May 14, 2018

Updated CMS Hospital Star Ratings Shows 213 with 5 Stars

CMS updated its Hospital Compare website late last month, revealing new HCAHPS summary star ratings for 3,466 hospitals, with 213 hospitals earning five stars. Since its launch in 2015, the summary star ratings program has assigned hospitals a one- through five-star rating based on HCAHPS survey scores, which assess patient experience. To determine these scores, CMS assigns hospitals star ratings for the 11 measures included in the HCAHPS survey before combining the ratings into one metric. CMS’ most recent update is based on HCAHPS survey data collected between July 1, 2016, and June 30, 2017. Here’s how the 3,466 hospitals fared: Five stars: 213 hospitals; Four stars: 1,177 hospitals; Three stars: 1,522 hospitals; Two stars: 495 hospitals; One star: 59 hospitals. Click here for the CMS update.  Click here for a good summary from the Advisory Board.

Hundreds of Hospitals Receive Healthgrades’ Top Patient Safety and Patient Experience Awards

Healthgrades last week announced the recipients of their 2018 Patient Safety Excellence Award and their 2018 Outstanding Patient Experience Award.  For 2018, 458 hospitals across the U.S. received the Healthgrades Patient Safety Excellence Award, which puts them in the top 10 percent of all short-term acute care hospitals that report patient safety data.  439 hospitals received the Healthgrades Outstanding Patient Experience Award, which puts them in the top 15 percent of hospitals for patient experience.  To see the list of awardees, click here.


Trump Releases Plan to Lower Drug Prices – 340B Reform Included

President Trump on Friday released his “Blueprint To Lower Drug Prices.” Joined by HHS Secretary Alex Azar, the President declared that the middle men in the drug supply chain would no longer be able to drive up drug prices and that manufacturers should no longer be able to give other countries lower prices and make Americans pay for it. The HHS Secretary called for more transparency in prices stating that manufacturers will have to disclose their prices in their ads. On 340B, the Blueprint proposes to set a minimum charity care requirement for participation on the program.  The plan also calls for the elimination of “gag rules” that prevent pharmacists from informing patients when they could pay less out-of-pocket by not using insurance, and it reduces the incentives to deliver Medicare Part B drugs in the most expensive setting. To read the blueprint, click here, for the White House summary, click here, and for Azar’s speech in the Rose Garden, click here.

  • The HHS Secretary, the FDA Administrator, and the CMS Administrator released a joint op-ed outlining what the agencies plan to do to bring down drug prices, click here.
  • The Senate Health Committee will hold a 2nd hearing on the 340B program on May 15th.  The GAO, Inspector General, and HRSA will testify, click here.
  • HRSA posted last week an intention to propose 340B mega-guidance — than promptly removed it stating that it was an error.

CMS Administrator Warns No-Risk ACOs Won’t Continue 

In a speech last week, CMS Administrator Seema Verma hinted that Medicare will soon discontinue the no-risk – and very popular – Track 1 Accountable Care Model. Under this model, ACOs are paid bonuses by CMS if they hit certain performance thresholds but do not undertake any risk if they fail. Verma told the group that Track 1 ACOs are increasing Medicare spending and may be encouraging industry consolidation stating, “our system cannot afford to continue with models that are not producing results.” Click here for the Administrator’s speech.

  • Usage of outside specialists by ACO patients participating in Medicare Shared Savings Program decreased among primary care ACOs but changed little among specialty ACOs from 2010 to 2014, according to a study, click here.

White House Proposes $7 Billion CHIP Cut, $800 Million CMMI Reduction

Early last week, the Trump Administration released a rescission package calling for $15 billion in cuts to funds that was previously appropriated. The controversial package includes the following cuts –

  • $7 billion from the Children’s Health Insurance Program
  • $252 million from the 2015 Ebola outbreak response
  • $15 million from USDA’s Rural Cooperative Development Grant program

They have turned the proposal into legislation that may go directly to the House floor for a vote. It faces an uphill battle as it hits on programs with vast bipartisan support. For the White House proposal, click here. For the House bill, click here.

