22 Jan January 22, 2018
Federal Government Shutdown Continues; No Immediate Impact on Medicare, Medicaid
Federal government funding ended at midnight on Saturday; however there will likely be little disruption to Medicare and Medicaid payments for a while. CMS’ other non-discretionary activities also will continue, the agency said in a notice released Friday. Click here. In addition, states will have sufficient funding for Medicaid through the second quarter; the Children’s Health Insurance Program will make payments to eligible states from remaining carryover balances; and key federal health insurance exchange activities will continue using carryover from user fees. The contingency plan calls for HHS to furlough half of its staff. Click here for the White House Office of Management and Budget’s memo on shut down activities. Click here for a complete review of what happens during a government shutdown.
- CMS is not processing certain claims for physical, speech and occupational therapy treatments to at least temporarily prevent patients from having to pay out of pocket for services once they hit an annual cap. Click herefor the CMS notice.
Hospitals Overwhelmed By Flu Epidemic; Many More Deaths Attributed to Flu The current influenza epidemic is sending people to hospitals and urgent-care centers in every state, and medical centers are responding with extraordinary measures: asking staff to work overtime, setting up triage tents, restricting friends and family visits and canceling elective surgeries, to name a few. (click here for more on the hospital impact.) On Friday, January 12, the CDC announced – for the first time – that every part of the contiguous United States exhibited widespread flu activity. Click here to see the CDC map. Click here for the latest CDC flu surveillance report. Flu has claimed the lives of at least 20 children with California being hit particularly hard, with reports of 74 deaths – click here. “This is the first year we had the entire continental U.S. be the same color on the graph, meaning there’s widespread activity in all of the continental U.S. at this point,” CDC Influenza Division Director Dr. Dan Jernigan said during the January 12 briefing to reporters. Click here for the transcript of the CDC’s meeting on the widespread flu activity in the country.
About 300,000 Clinicians To See Medicare Payment Penalties this Year
CMS has announced that this year they will penalize nearly a quarter of doctors and nurses for poor cost and quality performance under an Affordable Care Act program. In the released CMS fact sheet, Medicare states that nearly 300,000 providers will see up to a 4 percent cut in Medicare payments – depending on their practice size – based on their 2016 performance under the Value Modifier program. However, about 20,000 Medicare providers, less than 2 percent of those eligible, will see between a 6.6 percent and 19.9 percent bonus for doing well in the Value Modifier program. The majority of doctors, 72.4 percent, will not have any change to their Medicare payments at all for the coming year. The program ends in 2018, before MACRA’s Merit-based Incentive Payment System takes over fully. Click here for the CMS fact sheet.
17 New Next Generation Medicare ACOs Begin
Seventeen new health systems joined Medicare’s Next Generation ACO program this year and it now serves about 2 million patients, according to new CMS data. The additions bring the total number of Next Generation accountable care organizations to 58, up from 44 last year. Three health systems left the program, which was launched by the CMS Innovation Center in 2016. Click here for the CMS list of Next Generation ACOs.
New 340B Reform Bill Introduced
Sen. Bill Cassidy (R-LA) last week introduced the Helping Ensure Low-income Patients have Access to Care and Treatment (HELP) Act (S. 2312) that stop certain types of hospitals from entering the 340B program until the government issues regulations that add transparency measures and other changes. It has no cosponsors. Click here for the Cassidy bill language. The bill joins other House 340B bills including ones by Rep. David McKinley (R-WV), bill (HR 4392), to halt the recently implemented CMS regulation (click here to see this bill’s 178 cosponsors). Rep. Larry Bucshon (R-IN) has a pharma-backed bill (HR 4710) that creates a moratorium on new 340B entities, as well as new reporting requirements for hospitals (click here to read the text). Rep. Chris Collins (R-NY) is reportedly working on a pharma-backed bill too. All of this follows the report recently released by the House Energy and Commerce Committee on the program. Click here for the report.
