25 Nov November 25, 2019

(The Strategic Health Care family wishes you a wonderful Thanksgiving!)

$4 Billion in Medicaid DSH Cuts Postponed a Month; Funding Continued for Other Health Programs
The President has signed legislation (H.R. 3055) to continue funding the government through December 20th, the bill included a delay in the $4 billion in cuts to Medicaid disproportionate share hospital allotments. The bill also extends the Certified Community Behavioral Health Clinic demonstration program, the current 100% Federal Medical Assistance Percentage for U.S. territories under the Medicaid program, and funding for Community Health Centers, the National Health Service Corps, Teaching Health Centers that operate graduate medical education programs. There is broad congressional support for another 2 year delay in the scheduled DSH payment cuts.  Congress has until December 20 to pass another funding bill.  Click here for the bill and here for the section-by-section summary.

• The U.S. Chamber of Commerce, the Business Roundtable, and the National Association of Manufacturers called on Congress to repeal the Health Insurance Tax, the Medical Device Tax, and the “Cadillac tax” on generous employer-sponsored health plans before the end of the year, click here.

Surprise Billing Legislation Languishes; New Report Shows Which Specialties Generate Most Surprise Bills
The House Ways and Means Committee has reportedly developed a compromise on the surprise billing issue, but no new actual bill has yet emerged to be reviewed outside the committee.  The Senate surprise billing legislation continues to languish as more than a dozen senators have placed ‘holds’ on the Senate Health Committee-passed bill, keeping from moving to the Senate floor for a vote.  It appears increasingly unlikely that Congress will pass surprise billing legislation before the end of the year. A new report from the Health Care Cost Institute analyzed the services most likely to send a surprise bill to a patient. According to the report, cardiovascular specialists are the least likely to send a surprise bill at 2 percent, while emergency department visits resulted in 17 percent of all surprise bills. The data also shows variation between states, even by specialty. For instance, 45 percent of pathology visits in Connecticut resulted in an out-of-network claim, while 0 percent were in Minnesota. Click here for the HCCI report.

CMS Chief Hits Hospitals for Suing Patients, Defends New Transparency Regs
CMS Administrator Seema Verma last week slammed non-profit hospitals for suing patients over unpaid patient bills.  Her comments came in remarks she made to support the agency’s new price transparency regulations, which are broadly opposed by hospitals and health plans. Click here for details.  Click here for more about Verma’s comments about the new regs.  CMS will host a call for the public to discuss the final rule that requires hospitals to disclose payer-specific negotiated rates that will go into effect on Jan. 1, 2021. Click here for details about the national conference call.  A detailed slide presentation is included.

• CMS is seeking comments from providers on what questions to include in surveys to assess and strengthen outreach, monitoring and enforcement for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program, click here.

Sign-up on HealthCare.gov Continues to Lag in Week Three
For a third week in a row, the number of people signing up for coverage under the Affordable Care Act is less than during the same period in 2018, down by 1.9 percent. Through the first 16 days of open enrollment, almost 1.7 million people enrolled in coverage, about 255,000 fewer people than at this point in 2018. CMS reported that in week three of open enrollment, 737,352 people selected plans using HealthCare.gov. Open enrollment continues through Dec. 15th. To view the CMS Snapshot, click here.

• House and Senate Democrat Health Leaders sent a letter last week to HHS Secretary Alex Azar after reports of the lower sign-ups urging the HHS to make sure the website is fully functional, click here.
• As the ACA goes into the seventh year, the individual market health insurance exchange appears to be experiencing more stability, according to the American Action Forum, click here.
• 11 health plans filed suit in the in the U.S. Court of Federal Claims, where insurers have filed more than 50 lawsuits since Congress curtailed risk corridor payments, involving more than $107 million in unpaid funds, click here.

Bipartisan House Bill Targets Anti-Competitive Rx Tactics; Senate Committee Grills FDA Nominee on Drug Prices
The House Judiciary Committee last week passed legislation (H.R. 5133) that would give the Federal Trade Commission the authority to prosecute pharmaceutical manufacturers that create non-substantive changes to prescriptions. The legislation would end a practice known as “product hopping,” which occurs when a company makes a nominal change to a drug that is facing the end of patent exclusivity then either removes the old product from the market or makes the old product seem much less attractive than the new product. Also last week, the Senate Health Committee held the confirmation hearing for the FDA nominee, Stephen Hahn, where senators grilled him on drug pricing, generic drug approvals, drug shortages and e-cigarette regulations. Hahn, the current chief medical executive of MD Anderson Cancer Center, promised committee members he would look into the issues and work with them to push certain efforts forward. Click  here for the review H.R. 5133. Click here for the Senate hearing with the FDA nominee.

• The AP reports that due to an error in Medicare’s new prescription plan finder, about 60 million seniors could be directed to unnecessarily expensive Rx coverage, click here.
• A new independent report shows that Rx prices have grown 1 percent since last October, the highest annual growth rate in more than a year, click here.

HHS OIG Says Hospice Nurses Missed 99,000 Required Visits
The HHS Office of Inspector General released a new report that reviewed visits of Medicare hospice beneficiaries by registered nurses who are required by law to visit patients at least once every 14 days to assess the quality of care and services provided by hospice aides. The report found that of the approximately 189,000 scheduled visits in 2016, there were an estimated 99,000 instances where registered nurses did not make the required supervisory visits at least once every 14 days, in addition to an estimated 5,000 instances in which supervisory visits were not documented in accordance with federal requirements. The OIG states that the “deficiencies occurred because of hospices’ lack of oversight, scheduling errors, employee turnover, and the registered nurses not being aware of the 14-day supervisory visit requirement,” and recommended that CMS promote requirements with hospice companies as well as state agencies and accrediting organizations. To read the full report, click here.