  • Despite the $800 million in proposed cuts to the Center for Medicare and Medicaid Innovation, which was established under the Affordable Care Act, health care experts say they see the Trump administration planning a new direction for CMMI, as evidenced by federal health officials’ outreach to stakeholders seeking feedback on ways to change the office. Click here for details.

House Committee Moves Bills Aimed at the Opioid Crisis

The House Energy & Commerce Committee last week approved 25 bills, with bipartisan support, as part of the overall effort to address the drug crisis. The proposals touch on various aspects of the health care system, including helping doctors link emergency room patients to follow-up substance abuse treatment care after an overdose, encouraging opioid alternatives to treat pain in emergency rooms, and requiring the CDC to expand a program to educate people about the risks of infectious diseases like HIV spread through injection drug use. They hope to get the opioid bills to the House floor by Memorial Day however, many believe that June is more likely. To view the markup and the bills voted out of Committee, click here.

  • The Energy & Commerce Committee heard from pharmaceutical distributors on their involvement in the crisis –  four of the five executives said their companies did not have a role fueling the public health crisis, despite a Committee report revealing all the companies had shipped massive amounts of painkillers to West Virginia and other areas, click here.
  • The House Energy & Commerce Health Subcommittee was divided over a controversial proposal last week that would change the law that limits the sharing of patients’ records that contain information about treatment for substance use disorders, click here.
  • The House Ways & Means Committee released its own package of proposals to help combat the opioid crisis, click here.
  • An NIH study calls into question how opioids actually treat neurons to relieve pain, click here.
  • Doctors who are cutting back on prescribing opioids increasingly are opting for gabapentin, a safer, non-narcotic drug recommended by the CDC. By doing so, they may be putting their opioid-using patients at even greater risk. Click here for details.

Hospital “Monopolies” Lead to Higher Prices: Study

According to a newly revised research paper by the “Health Care Pricing Project,” hospitals make a lot of money off patients who get health coverage through their jobs, and hospitals with little or no competition have the power to set their rates at will. In fact, based on claims of employer-sponsored plans covering 28 percent of Americans, hospitals with a monopoly have prices 12.5 percent higher on average and are less likely to be paid rates based of Medicare prices. The researchers state, “Prices at monopoly hospitals are 12 percent higher than those in markets with four or more rivals.” Click here for the full study.


CMS Releases Its Rural Health Strategy; Bill Creates New Medicare Facility
The Centers for Medicare & Medicaid Services (CMS) this week announced a new Rural Health Strategy. The Rural Health Strategy is aimed to help “improve access to high quality, affordable healthcare in rural communities.” The Strategy identifies five objectives:
Apply a Rural Lens to CMS Programs and Policies

  • Improve Access to Care Through Provider Engagement and Support
  • Advance Telehealth and Telemedicine
  • Empower Patients in Rural Communities to Make Decisions About Their Healthcare
  • Leverage Partnerships to Achieve the Goals of the CMS Rural Health Strategy

For each of these objectives, the Rural Health Council identified Key Supporting Activities to be taken. These objectives aim to assist CMS across the agency in supporting and improving health care access and affordability for the 60 million Americans living in rural areas. You can read the full Rural Health Strategy here. CMS’ Rural Health webpage can be found here.

  • Reps. Lynn Jenkins (R-KS), Ron Kind (D-WI) and Terri Sewell (D-AL) last week introduced legislation that would create a new Medicare facility designation to help rural communities maintain access to essential emergency and outpatient services for patients. Click here.

CMS Rule Boosts Some Rural DME Rates

On the heels of the Rural Health Strategy, CMS issued an interim final rule with comment period to increase the fee schedule rates from June 1, 2018, through December 31, 2018, for certain durable medical equipment (DME) items and services and enteral nutrition furnished in rural and non-contiguous areas (Alaska, Hawaii, and U.S. territories) of the country not subject to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP).  Click here for details.


CMS Changes Tune: Curry Medical Center Will Maintain CAH Status

One month after initially receiving a letter from CMS notifying them of the loss of critical access hospital (CAH) status, Curry General Hospital in Oregon can breathe a sigh of relief. In a letter sent this week, CMS told Curry that they’ll be able to keep their CAH designation. The original issue arose from CMS’s new policy saying that a Hospital Outpatient Department (HOPD) is an extension of a hospital and, therefore, a CAH within 35 miles of an HOPD is in violation of the rules. Curry General Hospital was never designated as a Necessary Provider because they clearly met the distance requirements. After appealing their loss of status and submitting that they would have qualified for Necessary Provider status, CMS agreed that “Curry did in fact meet the Oregon necessary provider requirements prior to January 1, 2006.” While this is a relief for Curry, questions remain for other CAH’s at risk of possibly losing their status due to an HOPD within 35 miles. Click here for more.

