRS conduct oversight to ensure their activities are in line with the benefits they enjoy under the Internal Revenue Code.” Click here for the letter.

•  Springfield Hospital in Pennsylvania loses its tax-exempt status, click here.

340B Changes in President’s Budget

The HHS budget proposal makes several recommendations for changing the 340B program, including imposing a user-fee for providers that would raise $16 million to assist HRSA in its administration of the program. It says that CMS could further regulate the 340B program. Click here for the HHS budget document and see pages 24 and 62 for the 340B policy changes. The Chairman of the Energy and Commerce Health Subcommittee also stated during the Azar hearing his desire to legislate “improvements to programs like 340B drug discount” to assist with lowering drug costs for seniors.

• 30 health care organizations, many backed financially by pharma interests, sent a letter lawmakers looking to curb the 340B program and thanking them for legislation they are backing, click here.
• 40 different Ryan White Clinics, sent a letter to the House Energy and Commerce Committee stating any changes to the 340B program would, “lead to future policies and practices that would seriously diminish our ability to comprehensively serve our communities,” click here.

Medicaid Changes Go Well Beyond Work Requirements

Requiring able-bodied adults to work for their Medicaid is just part of the Trump administration’s drive to remake the decades-old health insurance program for the poor, according to a new Pew report. The administration signaled late last year that it welcomes state-based ideas to retool Medicaid and “help individuals live up to their highest potential.” At least 10 states have requested waivers that would allow them to impose work requirements and other obligations. Click here for details.

Hospitals Are Focus of Hearing on Health Care Consolidation Health care consolidation – and its contribution to the rising costs of health care – was the focus of a hearing last week in the Oversight and Investigations Subcommittee of the House Energy and Commerce Committee. Witnesses testified that hospital systems have financial incentives to acquire physician practices because of the differential in payment rates and that the 340B program may incentivize hospitals to acquire physician offices. While the hearing was supposed to address both hospital and insurance consolidation, the majority of the questions focused on hospitals. Information on the hearing, including witness testimony, may be found here.

• Speaking of consolidation, two health-care juggernauts are locked in a battle for patients in western Pennsylvania that could foretell the future of American health care. On one side is UPMC, a health system that built its brand on cutting-edge research and university-affiliated hospitals. On the other is Highmark Health, best known as one of the country’s biggest health insurers. Click here for the story.

Amazon Wants To Be Major Hospital Supplier

Amazon is pushing to turn its nascent medical-products business into a major supplier to U.S. hospitals and outpatient clinics that could compete with distributors of items ranging from gauze to hip implants, according to a Wall Street Journal report. Amazon has invited hospital executives to its Seattle headquarters on several occasions, most recently in late January, to sound out ideas for expanding its business-to-business marketplace, Amazon Business, into one where hospitals could shop to stock outpatient locations, operating suites and emergency rooms, according to hospital executives who attended the meetings. Click here.

Senator’s Report Links Drug Industry and Pro-Opioid Advocacy Efforts

A new report released last week by Sen. Claire McCaskill (D-MO) has raised concerns about drug company money fueling pro-opioid advocacy by many patient and physicians groups. According to the report, five drug companies provided more than $10 million in payments to patients and physicians working on chronic-pain and opioid issues between 2012 and 2017. In that time frame, many of these groups championed messages that favored an increase of opioid use. For instance, the American Academy of Pain Medicine, which received almost $1.2 million from the five companies between 2012 and 2017, issued a 2009 patient guide stating that opioids are “rarely” addictive when used properly for chronic pain. To read the full report, click here.

• Sens. Rand Paul (R-KY) and Ed Markey (D-MA) wrote a letter to Assistant Secretary for Mental Health and Substance Use asking for an update on implementation of a provision in the Comprehensive Addiction and Recovery Act to expand medication assisted treatment for opioid abuse, click here.
• The House Energy and Commerce Committee continued probed into “pill dumping” in West Virginia with follow-up letters to pharmaceutical distributors, click here.

Trump Administration Limits Use of Guidance Documents in Regulation

In a major shift of regulatory power, the Trump administration has adopted new limits on the use of “guidance documents” that federal agencies have issued on almost every conceivable subject, an action that could have sweeping implications for the government’s ability to sue companies accused of violations. Guidance documents offer the government’s interpretation of laws, and often when individuals or companies face accusations of legal violations, what they have really violated are the guidance documents. Defense lawyers say the change in policy gives them a powerful tool to fend off allegations of wrongdoing against their clients. Click here for the NYTimes report.

MIPS Scores Available on CMS Website

Individual clinicians who submitted 2017 quality performance data may now login to the CMS website to see their scores. Scores are calculated automatically and may change monthly as additional claims and adjustments are processed for up to 90 days after the new year. Individual physicians may still submit quality data via claims until March 1. Final scores for 2017 will be available after March 31. Only individual clinicians, not groups, are eligible to use claims-based data submission. Individual clinicians may login to the QPP site by clicking here.

