November 11, 2019

Leapfrog Releases New Hospital Safety Grades, “D Level” Hospital Files Suit
At least a third of 2,600 surveyed general acute-care hospitals earned an “A” for safety efforts, according to a new report from The Leapfrog Group, 25 percent received a “B” grade and 34 percent a “C” grade. The Leapfrog Hospital Safety Grade is a bi-annual grading assigning “A,” “B,” “C,” “D” and “F” letter grades to general acute-care hospitals that bases the grades entirely on patient safety -preventable errors, accidents, injuries and infections. The five states with the highest percentages of “A” hospitals are: Maine, Utah, Virginia, Oregon, and North Carolina, while Wyoming, Alaska and North Dakota hospitals did not receive any “A” grades. NCH Healthcare in Naples, Florida, filed a suit to challenge its “D” rating in an effort to keep the grade from being published alleging deceptive and unfair trade practices, as well as defamation, saying the health system did not participate in the 2019 survey and, thus, Leapfrog had to rely on secondary information. Click here to view the Hospital Safety Grades, and here for more on the lawsuit.

  • According to an article published in Health Affairs, the Hospital Acquired Condition Reduction Program may not be associated with additional patient safety improvement, click here.

Trump To Make Price Transparency Center of Health Care Campaign
The President’s top domestic policy advisor, Joe Grogan, said late last week that the Administration plans to make price transparency the centerpiece of its health care policy agenda going into the 2020 campaign.  CMS unexpectedly pulled the proposed price transparency regulation from the Medicare outpatient prospective payment system regulation that was finalized last week and takes effect in January.  CMS Administrator said at the time that the transparency regulations were pulled to give them more time to work on them.  Grogan said the new initiative will be revealed this month.  The proposed regulations included a requirement for hospitals to post their prices on up to 300 “shoppable services,” including prices in their privately negotiated insurance contracts.  Click here for the report.

2020 Physician Fee Schedule Could Lead To Radiology Loss of $5 Billion
The recently finalized physician fee schedule rule from CMS will lead radiologists to lose approximately $5 billion over the next 10 years due to the new coding structure for outpatient evaluation and management codes as recommended by the American Medical Association, according to the American College of Radiology. Because radiologists and other specialties such as pathologists and surgeons rarely bill for office visits and since CMS did not make any changes to the E/M office visits captured in the 10- and 90-day global codes, they will be the most penalized under the new structure. The ACR is urging Congress to change the new rule legislatively but is not optimistic that anything will be done. Click here for a media summary and here for ACR’s take on the rule.

  • Operators of outpatient endovascular suites appear to be excited about changes CMS has made to payment rules governing them and it is likely competition for these services with hospitals will be heating up.  Click here.

CMS’ Site-Neutral Payment Policies Touted by MedPAC
Medicare’s efforts to pay the same rate for medical services provided in doctors’ offices and hospital outpatient departments could reduce the growing incentive for hospitals to acquire physician practices, according to an upcoming report from MedPAC. The preliminary report, presented at last week’s meeting of the Medicare Payment Advisory Commission, will support previous research that found increasing hospital purchases of physician practices is fueling higher prices for commercial insurers and for Medicare, which pays more for services provided in hospital-based settings than at doctors’ offices. The report’s findings appear to validate a move by CMS to push ahead in 2020 with a plan for Medicare to pay the same rate for care provided at doctors’ offices and at off-campus, hospital-based clinics, despite a loss in court. Click here for MedPAC’s slide presenation.

Air Ambulance Issues Central To Surprise Billing Debate
Good Morning America last week interviewed a family saddled with a large bill from an air ambulance, which was followed by an interview pf the Chairman and Ranking Members of the House Energy and Commerce Committee where they explain that the air ambulance issue is too complicated to tackle right now. Although  staffers in both the House and Senate have said they are open to including a fix. Meantime, the Health Care Cost Institute released a report funded by the insurance industry saying while air ambulance usage is down among people with employer coverage, the average cost has more than doubled. To view the GMA piece, click here, for the HCCI report, click here.

