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.

Major Opioid Legislative Package Near the Finish Line
The House last week passed the compromise opioid package worked out between the House and Senate Conference Committee earlier in the week. The bipartisan, bicameral package to address the opioid crisis is made up of dozens of proposals focused on both law enforcement and public health aspects of drug addiction. The 660-page bill encompasses over 75 pieces of legislation from both the House and Senate includes several provisions that would expand access to addiction treatment, including a proposal to allow Medicaid reimbursement for additional inpatient addiction treatment facilities by partially lifting the decades-old IMD exclusion. It does not include controversial changes to privacy rules for drug-addiction treatment records, known as Part 2 rules, or a pharmaceutical industry provision that would ease how much it owed in covering some Medicare drug costs. Click here for the legislation, and here for a section-by-section summary.
  • 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.
HHS Leaders Lay Out Priorities for the Rest of the Year
In speeches last week, HHS Secretary Alex Azar and CMS Administrator Seema Verma described the Administration health care priorities for the remainder of 2018 and defended current policies. The HHS secretary championed the Trump Administration’s push for short-term and association health plans as well as announced that premiums for ACA plans sold on will fall by an average of 2 percent next year.  Azar stated that the decrease in premiums are due to the actions by the policies of the Administration.  Administrator Verma reiterated her commitment to Medicaid work requirements and laying out the agency is working to transform Medicaid based on three key “pillars” -flexibility, accountability, and integrity. Click here for Azar’s speech and here for Verma’s speech.
Two Bills Sent to the President Aimed at Lowering Drug Prices
The House last week approved a pair of Senate bills aimed at making it easier for patients to get the lowest price on prescription drugs at the pharmacy counter. President Trump is expected to sign them. Both The Patient Right to Know Drug Prices Act (S. 2554), and the Know the Lowest Price Act, (S. 2553) prohibit “gag clauses” that prevent pharmacists from telling customers whether they could save money by buying prescription drugs out-of-pocket rather than using their health insurance. S. 2553 bars gag clauses in Medicare Advantage and Part D plans, while S. 2554 targets private health plans, including those in the ACA market. The true effect of gag clauses on patient costs is unclear as the three major pharmacy benefit managers have denied using the provisions in their contracts. Click here for S. 2554 and here for S. 2553.
  • 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 Seems to be “Easing Up” on Readmission Policies for Safety-Net Hospitals
According to a media investigation, CMS appears to be easing up on its annual re-admissions penalties for hundreds of hospitals serving large populations of low-income patients based on a a directive from Congress. Reviewing records recently released, CMS has stopped judging each hospital’s performance against all others and instead has assigned hospitals to five peer groups of facilities with similar proportions of low-income patients for the comparison. With this change, penalties against safety-net hospitals will drop by a fourth on average from last year, the analysis found. To read the full report done by NPR, click here.
Medicare Advantage Premiums Will Drop Six Percent
CMS announced last week that the average premium for Medicare Advantage plans next year will be $28, a 6 percent drop from the current year premium. Additionally, more than 8 in 10 current customers will see their monthly premium either stay the same or decrease in 2019 and nearly half of all current enrollees will have no monthly premium next year at all. CMS records also show that competition for Medicare Advantage customers is raising sharply. There will be roughly 3,700 plans offered next year, or almost a 20 percent increase from 2018, and more than 90 percent of Medicare beneficiaries will have at least 10 MA plans to choose from. To read the announcement, 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.

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