01 Oct October 1, 2018
Just 200 Hospitals Take 73% of Payment Cut under CMS’ Proposed HOPD Site Neutral Rule
200 hospitals would shoulder 73% of the cuts in CMS’ proposed site neutral payment rule, according to a new study commissioned by the Integrated Health Care Coalition by Dobson DaVanzo and Associates. This means that just 5.5% percent of the 3,333 hospitals affected by this policy will lose $628.5 million in Medicare reimbursement in 2019. The proposed CMS policies are contained in the CY 2019 Medicare Hospital Outpatient Prospective Payment System (OPPS) proposed rule. CMS is moving toward site neutral payments for clinic visits, where the clinic is part of a hospital outpatient department. 0.5% of hospitals – about 3,100 – will collectively have payments reduced $235.6 million for a total reduction of $864.1 million, according to the study. The analysis focused exclusively on Medicare fee for service (FFS) claims. About one in five Medicare beneficiaries are enrolled in Medicare Advantage (MA). The analysis says, “If we assume that the utilization patterns for MA beneficiaries are the same as utilization patterns for FFS beneficiaries, the total impact of this site neutral proposal could be as high as $1.03 billion.”
- Click here for the analysis
- Click here for the list of 200 hospitals
- Click here for the 200 hospitals by state
President Signs Appropriations Bill Just in Time
Before the 2018 fiscal ran out last week, the President signed the bi-partisan Appropriations package that included five spending bills – 75-percent of the government funding – and the rest funded through Dec. 7th. The Appropriations “minibus” funding bill which includes the Department of Defense (DOD), the Labor, Health and Human Services and Education Appropriations bills for fiscal year 2019, as well as a short-term Continuing Resolution to temporarily fund remaining government programs until December 7, 2018. The bill includes $90.5 billion for HHS – $2.3 billion increase from fiscal 2018 – increased funding to combat the opioid epidemic and gives SAMHSA an increased by $500+ million alone. For the conference report (legislative test) click here, and for the joint explanatory statement on the bill, click here.
- According to NORC at the University of Chicago, almost 2/3 of Americans have been prescribed opioids at one time, click here.
- Office of National Drug Control Policy announced a two year grant of $4 million for the National Association of Drug Court Professionals to provide training and technical assistance to drug courts across the country, clickhere.
- The Associated Press conducted an analysis of brand-name prescription drug prices and found 96 price hikes for every one drug that had its price cut, click here.
- CMS also announced that it will extend for one year the ability of Medicare-eligible seniors who were enrolled in exchange coverage to switch to Part B coverage without a penalty, click here (look under note of “I have marketplace or other insurance”).
- A new HHS Inspector General report states that CMS should enhance its oversight of Medicare Advantage organization contracts and address persistent problems related to inappropriate denial of services and payment, click here.
GAO Report Shows Spike in Rural Hospital Closures in the Last Five Years
According to a new Government Accountability Office report released last week, between 2013 and 2017, 64 rural hospitals closed which is more than twice as many as in the prior five-year period. The report found that closures were disproportionately in the South and at facilities with a higher amounts of Medicare beneficiaries. GAO believes that the financial distress causing the closures is mostly due to reduced Medicare payments and fewer people seeking inpatient care. In particular, rural hospitals that closed typically had negative margins that made it difficult to cover their fixed costs. States that expanded Medicaid under Obamacare experienced fewer closures. To read the full report, click here.
- A new study from the Georgetown University Health Policy Institute Center for Children and Families found that the rates of uninsured low-income adult citizens has sharply decreased across the country, click here.
- The Critical Access Hospital Coalition advocates for the health of rural communities. Click here to learn more.
New Device Could Help Treatment for Heart Failure
A new clinical trial conducted at 78 sites in the US and Canada found that a tiny clip inserted into the heart greatly reduced death rates in patients suffering from heat failure. The study also found that patients who received this device avoided increased hospitalizations and reported better quality of life with fewer symptoms. The device, called the MitraClip, repairs the mitral valve in the heart by clipping the flaps together to help facilitate proper blood flow through the heart. 614 patients with severe heart patients were randomly given the device. 151 patients that only received medical treatment were hospitalized compared to 92 who were given the device. The device is approved the FDA, but only for patients who are not in a position to have surgery. Doctors expect that the FDA will soon approve this device for patients with severe heart failure. For more on the study, click here.
“Hangry” May Not be a Made-up After All
Researchers in Ontario, Canada found that the sudden drop in glucose we experience when we are hungry can impact our mood – causing “hanger”. The study, conducted on rats, showed that glucose depletion can cause stress and or anxiety. Professor Francesco Leri, in the Department of psychology at the University of Guelph, says that hypoglycemia truly can cause “grouchiness” and is a strong physiological and psychological stressor. For the report, click here.
New Study Looks at Genetically Modified Mosquitoes to Fight Disease
Researchers have turned to taking an aggressive approach in the fight against Malaria and possibly other mosquito based diseases. A study published in Nature Biotechnology described the genetic modifications that will lead to rapidly sterilizing Malaria spreading mosquitoes. Eventually, this means wiping Malaria and the species out. Researchers are unsure how this could affect the ecosystem in the long term however. Click here for the study.