- Click here for an updated Pew report on the 340B and DSH cuts that are already underway.
Gallup: More Americans Uninsured in 2017
The percentage of adults without health insurance coverage rose 1.3 percent in 2017, from a record low during the previous year, a new Gallup poll shows. Last year’s rise marked the largest single-year increase since Gallup began tracking the statistic in 2008 shortly after the ACA. The uninsured rate rose to 12.2 percent in the fourth quarter of 2017 compared to 10.9 percent in 2016. That translates to an additional 3.2 million Americans who became uninsured last year. Click here for Gallup’s analysis on the uninsured population.
IRS Will Hold Off Imposing Medical Device Tax Penalties for Nine MonthsWhile Congress weighs further delaying the Medical Device Tax – perhaps indefinitely – the IRS will hold off on penalizing companies for failing to pay the medical device tax for nine months. This will give device manufacturers temporary administrative relief as well as allowing providers increased payments. The notice posted last week by the IRS cites the short month-long gap between the end of the moratorium on the device tax and the Jan. 29 due date for this year’s first payment. The stopgap spending bill that the House passed late last week would delay the medical device tax another two years. To read the notice from the IRS, click here. Finance Committee Backs HHS Secretary Nominee Azar The Senate Finance Committee last week approved the nomination of Alexander Azar to lead the Department of Health and Human Services by a mostly party-line 15-12 vote. Sen. Thomas R. Carper, D-Del., was the only Democrat on the panel to vote with Republicans to advance the nomination. Azar’s nomination now moves to the full Senate, which could consider it as soon as next week, although a vote has not been scheduled. Click here for the Senate Finance Committee’s hearing to consider Mr. Azar, and here for the status update on Mr. Azar’s nomination.
Physicians, Disease Groups Fighting Anthem Payment Changes
Specialty physicians and disease advocacy groups are calling attention to controversial changes to the Anthem’s payment policies for advance imaging services. Last year, the country’s largest Blue Cross Blue Shield plan began cutting off payments for many patients who get MRI and/or CT scans at hospital-owned outpatient facilities, a change that will result in major revenue losses for many hospitals and lead to possible gaps in patient care. In a letter to Anthem, 11 national groups that include the American College of Emergency Physicians and the American College of Surgeons argue that Anthem implemented the changes largely without input from providers and that it’s ignoring evidence of likely harm to patients. For the full letter, click here.
New Report Recommends Innovations for Rural Health Care The Bipartisan Policy Center (BPC) released its report, “Reinventing Rural Health Care: A Case Study of Seven Upper Midwest States.” The study took place in 2017 and interviewed more than 90 leaders in rural health in Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota, and Wyoming. The BPC believes local, state, federal policymakers as well as health care leaders must work together in order to accomplish rural health care innovation. To read the full report, click here.
- The CAH Coalition is also working to support Critical Access Hospitals nationwide. Click here.
Lawmakers Debate Medicaid Role in Opioid Crisis Lawmakers are examining whether states’ expansion of Medicaid in recent years has contributed to the opioid crisis by making access to prescriptions drugs easier and cheaper. “This is an unintended consequence,” Committee Chairman Ron Johnson stated during a congressional hearing last week. Coinciding with the hearing, Johnson released a report that he said highlighted cases of Medicaid fraud involving opioids and sent a letter to HHS asking for data on Medicaid and Medicare spending on prescription opioids. Conservatives say Medicaid expansion has helped fuel the opioid epidemic in some states by making prescription painkillers available for little to no cost for patients. Click here to view the hearing and read the testimony, and here for Sen. Johnson’s report on Medicaid and the opioid crisis.
Premium Differences Among Rural States Expected to Widen with Mandate Repeal
Insurance premiums in rural states with high populations of farmers will likely face very different premium prices due to the repeal of the individual mandate. The report focused on states with high populations of farmers and the insurance plans available to them, most of whom are unsubsidized and over 35 years old. When comparing the cheapest Bronze plan options for this population in the top ten farm states, researchers found a wide variety of prices. To read the full report, click here.