Medicare Beneficiaries Struggling with Bills as Hospitals Sue More 
Hospitals across the country are increasingly suing patients for unpaid bills, a step many institutions were long unwilling to take.In some places, major hospitals now file hundreds or even thousands of lawsuits annually. Those cases strain court systems and often end in wage garnishments for patients. Click here for the NY Times report.

  • According to a new survey in Health Affairs, 53 percent of seriously ill Medicare beneficiaries have experienced financial hardships due to high medical bills citing prescription drug costs as the biggest driver, click here.
  • According to the Kaiser Family Foundation, Medicare beneficiaries spent on average $5,460 out-of-pocket costs on health care in 2016, including about $1,000 on long-term care facility services, click here.
  • ProPublica details how an employer left a new mom with a $898,984 bill for her premature baby saying that the employee failed to meet the deadline to add her premature newborn to its health plan, click here.
  • According to a new report by the Organization for Economic Cooperation and Development, The United States spends more than twice as much as the average country on healthcare, yet it lags in many health indicators, click here.

House and Senate Are Moving on Rx Price Cutting Bills; Drug Shortage Growing
Both the House and Senate have been sending through separate proposals to attack the drug pricing issue; however, both are moving slower than originally expected. The House bill (H.R.3), promoted by Speaker Pelosi and introduced by the Energy and Commerce Committee Chairman, Frank Pallone (D-NJ), was initially thought to be going to the House Floor for a vote as early as next week but aides state that they are awaiting a full Congressional Budget Office estimate, pushing the vote to December. The bill would allow CMS to negotiate with manufacturers and index costs to international prices. In the Senate, Finance Committee Chairman Chuck Grassley (R-IA) says he plans to update his legislation (S. 2543) with new provisions that will garner more Republican support including overhauling prescription drug rebates, yet promising not to do anything that would detract from the goal of the legislation. Click here for H.R. 3, and here for S. 2543.

  • A severe shortage of immune globulin, a drug used for cancer, immune disorders, epilepsy, has led to canceled treatments and rationing of care, click here.
  • A Senate drug shortages bill — that requires the FDA to speed facility inspections and application reviews for generic drugs in short supply, makes bulk drug manufacturers disclose supply disruptions, directs makers of life-supporting drugs to develop back up manufacturing plans, and identifies where drugs are made — is gaining major support from the hospital and pharmacy community, click here.
  • A drug pricing model pushed by the Institute for Clinical and Economic Review and used by other countries – but long opposed by drugmakers in the U.S. – is getting new attention amid the political debate over drug prices, click here.

Changes in Physician Consolidation with the Spread of ACOs; MedPAC Questions ACO Value in Post Acute
According to a study that investigated whether physician practices consolidated following the introduction of ACOs, researches found that counties with more ACOs had more large practices than smaller practices. The study comes as a response to concerns that ACOs “may incentivize consolidation of physician groups,” which has been associated with lower quality of care and higher costs, despite early research suggesting the opposite. To read the full study, click here.

  • The groups of doctors, hospitals, and other caregivers that provide coordinated care for Medicare patients discharged from hospitals have had a modest impact on reducing program spending for care. That’s the finding of new research on accountable care organizations in the Medicare Shared Savings Program presented at last week’s MedPAC meeting. Click here for MedPAC’s slide deck.

Medicare Parts A and B Will See Increases in Coinsurance, Deductibles, and Premiums in 2020
CMS has released the 2020 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, all of which will see increases. The standard monthly premium for Medicare Part B enrollees will be $144.60 for 2020, an increase of $9.10  and the annual deductible for all Medicare Part B beneficiaries is $198 in 2020, an increase of $13 from 2019. The Medicare Part A inpatient hospital deductible will be $1,408 in 2020, an increase of $44, coinsurance amount will increase $352 per day for the 61st through 90th day of a hospitalization from $341 in 2019 and $704 per day for lifetime reserve days from $682 in 2019. For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $176.00 in 2020 up from $170.50 in 2019. Click here for the CMS fact sheet.