• Democratic lawmakers last week sent letters to four private equity firms – Carlyle Group, Formation Capital, Fillmore Capital Partners and Warburg Pincus – that invest, or have invested in, companies providing nursing home care and other long-term care services after reports that private equity investment played a role in declining care, click here.

Suicide and Overdose Rates up, Behavioral Health Coverage Down; FCC Considers National Suicide Hotline 9-8-8
A new report commissioned by the Mental Health Treatment and Research Institute reveals a striking correlation between the decrease in behavioral health coverage, and in the increase of suicide rates. The report found disparities in coverage in 49 states showing that 217 out-of-network rates for behavioral health visits were 7 to 11.5 times higher than for primary care; in outpatient facilities relative to medical/surgical inpatient facilities increased by 90-percent. In the wake of the number of increasing suicides, Congress voted last year to condense the suicide prevention hotline. FCC Chairman Ajit Pao announced last week the next steps in designating a new number and on December 12 the FCC will vote to approve 9-8-8 as the new national hotline number. For the behavioral health report, click here. For the FCC Chairman’s remarks and more suicide statistics, click here.

CDC Finds Widening Gaps in Preventable Deaths Between Rural and Urban Areas
The Centers for Disease Control and Prevention released a pair reports that compare health issues between metropolitan and nonmetropolitan areas and found the gaps in percentages of preventable deaths between rural and urban counties have widened over the past eight years for certain diseases. From 2007 to 2016, cancer, heart disease, and chronic lower respiratory disease increased the mortality gap between urban and rural patients, while numbers remained relatively stable for stroke, and decreased for unintentional injuries. Click here for the studies.

• To celebrate National Rural Health Day, CMS Administrator Seema Verma penned a blog on rural health policies coming out of CMS, click here.
• The Washington Post takes a close look at a rural telemedicine call center that provides remote emergency care for 179 hospitals across 30 states, click here.

Declines in Pediatric Mortality Slower in Rural Areas
While the average pediatric mortality rate is decreasing across the country, rural pediatric mortality rates are decreasing at a significantly slower rate, according to a new study. Death rates for rural children only dropped 19% from 1999 to 2017, whereas it dropped by 24% for urban children during the same period. The disparity between mortality rate increases further for rural non-Hispanic black children compared to rural white children. To read the full study, click here.

Bill Banning Flavored Vaping OK’s by House Committee; States File Lawsuits Against Juul
After the Administration backed down on an all out ban on flavored vaping, the House Energy and Commerce Committee voted on a bill (H.R. 2339) banning flavored vaping products and raising the smoking age to 21. It passed 28-24.  Meantime, New York Attorney General Latitia James sued e-cigarette maker Juul last Tuesday over its marketing techniques, just one day after the California Attorney General filed a similar lawsuit. The AMA released this week a plea to halt e-cigarette sales. Click here for the markup materials and here for H.R. 2339. Click here for more on the lawsuits. Click here for the AMA statement.

• Massachusetts Senate approved a sweeping state-wide ban on flavored tobacco; the governor is expected to sign the bill, click here.

Patient Visits to Primary Care Doctors Decreasing
According to two studies published in the Annals of Family Medicine, the average number of visits made to primary care physicians went down 20 percent from 2008 to 2015, due to a number of factors including increases in specialty physician appointments.  Visits to emergency departments also factored in; however, researchers found that the fewer visits to primary care also may include more comprehensive appointments and increased out-of-office care, as well as in the increase in high-deductible health plans. Click here to see the studies.

• A new report found that 98 percent of respondents consisting of consumers, nurses, doctors, and healthcare executives, agree that healthcare costs and care vary by location, health system and even within departments at the same hospital, click here.
• A new study found that the more hospitals participate in health information exchanges, the more they share patients, which leads to a reduction in the effort required for patients to switch between providers, click here.

House Committee Looks for Answers on Ascension, Google Health Information Project
House Energy and Commerce Committee leaders sent letters to the CEOs of Ascension and Google requesting briefings from the companies following reports that the health information of tens of millions patients — part of an initiative called project Nightingale — was exchanged between the two. “This initiative raises serious privacy concerns,” the Committee leaders wrote to leaders of Ascension and Google. The Members are requesting briefings from each company by Dec. 6 including but not limited to what data is being shared, how it is being shared, how it is being used, and how privacy of patients will be maintained. Letter to Ascension, click here. Letter to Google, click here.

Early Menopause Linked to Increased Risk to Heart Health
A new study suggests menopause before the age of 40 puts women at a greater risk for cardiovascular diseases. The study found that women who underwent surgical menopause, e.g. caused by a hysterectomy, were at an even higher risk for such diseases. Premature menopause was found to be associated with a higher risk of heart failure, coronary artery disease, heart valve problems and blood clots. Click here for the study.

Not Surprising: Increased Exercise Can Help Lower Risk of Heart Disease in Aging Adults
Adults 65 and older who exercise for varying amounts of time decrease their risk of heart attack, stroke, and Type 2 diabetes, according to a new study. It also found that any level of exercise will decrease the risk of cardiovascular episodes, but starting and stopping will increase the risk by 27%. The World Health Organization recommends exercising for at least 150 minutes per week at a moderate intensity in 10-minute intervals. To read the study, click here.