March 11, 2019

293 Hospitals Receive 5 Star Rating from CMS

CMS has released its hospital rankings of more than 4,000 hospitals, of which 293 scored 5 out of 5 stars. The whole list documents: One star: 282 hospitals; Two stars: 800 hospitals; Three stars: 1,264 hospitals; Four stars: 1,086 hospitals; Five stars: 293 hospitals. To find any hospital click here; for a list of the 5 star hospitals by state, click here;  and the CMS request for input on how the star rating program should be changed, click here.

HHS Considering Requiring Public Disclosure of Private Contracts Between Hospitals and Insurers
The Trump administration is seeking input from the public on whether to require hospitals, doctors and other health-care providers to publicly disclose the privately negotiated prices they charge insurance companies for services, a move that would expose for the first time the actual cost of care. Mandating public disclosure of the rates would upend a longstanding industry practice. The request for public comment has been largely overlooked because it was tucked into a 700-page draft regulation released last month on improving patients’ access to their electronic health records. Click here for the Wall Street Journal story.

340B Lawsuit: Government Appeals Ruling To Overturn Regulation; Hospitals and CMS Push for a Remedy
As reported last week, on February 22, 2019, CMS filed a notice of appeal on the federal district court’s ruling with respect to the 2018 340B rule, although the Court has yet to rule on the actual relief it will grant to 340B providers. Prior to that, the hospitals asked the district court to make CMS recalculate payments due to 340B hospitals for 2018 and pay those providers at a rate of the average sales price plus 6 percent. However, in a twist, last week CMS and the hospitals asked the DC Circuit to hold off on the appeal until the district court determines the relief due to the hospitals. In late February hospitals supplemented the initial complaint to add the 2019 340B rule on grounds identical to its challenge on the 2018 340B. The hospitals asked the court for the same relief for 2018 and 2019. CMS filed a motion to dismiss the claim on the 2019 340B rule making the same arguments it made with respect to the complaint regarding the 2018 340B rule. It’s déjà vu all over again, as the Hospitals argued in the response. The federal district court is expected to schedule a hearing to rule on the 2019 340B rule in the near future. Whether that hearing will occur before or after the court determines the remedy for the claims regarding the 2018 340B rule is unknown. Click here for the notice to appeal, here for the CMS brief on how to provide relief, here for the motion to dismiss, and here for the hospitals’ response to the motion to dismiss.

Patient Advocacy Groups That Oppose Medicare Changes Receive Big Money from Drug Companies
A Kaiser Family Foundation investigation has found that several patient advocacy groups have received large donations and funding from drug manufacturers and also oppose policy proposals that could limit drugs covered by Medicare providers. In 2015 alone, the study found that drug companies gave more than $58 million to the groups.  For example, groups were featured in advertisements that attack CMS’ proposed changes to Medicare Part D’s “protected” drug classes (requiring that “all or substantially all” drugs must be covered by all insurers) to allow for insurers to steer patients toward lower-cost therapies and generics using prior authorization or step therapy for medicines. To read the details of the investigation, click here.

Standalone ED Care Comes with a High Price Tag as Facilities Multiply
According to new analysis by UnitedHealth Group, freestanding emergency departments – known as standalone EDs – offer convenient care options for patients but come at a very high cost. The analysis found that they can charge many times more than other providers for the same care provided to patients mostly for common non-emergent conditions (only 2.3-percent is actually for emergencies). For instance in Texas, the average cost of treating common conditions at a standalone ED is 22 times greater than treatment at a physician office, and 19 times more than at an urgent care facility. Moreover, there has been a huge increase in actually facilities, both independent and hospital-owned. Over the eight-year period the study examined, the number more than doubled from 222 in 2008 to 566 in 2016. Click here to view the analysis.

  • MedPAC is taking a closer look at how to stem the growth in spending at urgent care centers and hospital EDs.  In last week’s MedPAC meeting, staff outlined the issues and possible remedies.  Click here to see the slide deck.