CDC Finds Preventable Diseases to be Deadlier in Rural Areas
A report from the Centers for Disease Control and Prevention has found preventable diseases to be deadlier in rural America, in comparison to urban areas. The report looked at the five leading causes of death in America to see how rural and urban areas compared. The leading causes included heart disease, cancer, chronic lower respiratory disease, stroke, and unintentional injury. For all the five causes of death, rural areas had higher rates than urban areas. Click here for the report.

  • Another study finds that adults with diabetes are nearly twice as likely to die from heart disease or stroke and for people living in rural areas, the risk factors associated with diabetes are higher, click here.
OIG Finds $54 Million in Improper Medicare Payments 
The Office of the Inspector General release a report last week revealing that acute-care hospitals billed 18,647 claims incorrectly, resulting in Medicare paying $54.4 million. The claims were billed under the incorrect patient discharge status codes for post-acute care, of which 83 percent were followed by claims for home health services, and 17 percent were followed by claims for services in other post-acute-care settings. To read the summary click here, to read the full report click here.
  • The House Ways & Means Committee announced a hearing scheduled for November 14 on long-term care issues that will look at care in the home, hospice, nursing homes, antipsychotic use in nursing homes along with other issues, click here.

CMS Releases Data on Week 1 of Open Enrollment, Already Lagging Behind Last Year
In the first week of open enrollment of, CMS announced that 177,082 people selected plans from the ACA federally-facilitated exchange and the state-based exchanges. This is less than half of last year’s week-1 figure of 372,000 sign-ups; however, this tally is only two days of results as the opening day of enrollment was on a Friday. The lag was also likely impacted by technical glitches for the website on the opening day. For the CMS snapshot, click here.

CMS Publishes 2019 Medicaid and CHIP (MAC) Scorecard
This year’s Medicaid and CHIP (MAC) Score published by CMS that measures state health system performance, state administrative accountability, and federal administrative accountability was released last week. New measures have been added to the Fall 2019 additions of each category. These new additions will serve to inform about care delivery, enrollment, and annual expenditures. Click here for more on the new scorecard.

Alzheimer’s Drug Developed in China Receives Conditional Approval
The seaweed-derived Alzheimer’s treatment received conditional approval from Chinese drug regulators. The company developing the drug, Shanghai Green Valley Pharmaceuticals, reports the drug will be made available in China by the end of the year; Green Valley has further research to conduct for the drug, but they hope to start a global Phase 3 trial to allow the drug to be approved in other countries. The drug differentiates itself from previous Alzheimer’s drugs by focusing on the brain and gut microbiome connection. The next drug trial will include U.S. sites. To read the full article, click here.

In a First, CMS Grants Approval of Medicaid Mental Illness Services in D.C.
CMS announced the expansion of treatment services available to Medicaid beneficiaries living in the District of Columbia diagnosed with serious mental illness and/or serious emotional disturbance.  CMS is also approving DC’s request to begin providing new services for its beneficiaries diagnosed with substance use disorder.  “Today’s historic approval will substantially increase the range of services that are available to meet the needs of the District’s Medicaid beneficiaries who are diagnosed with serious mental illness and substance use disorder,” said CMS Administrator Seema Verma. For the news release click here.

Apple Opens Healthcare Access to Veterans
The Department of Veteran Affairs and Apple announced last week that veterans will now be able to access their health records on their phones. The health records will be available under the Health Records feature in the Health app on their iPhone. The VA launched Health Records to a small number of patients this summer, but now all veterans who are iOS users and receive care through the Veterans Health Administration can access their health information. Click here to read more.

Millennials’ Health Problems on the Rise, Along with Associated Costs
A new report from the Blue Cross Blue Shield Association finds that as millennials (born 1981 – 1996) age, their health declines at rates faster than Generation X (born 1965 to 1980). Additionally, millennials are increasingly suffering from conditions, such as depression, high cholesterol, hyperactivity, and hypertension. Without intervention, millennial mortality rates could increase by more than 40 percent, compared to Generation X’s. This could significantly raise the demand for treatments, resulting in higher healthcare costs. At this rate, treatment costs for millennials is predicted to be as much as 33 percent higher than the costs Generation X’s experienced as the same age. Click here for the full report.

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