AHRQ: Elderly See Biggest Drop in Hospitalizations

While the rate of hospitalizations (excluding pregnancies and newborns) declined for all age groups from 2000 to 2015, the biggest drop — 25 percent — occurred among patients 65 and older, according to a new AHRQ analysis.  Additionally, from 2007 to 2015, Medicaid was the top primary payer for patients under age 18 years with nonneonatal, nonmaternal inpatient stays; its share exceeded 50 percent starting in 2012.  And from 2000 to 2015, the share of Medicaid among nonneonatal, nonmaternal inpatient stays for those aged 18-44 years and 45-64 years increased by 74 percent and 68 percent, respectively. Click here for the report.

Study: Hospital Cost-Shifting To Private Insurers Continues

According to a National Bureau of Economic Research study, hospitals are boosting prices for privately insured patients because of the reductions to their Medicare reimbursements. On average, health systems negotiated 1.6 percent higher payments from private insurers, which generally added about $86,500 per hospital for those patients’ acute care claims. Medicare reimbursement penalties averaged approximately $153,000 per hospital under the readmission reduction program in the ACA as well as a separate program to boost value-based payments. Click here to read the report.

Officials Warn of More Flu Deaths Among Children

The HHS Secretary and Acting CDC Director urged Americans to get flu shots as the severe outbreak of flu continues to rise. Flu has already killed 63 children. The CDC said that three-quarters of the children who have died were not vaccinated.  Since 2004, the number of annual pediatric flu deaths has ranged from 37 to 171, according to the CDC. For more on the flu pandemic from the CDC, click here.

• FDA Commissioner says flu vaccine this year is only 36 percent effective but urges more usage. Click here.

FDA OKs Blood Test for Concussions

The FDA last week approved a long-awaited blood test to detect concussions in people and more quickly identify those with possible brain injuries. The test, called the Banyan Brain Trauma Indicator, is also expected to reduce the number of people exposed to radiation through CT scans, or computed tomography scans, that detect brain tissue damage or intracranial lesions. If the blood test is adopted widely, it could eliminate the need for CT scans in at least a third of those with suspected brain injuries, the agency predicted. Click here for the FDA announcement.

Health Spending Projected to Increase 5.5% a Year Through 2026

CMS Office of the Actuary has projected health spending to increase 5.5 percent on average each year until 2026. In 2017, health spending rose by 4.6 percent, the new projection estimates that health spending will reach $5.7 trillion by 2026 as a result of fundamental economic factors such as rising incomes and an aging population. However, the report states that higher prices in health care will also contribute to the rise. Prices for prescription drugs are projected to grow the fastest, rising 6.3 percent by 2026 as more specialty drugs with fewer rebates hit the market. Prices for hospital services are also estimated to rise to 5.7 percent as they climb from historic lows. Spending on private health insurance is projected to increase the slowest among coverage programs, ticking up 4.7 percent each year on average until 2026 as the aging population will shift older, sicker enrollees into Medicare. To read more from CMS, click here.

• For  a good perspective on this report, click here for a Health Affairs analysis.

Report Details Unique Social Determinants in Rural Health A new government report published last week found four key social determinants unique to rural areas; geography, income, education, and transportation. As health care continues to shift from volume to value, developing and implementing partnerships to address the social determinants of health – the structural determinants and conditions in which people are born, grow, live, work and age – becomes even more important, especially in rural communities. For more on these social determinants of rural health and proposed solutions, read the full report here.

• The CAH Coalition is actively working with Congress and federal agencies to support the needs of Critical Access Hospitals as they work across rural America.  Click here.

CMS List of Essential Community Provider for 2019 Is Released

CMS last week published a final list of Essential Community Providers for plan year 2019, available on the CMS website under “Application Resources.”  Click here. Health insurers use the annual list to identify providers meeting ECP requirements for Qualified Health Plans participating in health insurance exchanges. The ECP hospital category includes disproportionate share hospitals, children’s hospitals, rural referral centers, sole community hospitals, free-standing cancer centers and critical access hospitals. Qualifying hospitals should confirm they are on the list and report any errors to the CMS regional office. Hospitals that serve predominantly low-income, medically-underserved individuals may petition CMS (click here) through Aug. 22 to be on the ECP list for plan year 2020.

New Federal Poverty Guidelines Announced

The HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) recently published the 2018 federal poverty guidelines to be used in determining eligibility in income-based federal programs, including several that may affect the health and welfare of both rural and urban communities alike such as the Low-Income Home Energy Assistance Program (LIHEAP), the Supplemental Nutrition Assistance Program (SNAP), the Children’s Health Insurance Program (CHIP), and Medicare subsidized prescription drug coverage. The Guidelines went into effect on January 13, 2018. Click here to view the new guidelines.

Ultra-Processed Foods ‘Linked to Cancer’ in French Study A study conducted by researchers in France detected different types of highly processed foods linked to colorectal cancer. The results analyzed the proportion of ultra-processed food in the diet increased by 10%, the number of cancers within the population detected increased by 12%. A heavy intake of mass-produced packaged breads and buns, sodas and sweetened drinks, meats, instant noodles and soup and frozen or shelf-life ready meals can lead to higher risk of attaining cancer. Click here for the study.