56% of Hospitals Get “A” or “B” on New Leapfrog Safety Scorecard

The independent, nonprofit grading system by the Leapfrog Group assigns “A,” “B,” “C,” “D” and “F” letter grades to general acute-care hospitals and focuses entirely on errors, accidents, injuries and infections. Of more than 2,600 hospitals graded, 32 percent earned an “A,” 24 percent earned a “B,” 37 percent a “C,” 6 percent a “D” and just under 1 percent an “F.” The only states without a grad “A” hospitals are Washington, D.C., Delaware or North Dakota. The five states with the highest percentage of “A” hospitals are New Jersey, Oregon, Virginia, Massachusetts, and Texas. New this year to the grading system, a measure for prevention and identification of medication errors. The measure was added as medication errors are the most common hospital error, harming as many as one in four patients.

• To view the scorecard, click here.
• Click here for the state rankings.

CMS Medicaid Rule Would Increase Flexibility, Could Limit Networks, Expand Telehealth

CMS has released a proposed rule to “streamline the Medicaid and CHIP managed care regulations by reducing unnecessary and duplicative administrative burden.” The proposal contains a policy that would eliminate rules that require state Medicaid programs to set limits on how long or far people have to travel to get to their doctors. This could allow state Medicaid programs to create weaker/smaller provider networks and could limit access to care for Medicaid/CHIP beneficiaries. Additionally, under this new plan, the rule would make it easier for telehealth-heavy providers and plans to get approved for Medicaid and CHIP managed care. For example, states could choose other benchmarks to reflect accessibility.  For instance, rural states may opt for different metrics – such as the time it takes to get a virtual appointment – compared to the ones chosen by more densely populated states. Click here for the rule andhere for the CMS fact sheet.

Of the over 1 million clinicians who submitted data, 93 percent of MIPS eligible clinicians received a positive payment adjustment for their performance in 2017 under the Quality Payment Program, according to CMS. Doctors who participated in 2017, the first year of the program, will get their claims payments adjusted up or down in 2019 on a range, depending on their score. The year 1 scores shows that 71 percent of doctors in program will get money for exceptional performance and only 5 percent will get their payments cut by as much as 4 percent because of poor performance or lack of participation. “Admittedly, the MIPS positive payment adjustments are modest,” Verma said in a statement as most will receive a bonus from 0.28 to 1.88 percent above the normal Medicare reimbursement. To read the full statement from Verma, click here.

• CMS sent a letter to clinicians last week explaining the physician fee schedule final rule including QPP updates, click here for the letter.

The American Medical Association is urging Administration and Congress to reduce pre-authorization requirements in Medicare managed care and will be addressing the issue as part of its Interim House of Delegates meeting this week, click here.

In a speech last week to the Patient-Centered Primary Care Collaborative, HHS Secretary Alex Azar said CMS will revisit using mandatory bundled payment models, possibly for radiation oncology and cardiac care in the coming months. According to Azar, HHS is reexamining the role mandatory bundled payment models can play in the transition to value-based care as part of the Administration’s goal of paying for outcomes, rather than process. Azar said, “Imagine a system where physicians and other providers only had to worry about the outcome, rather than worrying about their staffing ratios and the individual reimbursements for every procedure they do and every drug they prescribe.” For the full speech, click here.

Despite election year rhetoric, it’s always hard to know exactly what a new Congress will actually do.  Health care is no exception.  The new Democratic majority in the House, which will begin in January, is expected to focus on issues ranging from tweaking the Affordable Care Act to reigning in drug prices.  Hospitals are expecting broad Democratic support for a new 340B bill that will reverse the Trump Administration’s 340B payment cuts, but it is unclear whether the new House majority has an interest in “fixing” the cuts imposed on hospital outpatient departments that takes effect January 1.  Click here for a good NYTimes story on what could happen next.

In a letter to HHS Secretary Alex Azar last week regarding Arkansas’ Medicaid work requirements, the Medicaid and CHIP Payment Access Commission requested “a pause in disenrollments in order to make program adjustments to promote awareness, reporting, and compliance.” MACPAC Commissioners state that they are “highly concerned” that Arkansas hasn’t sufficiently informed beneficiaries that they’re at risk of losing coverage as more than 90 percent of beneficiaries who were required to report their working hours didn’t do so in September. Since the program took effect in June, almost 8,500 Medicaid beneficiaries in the state have been dis-enrolled and locked out of the program. Clickhere for the letter.

• Kaiser Family Foundation has released a Medicaid Waiver Tracker to view pending and approved Section 1115 Medicaid waivers, click here.

In the first week of this year’s ACA Marketplace open enrollment, CMS says about 372,000 people have signed up for health insurance, almost half of what signed up in 2017. Most of those who enrolled so far are existing customers with only about 89,000 new enrollees purchasing plans. CMS plans to release weekly enrollment snapshots for the HealthCare.gov platform, which is used by the Federally-facilitated Exchanges, the State Partnership Exchanges, and some State-based Exchanges. Click here for the first snapshot.

For the second year, CMS is looking to recognize organizations that demonstrate a commitment to health equity by reducing disparities among the CMS beneficiaries they serve, particularly among racial and ethnic minorities, individuals with disabilities, sexual and gender minorities, and those living in rural areas. Last year the Health Equity awardees were Kaiser Permanente and Novant Health, who both worked to close the gap for African Americans through their health services networks. Awardees will be organizations that can show reduction in disparities in health care quality, access, or outcomes for a priority population. For more on the award and the nomination form, click here.

Are Two Flu Shots Better than One?
Studies have found that additional booster doses of the flu vaccine can make it more effective, but only in specific groups of people. Children are one group that can benefit from receiving two doses of the vaccine during the same flu season. The CDC recommends that children 6 months through 8 years should get two doses of the vaccine this season. Children younger than 5 years of age – especially those younger than 2 years old – are at an especially high risk of serious flu-related complications. Each year, millions of children get sick with seasonal flu; thousands of children are hospitalized and some children die from flu. For the full recommendation from the CDC, click here.

FDA to Place Large Restrictions on Flavored E-Cigarettes

The FDA is expected to announce a ban on the sale of flavored e-cigarettes in gas stations and convenience stores to cut down on the rate of underage use of the products, perhaps as early as this week. Additionally, the agency has plans to create new age-verification requirements to help curb on illegal online sales to minors. The forthcoming ban on flavors targets points of sale where youths are most likely to buy e-cigarettes but won’t include menthol e-cigarettes, since that flavor is allowed in regular cigarettes. For more on the planned proposal from USA Today, click here.

• According to research by CDC, FDA, and NIH, adult reported being current smokers is at an all time low at 14 percent in the United States, click here.

Spanking Not a “Healthy Discipline” in Children’s Punishment
The American Academy of Pediatrics reported that spanking leads to more aggressive children and doesn’t teach responsibility or self-control.  They will submit an updated policy statement during its annual conference in Orlando. Children are less likely to have good relationships with their parents and will be more defiant. The AAP suggests using positive reinforcement and setting limits as alternatives because corporal punishment or harsh verbal abuse won’t change behavior over the long term and can make children more aggressive. The group recommends pediatricians help parents with age-appropriate plans for disciplining kids, including advising them of community groups offering assistance. Clickhere for the AAP statement, and here for the report it is based on.