04 Mar March 4, 2019
Senate Chairman Opens Investigation into Not-for-Profit Hospitals
Senate Finance Committee Chairman, Sen. Chuck Grassley (R-IA), has re-opened an investigation into tax-exempt hospitals due to his concern that the hospitals aren’t using billions of dollars in tax savings to prioritize community needs. Saying in a letter to the IRS Commissioner, “according to reports, it appears that at least some of these tax-exempt hospitals have cut charity care, despite increased revenue, calling into question their compliance with the standards set by Congress.” In the letter, Grassley asks detailed question of the Commissioner of its recent oversight into tax-exempt hospitals as well as explain the financial performance of the industry. This probe is expected to also lead to hearings on the subject in the near future. Click here for the letter.
CMS Updates Hospital Star Ratings System and Proposes Improvements
For the first time since December 2017, CMS has updated it’s much criticized star quality ratings for hospitals that participate in Medicare while at the same time the agency requested feedback from stakeholders on proposed improvements to the methodology that is used to determine the ratings. While the ratings are normally released quarterly, CMS had delayed this update for over a year because of concerns from industry that the formula does not accurately reflect the true quality of care at facilities. CMS states the proposed methodology is, “intended to respond to stakeholder feedback, seek to enhance the Star Ratings methodology by making hospital comparisons more precise and consistent, and by allowing more direct, “like-to-like” comparisons.” Comments on the potential changes are due March 29, 2019. Click here to view the new Hospitals Compare ratings, and here for the proposed improvements to the formula.
Medicare-For-All Bill Introduced While Moderates Look to Shore Up ACA Markets
The long awaited “Medicare-For-All” legislation was introduced in the House last week by 107 democrats. Some analyses say the price tag could be as much as $32 trillion but the bill does not include a plan to pay for the revamping of the U.S. health care system. The lead sponsor, Rep. Pramila Jayapal (D-WA), has said that a new tax on high earners or mandated employer contributions could be used. H.R. 1384 would essentially eliminate all private insurance and require all U.S. residents to enroll in the government funded health plan. Meanwhile, the New Democrat Coalition, a group of House moderate democrats, created a new Healthcare Task Force to stabilize the individual markets and expand on the Affordable Care Act to work toward universal affordable health care. In the short term, they state that they will try to work with Republicans to bring down ACA marketplace premiums and reverse the Trump Administration’s “sabotage” of the health care law. To view H.R. 1384, click here, for a summary of the bill, click here, and for a list of co-sponsors, click here. To read more on the new Healthcare Task Force, click here.
- In a speech to the National Association of Health Underwriters, HHS Secretary Alex Azar pushed the policy proposal to move ACA subsidies into HSAs for people in the individual market to pay for premiums and other out-of-pocket health costs, click here.
Majority of Americans Support Administration’s Proposals to Lower Drug Prices
According to a new Kaiser Family Foundation poll, most Americans agree with the President’s proposals to lower drug prices with requiring drug companies to put prices in their ads and making it easier for generics to get to market topping the list with 88 percent of respondents in favor and 80 percent are in favor of allowing drug imports from Canada. Of all the proposals, only allowing Medicare plans to exclude certain drugs from health plans received less than a majority at 25 percent. Surprisingly, 65-percent of those polled agreed that drug prices should be targeted to costs in other countries, a plan that has been widely opposed by drug manufacturers and providers alike, but now being pursued by HHS. Click here to view the entire poll.
- FDA has issued a warning letter to a pharmacy based in Canada, CanaRx, that has stated it is contracting with U.S. health plans to import unapproved and potentially dangerous versions of prescription drugs, click here.
- American Action Network, a GOP-aligned group, has launched a $2.9 million ad campaign against policy proposals to allow Medicare to negotiate drug prices, click here.
Molina, BCBS of South Carolina Lead ACA Claims Denials
Through a review of ACA Marketplace insurers, the Kaiser Family Foundation found that of the reported 229.8 million in-network claims received, 42.9 million were denied, for an average in-network claims denial rate of 19% nationwide. Within those claims, the data shows that Molina Healthcare reported denying 32-percent of in-network claims submitted in 2017, up from 22 percent in 2015 and Blue Cross Blue Shield of South Carolina reported denying 30 percent of claims in 2017, up from 15 percent in 2015. Of all these denials, the data also shows that patients rarely appealed the denied claims, of the more than 42 million claims fewer than 200,000 were appealed – a rate of less than one-half of one percent. To view all the data, click here.