  • The CAH Coalition is actively working with Congress and federal agencies on this issue. Click here to learn more about their work.

Uninsured Rate on the Rise: Gallup

The uninsured rate increased in 17 states last year — and not a single state saw its uninsured rate drop, according to the latest Gallup survey data.  Nationwide, the share of individuals lacking coverage jumped by 1.3 percentage points last year, reaching 12.2 percent in the first year of the Trump presidency. Four states — Hawaii, Iowa, New Mexico and West Virginia — saw their uninsured rate jump by at least three percentage points. The uninsured rate jumped regardless of whether state had implemented Medicaid expansion under Obamacare. In expansion states, the share of individuals lacking health care coverage increased from 8.2 percent to 9.1 percent. There was a 1.4 percentage point increase in non-expansion states, with the uninsured rate hitting 15. 9 percent. Click here for the Gallup report.


AARP and UnitedHealth Hit with Lawsuit for Diverting $400 Million a Year 

America’s largest Medigap insurer and the biggest interest group for seniors have been hit with a class action lawsuit that claims that UnitedHealth and AARP have been illegally diverting millions to fund a “rebating scheme” under their Medigap plan. On behalf of “a nationwide class of Medicare-eligible individuals,” the suit alleges that UnitedHealth allows AARP to take a 4.9% rebate from monthly beneficiary payments in exchange for AARP sponsoring UnitedHealth’s Medigap plan. According to the complaint, AARP uses the rebates to pay for the monthly collective group plan premium in order to bind coverage. The suit claims an agreement between UnitedHealth and AARP violates the law by disguising the rebates as an “allowance” or “royalty” payment for AARP’s sponsorship of the plan to avoid paying taxes. To view the complaint, click here.

CMS To Hold National Learning Session on MIPS and Advanced APMs

CMS’ Learning Center will be holding a national conference call on Wednesday, May 16, to answer frequently asked questions about the Quality Payment Program from the 2018 Healthcare Information and Management Systems Society (HIMSS18) Annual Conference & Exhibition and inquiries received by the Quality Payment Program Service Center. Then, CMS will open the phone lines to take questions. MACRA requires CMS to implement an incentive program, referred to as the Quality Payment Program, which provides two participation tracks for clinicians: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs). The call’s target audience: Medicare Part B fee-for-service clinicians; office managers and administrators; state and national associations that represent healthcare providers; and other stakeholders. Click here to register.


Survey: Physicians Don’t See Social Determinants as Their Responsibility 

A recent study conducted by Leavitt Partners, a health care analytics firm, shows that physicians don’t consider it their responsibility to address social issues that might affect their patients’ health. The white paper  based on a national survey of 621 physicians found that the majority agreed that their patients would benefit from assistance with social determinants of health however, they did not believe addressing these determinants was their responsibility. For example, 69 percent didn’t think it was up to them to help patients with transportation, and 91 percent said they are not responsible for helping patients find affordable housing. Physicians also frequently reported that patients have other resources for their social needs. To read the full study, click here.

  • A group of medical associations launched a new coalition – the Partnership to Empower Physician-Led Care – last week to support the independent physician business model, click here.

Where It Is Needed Most, Obesity Surgery Not Covered

Many states have little or no coverage of bariatric surgery that shrinks the size of the stomach essentially changing the body’s hunger hormones and reducing a person’s natural weight, according to a new report.  While studies show bariatric surgery is more effective long-term than diet and exercise for people who are more than 100 pounds overweight, many insurance companies, Medicaid programs, and plans treat it as a “frivolous and optional” procedure. There are variations from state to state with some with the biggest obesity problem areas having little or no access.  Click here for more.

  • In first quarter of the year, Seattle collected more than $4 million on new tax on sugary beverages that took effect on January 1, 2018, click here.
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