CMS’ Proposed Changes to Nursing Home Ratings System Require Higher Quality Standards
CMS announced updates coming next month to Nursing Home Compare and the Five-Star Quality Rating System last week that will include several changes including new ratings for health inspection performance and stricter criteria for staffing level ratings. The stricter system will downgrade homes that have four or more days per quarter with no registered nurse on site to the lowest quality rating. The Star Ratings System gives each nursing home a rating between 1 and 5 stars – with 5 stars to above average quality and 1 star to those with quality below average. The changes that include revisions to the inspection process, enhancement of new staffing information, and implementation of new quality measures, will likely go live in mid-April. To view the CMS fact sheet on the changes, click here.

CMS Seeks Information on Selling Health Insurance Across State Lines
“In an effort to stem the rising tide of healthcare premiums,” CMS issued a request for information (RFI) on what it would take and the possible implications of allowing Americans to buy health insurance across state lines. This RFI is the latest foray into President Trump’s October 12, 2017 Executive Order, “Promoting Healthcare Choice and Competition Across the United States,” to increase the amount of choice that Americans have and to encourage insurance companies to compete to not only drive healthcare premiums down, but to allow smaller insurances the chance to become more competitive after rising premiums forced them out of the marketplace due to under enrollment. The RFI will be open for 60 days from March 6, 2019. Click here to view the RFI.

Suicide and Alcohol Deaths on the Rise
A new report shows that deaths from suicide and alcoholism are on the rise.  When combined with overdose deaths they accounted for more than 150,000 deaths in the United States in 2017 alone. Over the past decade over one million Americans died from drug overdoses, alcohol and suicides leading to a decrease in life expectancy in the country, or about one person dying every four minutes. Rural areas were hit the hardest with death rates in five states 60 per 100,000 or higher, with New Mexico having the highest rate of 77.4 per 100,000 followed by Alaska, New Hampshire, West Virginia and Wyoming. To view the report, click here.

United Loses Behavioral Health Lawsuit 
A federal district court ruled on March 5 that United Behavioral Health “failed in its fiduciary duty” to provide coverage for United Behavioral Health Group members from 2011 to 2017 by making it too difficult for members to utilize the coverage that they had through the nation’s largest behavioral health insurer. United Health was accused of usung unreasonable and restrictive criteria rather than adopting a more common criteria such as one developed by the American Society of Addiction Medicine, or ASAM, for addiction-treatment coverage. “UBH’s refusal to adopt the ASAM criteria was not based on any clinical justification,” the judge  wrote. “Indeed, all of its clinicians recommended that the ASAM criteria be adopted. The only reason UBH declined to adopt the ASAM criteria was that its finance department wouldn’t sign off on the change.” UnitedHealthcare is expected to appeal this decision. For more on the decision, click here.

Another Study Debunks Connections Between Autism and the Measles Vaccine
A new report published in the Annals of Internal Medicine denies any connection between the measles vaccine (known as the Measles, Mumps, Rubella (MMR) vaccine) and autism following a study of nearly a half million people. The paper, by researchers at Copenhagen’s Statens Serum Institut, determined that out of the 657,461 Danish children who received the MMR vaccine between 1999 and 2013, only 6,517 children were diagnosed with autism, an incidence rate of less than one percent, indicating no increased risk of autism. Researchers also concluded that vaccination is not likely to trigger any developmental disorders. This study coincides with recent measles outbreaks in the US of children who were not given the MMR vaccine. Click here for the study.

  • U.S. Reps. Adam Schiff (D-CA) and Michael Burgess (R-TX) introduced the bipartisan Vaccines Save Lives Resolution recognizing the importance of vaccines and immunizations in the United States, click here.

Widespread EHR Access Pushed by Top Government Officials
Jared Kushner, senior adviser to President Trump; Chris Liddell, the White House deputy chief of staff for policy coordination; and Seema Verma, the administrator of the Centers for Medicare & Medicaid Services are continuing their push for EHR interoperability and broader access for patients. Their first prong of attack stems from a rule proposed  by HHS that would require increased interoperability of electronic health information for Medicaid, the Children’s Health Insurance Program, Medicare Advantage plans and Qualified Health Plans in the Federally-facilitated Exchanges by 2020. In the meantime, the group wants to rope in private insurers to conform with similar standards, though private companies cannot be compelled to comply without congressional legislation. Click here for the Fortune article and here for the CMS fact sheet.