Sicker, Lower-Income Seniors Most Likely to Leave MA Plans for Traditional Medicare
In a study published in JAMA last week, researchers found that sicker and lower-income seniors are the most likely to transfer out of Medicare Advantage plans and into traditional Medicare, which could be a reason MA plans’ quality rankings are going up. The study showed that enrollees with complex medical problems, and those who are dual-eligibles for Medicare and Medicaid, are significantly more likely than healthier or wealthier patients to leave MA for traditional Medicare. Researchers surmise that “Disenrollment from Medicare Advantage may indicate that plans do not meet the preferences of enrollees with significant chronic illness and may complicate performance measurement and risk adjustment for Medicare Advantage plans.” Click here for the study.
CMS Requests Input on How to Increase Interoperability in Post-Acute Care
CMS issued a request for information last week on how to improve data interoperability for providers that did not receive incentives for using electronic health records previously. This group includes post-acute care providers, behavioral health providers, and community-care providers that serve dual-eligibles. Additionally, CMS is asking for assistance on how to improve interoperability for those providers and others through innovation center demonstration projects. CMS stated that post-acute care providers were not previously targeted because they were not eligible for incentives under meaningful use, therefore the Agency is looking for input on how it can help these providers financially to adopt and use technology. To view the RFI, click here, and here for the CMS fact sheet.
Senate Committee to Hold Oversight Hearings on Nursing Home Safety
The Senate Finance Committee will hold a hearing on Wednesday entitled, “Not Forgotten: Protecting Americans From Abuse and Neglect in Nursing Homes,” over recently reported concerns that CMS has allowed nursing homes to continue to operate even after track records of putting patients at risk. Witnesses include Kate Goodrich, CMS Chief Medical Officer, Antoinette Bacon, the Justice Department National Elder Justice Coordinator, and Patricia Blank, an Iowa woman whose mother died in a nursing home that has been cited for neglect and abuse. A discussion topic is expected to be a CMS proposed rule that would have required patients and their families to preemptively give up their right to sue nursing homes for negligence that has been vehemently opposed by patient advocacy groups. Click here for the hearing notice, and here for the proposed rule from 2017.
Babies Born with Syphilis at 20-Year High: Meth and Opioids to Blame
A new study has found that in 2017, 900 newborn babies had syphilis in 37 states – the highest number is the past 20 years. The researchers found a correlation between drug use and the rise in cases among babies. Opioids and meth promote risky sexual behavior that increases the likelihood of contracting syphilis and other sexually transmitted diseases. Female addicts are increasingly susceptible as their drug use continues to rise, leading to more of them passing on the disease to their infants. Further, many addicted pregnant women forgo prenatal visits for fear of being drug tested and losing custody of their babies, and mothers with untreated syphilis have an 80-percent chance of infecting their unborn children. To read more, click here.
FDA Issues Warning on Robotically-Assisted Mastec
The Food and Drug Administration issued a safety communication to caution patients and providers against using robotically-assisted surgical devices for mastectomy and other cancer related surgeries. The communication was released due to the limited, preliminary evidence that the use of these devices for treatment or prevention of cancers that affect women may be associated with diminished long-term survival. The FDA is monitoring the adverse events in the literature and reported to the agency to better inform stakeholders. To view the notification from the FDA, click here.
Exercise Could Help Reduce Colorectal Cancer Growth
Colorectal cancer is the third most common cancer in men and women. New research published in The Journal of Physiology suggests that exercise may help in reducing the growth of colon cancer cells. The study looked at data on colorectal cancer survivors undergoing sessions of high intensity interval training. Researchers found that blood samples of the participants showed an increase in inflammation, which lowers colon cancer cell progression. Therefore, researchers suggest that maintaining a physically active lifestyle is important in reducing human colorectal tumors. To read more on the study, click here.
All that Sleep on the Weekend Could Lead to Weight Gain
University of Colorado researchers have found that people who sleep-in on the weekends were more sensitive to insulin in their liver and muscles, leading to increased weight gain. The study looked at 36 healthy men and women to analyze different sleeping patterns pointing to circadian rhythms (or the biological clock) causing reduced insulin sensitivity during those extra hours of inactivity while sleeping. Click here, to read the study.