February 25, 2019

Hospitals, Doctors, Insurers Mobilize To Kill Medicare for All
Their message is simple: the Affordable Care Act is working reasonably well and should be improved, not repealed by Republicans or replaced by Democrats with a big new public program. More than 155 million Americans have employer-sponsored health coverage. They like it, by and large, and should be allowed to keep it. So, now they are working together in a cooridnated campaign to stop the legislative effort known as Medicare for All.  Click here for a good NYTimes report.

Hospitals Offer Solutions for Surprise Billing; States Take Action
In a letter to congressional leadership, hospital associations offered eight legislative solutions that could help protect patients from the financial burden as a “result from unexpected gaps in coverage or medical emergencies.” Signed by the American Hospital Association, Federation of American Hospitals, Children’s Hospital Association, America’s Essential Hospitals, Association of American Medical Colleges and the Catholic Health Association, the letter sent last week suggests that patients must be educated on their coverage and that hospitals should not send patients huge bills. Additionally, the hospitals state that payers should not deny coverage for emergency care that they later determine was not an emergency and legislation should maintain the right to private negotiations between providers and plans, among others. To read the letter, click here.

  • A new Brookings report looks at the actions taken by states to cut back surprise billing, primarily requiring plans to cover surprise out-of-network bills on an in-network basis, and prohibiting so-called balance billing by doctors and hospitals, click here.
  • Innovative personal technology devices are decreasing emergency visits and lowering costs, click here.
  • In a new editorial, CMS Administrator Seema Verma makes the case for price transparency, “Americans have the right to know their health care and hospital costs,” click here.

Average Cost of a Medicare Patient Will Be Almost $20,000 By 2027
According to the latest spending projections released by CMS just last week, the average spending on a Medicare patient annually by 2027 will be almost $20,000, an increase of about 5.5-percent every year over a ten year period. These numbers are based solely on current Medicare law and does not take into account the recently introduced legislation that would expand the pool of Americans eligible beneficiaries. Additional data within the new reports show that  about 10 percent of Americans will be uninsured in a decade about equal to the percentage today. Click here to view the models.

Hospitals Seek Delay in DSH Cuts Scheduled for Oct. 1
In a letter to congressional leadership, hospital associations last week asked lawmakers to once again delay the ACA Medicaid Disproportionate Share Hospital payment cuts, as they state that the expected coverage rates have yet to truly to materialize and Medicaid already underpays providers. Hospitals are scheduled to receive a $4 billion cut on October 1 of this year followed by additional cuts of $8 billion annually in each subsequent year through fiscal 2025. “Congress recognized the critical nature of fully funding the Medicaid DSH program by delaying the start of the cuts for the past six years. We urge you to once again delay the start of the Medicaid DSH cuts given the vital need for this program,” the groups state in the letter. Click here for the full letter.

Even with Increase in Funding, Overdose Deaths Among Medicaid Patients Remain High
Even with a large increase in Medicaid funding to treat addiction since 2010, overdose deaths remain high which, according to a new report, suggests that available drug treatment may not be meeting the demand, even in states that expanded eligibility. Research by the Urban Institute shows that the average spending on opioid use disorder treatment through Medicaid increased 25.1 percent per year from 2010-2017, with the fastest growth from 2014 to 2016. Addtionaly, during the time period that was reviewed spending on two of the three most common types of medication used to treat opioids – buprenorphine and naltrexone – and the opioid overdose reversal drug naloxone increased from $190 million to $887.6 million. To view the study, click here.

Senate Committee Leaders Launch Probe into Rising Insulin Prices
The Chairman and Ranking Member of the Senate Finance Committee announced Friday that they have launched an investigation into the rising cost of insulin, which has jumped up to 500-percent. In letters to pharmaceutical companies Eli Lilly, Novo Nordisk, and Sanofi, Sens. Chuck Grassley (R-IA) and Ron Wyden (D-OR) ask how they determine list and net prices of insulin, as well as how much the companies spend on research and development, production, marketing and advertising of the diabetic drug, and their revenues and gross margins from insulin. Click here to view the letters.

CDC Woefully Underestimating the Mortality of Superbugs: Study
Researchers at the University of Washington have found that a significantly higher number of deaths from multidrug-resistant infections by using a method different from the CDC’s to estimate the burden of antibiotic-resistant infections. By using estimates of deaths caused by sepsis and reported rates of multidrug resistance in U.S. hospitals, along with estimates of outpatient deaths caused by infections, the study found that the low end of their estimate of at least 153,113 deaths annually from multidrug-resistant infections is almost seven times higher than the CDC’s figure. Additionally, the researchers found their upper-end estimate of 162,044 deaths would make multidrug-resistant infections the third-leading cause of death in the U.S. To read more on the study, click here.

One in Five Rural Hospitals In Danger of Closing
According to new analysis by Navigant, an estimated 430 rural hospitals have dire financial outlooks that could lead closures, impacting access to health care and for many communities, a main job source. Researchers found that about two-thirds of states have at least five rural hospitals that face this risk due to declining and uncompensated inpatient care, uninsured and underinsured patients, and a severe lack of capital investment to upgrade technology. To view the study, click here.

  • 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.

Colorado County Creating a New Type of Health Plan Model
Residents of Summit County, Colorado face health care costs of 40-80% higher than the surrounding area and insurance prices often hundreds more a month than their neighboring communities.  Due to these high costs, residents often find themselves traveling sometimes over two hours to get care in Denver where cost of care is significantly less, even without having insurance. Community leaders have responded creating a nonprofit, the Peak Health Alliance, that will try to negotiate lower fee schedules and work with insurance companies directly for better rates. If it works, Colorado’s Insurance Commissioner said he hopes to take the idea statewide, perhaps by nudging the state employee health plan to join a statewide alliance that would bargain with health care providers. Click here for more.

Heart Attacks on the Rise Among Young Women
Researchers at the American Heart Association recently analyzed heart attack related hospital admissions in the U.S., and found an increase in the number of admissions among patients aged 35 to 54. The largest increase in admissions was observed among young women, from 21% in 1995-99 to 31% in 2010-14. Compared with young men, women were more likely to have a history of risk factors such as diabetes and hypertension, but were less likely to receive proper therapies. The findings of the study were also interesting because although the population is aging, a higher proportion of heart attack patients are young patients. Better research is needed to understand the risk factors for heart attacks, especially among young women. Click here to read the full study.

Study Shows People Paid for Research Studies Likely to Lie
A new study published by researchers at the University of Pennsylvania found that people who are paid to be a part of research are more likely to lie about their eligibility in order to be included. The study used flu shots to understand the authenticity of paid participants and showed that about 10 to 23 percent of participants lied about their eligibility to participate. This not only brings into question the results of studies with paid participants, but it also puts people at risk where the eligibility requirements keep them safe. To read the full study, click here.

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