4th National Summit on the Social Determinants of Health Announced

The Root Cause Coalition, a national member-driven nonprofit dedicated to achieving health equity through cross-sector collaboration, is hosting its 4th Annual National Summit on the Social Determinants of Health, in San Diego, California from October 20-22, 2019. This National Summit is an annual opportunity for leaders from across disciplines – healthcare, community and national non-profits, the faith community, researchers, government leaders, educators and businesses – to learn how to improve health and well-being through meaningful collaboration. To register or learn more about this event, please click here.

Hundreds of Physicians Say Opioid Prescribing Guidelines Are Often Misused

A group of over 300 medical doctors across the nation, sent a letter to the CDC citing misuse of opioid prescribing guidelines and the consequent suffering of some patients. The letter states that patients with legitimate chronic pain no longer have the kind of access to the medication that they medically require. In addition to this, the letter also points fingers at insurers and doctors alike for misusing the guidelines as a defense to avoid payment and to deny treatment. To view the 39-page letter, click here.

HHS to Incentivize At-Home Dialysis Treatment

Dialysis and other associated kidney care for end-stage renal disease accounted for about $113 billion annually in Medicare spending, making it a key factor in finding a better way to cut that cost without cutting care. HHS plans to incentivize at-home dialysis treatment, said HHS Secretary Alex Azar in his remarks to the National Kidney Foundation last week.  Azar said at-home care can be “more convenient, better for patients’ independence and self-sufficiency and better for their physical health.” HHS will also be looking at changing the payment structure to support not only at-home treatment, but to encourage transplants as treatment options rather than dialysis, which is more in -line with other developed countries approaches to end-stage renal disease. To view a full transcript of his remarks, click here.

Lawsuit Says Anthem Sending Big Checks To Patients Rather than Providers

In a multimillion dollar lawsuit brought by Sovereign Health, Anthem stands accused of sending massive checks to patients instead of their out of network providers. In their registration paperwork, patients can choose to have insurance payments sent to their providers rather than have payment sent to them and then be responsible for getting that payment to the provider, process called assignment of benefits. However, Anthem has anti-assignment language built in the patients subscriber agreement that nulls their choice in the provider’s office. Sovereign Health further charges that Anthem does this to force providers in-network. CNN reports that Anthem has filed for a motion to dismiss based on precedent of anti-assignment being legal. For the full CNN report, click here.

Maternal Morbidity on the Rise in America

The NIH has released the results of its latest maternal mortality study and the results are troubling. In the data pulled from this 20 year study, maternal morbidity increased over 170%. The study did not account for reasons in the disparity between groups of women, but did find that racial ethnic groups were the most severely affected. Data was pulled from over 8 million live births and considered 18 indicators of severe maternal morbidity. For the full results click here.

Secondhand Smoke Linked With CKD

In a new study published in the Clinical Journal of the American Society of Nephrology, Korean researchers found secondhand smoke to significantly increase the risk for chronic kidney disease. Researchers looked at three groups of nonsmokers, and determined that in comparison with individuals unexposed to secondhand smoke, those who were exposed up to three days a week had a 58% increased risk of developing kidney disease, and those exposed more than three days had a 62% increased risk. Chronic effects on the kidney are irreversible, which is why this study emphasizes the need to reduce risk factors, such as exposure to secondhand smoke. To read the study, click here.

British Man Becomes Second Known Patient to be Cured of HIV

US News reports that after receiving a bone marrow transplant from an HIV-resistant donor, a patient in London has become the second known person to be cleared of the AIDS virus. After the treatment and 18 months being off of antiretroviral drugs, the patient is functionally cleared of the disease. This treatment is rare due to the diagnosis of both HIV and Hodgkin’s Lymphoma. Researchers are claiming that this is a big step in HIV research, but chemotherapy for HIV patients is not a long-term path to a cure. To read the full article, click here.

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