FDA and Pentagon Issue Plans for Battlefield Medical Products The Food and Drug Administration and the Department of Defense last week launched a program to expedite the approvals of new medical products for use on the battlefield. Under the plan, officials will meet to determine priorities for military medical product development and products that are considered a priority will get a faster approval similar to the FDA’s breakthrough designation – a review that takes closer to six months than the normal 10 months. The FDA is also promising to offer advice on clinical development and product manufacturing. Click here for the FDA’s initial work plan on collaborating with the DOD.
Aetna Investors Sue Over $77B Merger with CVS Health An Aetna investor last week filed a lawsuit against the company and its Board of Directors alleging shareholders will be shortchanged if Aetna moves ahead with a proposed $77 billion merger with CVS Health. The proposed class-action lawsuit claims Aetna tried to convince shareholders to vote in favor of the CVS Health transaction with misleading information. To view the class action lawsuit, click here.
- Aetna has agreed to pay $17 million to settle claims that it breached the privacy of roughly 12,000 customers who take HIV medications, click here for more from NPR
Four Big Hospital Systems To Launch Generic Drug Company Four not-for-profit hospital systems – Intermountain Healthcare, Ascension, SSM Health and Trinity Health that own a combined 10% of U.S. hospitals – are banding together to create a new generic drug company. The Department of Veterans Affairs also is helping and has expressed interest as a purchaser. According to a press release from Intermountain Healthcare, “The new company intends to be an FDA approved manufacturer and will either directly manufacture generic drugs or sub-contract manufacturing to reputable contract manufacturing organizations, providing patients an affordable alternative to products from generic drug companies whose capricious and unfair pricing practices are damaging the generic drug market and hurting consumers.” Click here for the press release. Click here for the NYTimes report.
- The FDA has issued its 2018 Compounding Policy Priorities Plan, outlining how the agency will make it easier for certain compounding pharmacies to sell their products nationwide. Click here for details.
IV Saline Fluids in Short Supply: FDA
FDA is raising new concerns about the shortage of IV saline fluids — some of the alternatives that health facilities are turning to may spur shortages of other medical products. Trying to cope with the shortage of filled IV saline bags, hospitals and health care providers are repackaging or compounding IV saline fluids utilizing empty IV containers. The result is diminished supplies of containers as well as concerns that supplies of empty bags could tighten further, FDA Commissioner Scott Gottlieb said in a statement. Click here.
Study Suggests that Nursing Homes Inflate Quality Scores
According to a new study, nursing homes may be exaggerating their self-reported quality measures to ensure their Medicare star ratings are higher. Researchers noted that that there is little direct correlation between self-reported measures and on-site inspections. Additionally, nursing homes that have more to gain financially were more likely to improve their self-reported measures and resident complaints vary considerably between facilities with the same overall rating, but not inspection ratings, leading to the possibility of inflated self-reported measures. The Medicare Star Rating System rates nursing homes from one to five stars, and make the data publicly available. Results are based on an on-site inspection, staffing and quality reported by the facility. To read the report, click here.
House Panel OKs Bills on OTC Drugs and Medical Volunteers Bills related to over-the-counter drug approvals and manufacturers’ communication on unapproved uses of drugs are headed to the full Energy and Commerce Committee after the panel’s Health Subcommittee last week advanced the measures. The Subcommittee also approved a bill (HR 1876) that would shield health care professionals from liability if they caused harm while volunteering during a disaster response. The bill and a substitute that would limit the liability protections to activities that the providers are licensed to practice were adopted by voice vote. The discussion draft on over-the-counter medicines was approved with a bipartisan voice vote. But another bill (HR 2026) that would codify what kind of communication is allowed between drug manufacturers and entities that pay for the drugs, like insurance companies, was approved 18-14 after a partisan debate. To read text of the approved legislation as well as watch debate on the legislation, click here.