October 23, 2017

Hospitals’ “Secret” ER Fees Under Media Investigation

Hospital emergency bills will be getting a good look over by Vox, a national online news organization.  Vox reporter Sarah Kliff is asking readers to give Vox their ER bills from the last five years for an examination by the news service.  Click here to see how the investigation will begin.  Click here for the American Hospital Association advisory.


Medicare ACOs Showing Mixed Results, Saving Medicare $70 Million in 2016: CMS

CMS last week said generally half of the participants in the MSSP ACO program generated savings. Overall, 56 percent of Accountable Care Organizations generated savings relative to their benchmark in 2016, staying close to previous results of 52 percent in 2015 and 55 percent in 2015. Additionally, the results show that ACOs generally create more savings the longer they’re in the program and ACOs without hospitals on their rosters generally performed better. To view the CMS slidedeck, click here.

  • Click here to see the specific year-one financial performance of Medicare’s Next Generation ACOs.
  • Click here for performance year-five of Medicare Pioneer ACOs.

Best Hospitals Lead To Healthier Communities: Healthgrades Analysis Released

The nation’s healthiest cities, as scored by Healthgrades, puts Minneapolis, Denver, Sacramento, Cincinnati and Portland in the top five. The group’s annual Report to the Nation examined the quality performance of about 4,500 short-term acute care hospitals across the country. The top hospitals have better clinical outcomes for at least 21 of the 32 measures that Healthgrades analyzes, including sepsis, stroke, heart attack, heart failure and respiratory failure, and sustained those better outcomes for three or more years.  Click here for the annual report and the list of healthiest cities.  Healthgrades also evaluated the performance of nearly 4,500 short-term acute care hospitals nationwide, assessing hospital performance relative to each of 34 common conditions and procedures. Click here for details.

  • After hospitalization for acute medical illness, one in four Medicare patients is discharged to a skilled nursing facility. These care transitions are often marked by disruptions in care and poor communication. The Joint Commission is out with a new study that examines these patient care transitions. Click here.

Trump Expected to Declare National Emergency on Opioid Epidemic This Week

President Trump stated that he will will declare the opioid epidemic a national emergency this week. The announcement appeared motivated by a report from the Washington Post and 60 Minutes, which discussed the controversial new law that narrowed the authority of the DEA to suspend registration of controlled substance distributors. Click here for the Washington Post Article and here for the President’s remarks.

  • The CDC says a Hepatitis C epidemic is now underway and caused by the Opioid crisis.  Click here for details.

Majority of States Have Expanded Medicaid Benefits This Year

While Congress and the Administration debated cutting Medicaid funding, 26 states this year expanded or enhanced benefits and at least 17 plan to do so next year, according to a new report. The increased benefits were largely for mental health and substance abuse treatment, but states also added telemedicine and dental care. The number of states adding benefits was the highest in at least a decade, according to the 50-state survey. Last year, 21 states expanded benefits.

Just six states moved to cut Medicaid benefits in fiscal 2016. Click here for this detailed report from the National Association of Medicaid Directors and Kaiser Foundation.


Poll Finds Most Americans Uninformed on Open Enrollment

A new polls shows that only 12 percent of uninsured respondents know that open enrollment begins on Nov. 1, and just six percent know that the deadline to sign up is Dec. 15. In the poll conducted by Hart Research Associates between Sept. 28 and Oct. 3, insured respondents knew a bit more as 31 percent are aware when open enrollment begins and 12 percent know the deadline to sign up. This could stem from the fact that 60 percent of the uninsured polled expect the ACA will be canceled and consumers will lose their coverage next year or they aren’t sure. To read all the results, click here.


Senators Introduce Medicare Buy-In Bill

Sens. Tim Kaine (D-VA) and Michael Bennet  (D-CO) introduced legislation last week that would allow non-elderly, younger Americans to essentially buy into Medicare, initially in areas where there are few insurers or high health care costs. But by 2023, “Medicare-X would expand to every ZIP code in the country,” according to a joint release from the senators. “By 2024, the public plan would be added as another option on the Small Business Health Options Program (SHOP) Marketplace.” For a summary from the sponsors, click here, and for bill text, click here.


Senators Grill Pharma Execs Over Drug Pricing

Citing growing frustration over high drug prices, Senators last week dug into drug importation from other countries and pharmaceutical patents when questioning prescription drug industry executives, during a senate hearing. It was the second in a series of sessions examining drug pricing with executives representing drug manufacturers, pharmacists and pharmacy benefit managers, Chairman Lamar Alexander, noted that more than 4.4 billion prescriptions for drugs are written each year in America at an estimated cost of $450 billion and questioned the need for manufacturer rebates. Click here to read written testimony and view the hearing.

  • President Trump is considering launching a bipartisan task force to investigate the rising cost of prescription drugs. The announcement could come as early as next week, maybe as part of an expected announcement on the opioid crisis. Click here.
  • Pharma says a big part of the pricing problem is hospital drug-price markups.  Click here.

Senate Likely Has Votes Now to Pass Obamacare Subsidies Bill

A group of 24 senators – 12 Republicans and 12 Democrats — have signed on to legislation that would fund the Obamacare insurance exchange subsidies for two years.  If all Democrats vote for the compromise, as expected, the bill has the 60 votes (48 Democrats and 12 Republicans) to overcome an expected filibuster attempt.  The bill’s fate is uncertain at this time, as GOP leaders have not committed to bringing the legislation to the floor for a vote.  There is also uncertainty in the House.  Expectation are that Democrats will use their vote leverage in the senate in December to force the legislation into “must pass” bills needed to fund the government and increase the debt ceiling.  Click here for the details on the CSR bill.

  • The White House signaled to Senate Republican negotiators Friday that it wants a bipartisan health-care bill to include retroactive relief this year for individuals and employers subject to the Affordable Care Act’s insurance mandate. Click here for the story.
  • Unless Congress takes action, the number of uninsured will likely continue to increase, according to a new survey showing that 3.5 more people are now uninsured compared to the last quarter of 2016.  Click here for the Gallup report.

CSR Elimination Could Cost Issuers $1 Billion

The Administration’s decision to end cost-sharing reduction payments could result in a significant decrease to fourth-quarter financials for health insurance plans, especially in Florida, California, Texas, North Carolina and Virginia, according to a study by Avalere. Issuers in 27 states will lose $10 million or less; 16 states will lose between $10 million and $25 million; five states will lose between $25 million and $100 million; and those in two will see losses between $100 million and $200 million. Click here for the Avalere study.

VA Seeks Major Change to Choice Program

The VA announced that it has submitted the Veterans Coordinated Access & Rewarding Experiences (CARE) Act to both the House and Senate Veterans Affairs committees. The bill would eliminate the current wait time and distance requirements under the Choice program, which limits participation to veterans who face a 30-day wait for an appointment at a VA hospital or who live 40 miles or more from a VA facility.  Instead, veterans would be able to seek care outside of the VA if they face a wait that is longer than a “clinically acceptable period.” The changes would create options for veterans to use walk-in clinics for nonemergency needs and would place veterans and their physicians “at the center” of decisions on where to receive care. Click here for details from the VA.


HRSA Awards $2.36 Billion To Ryan/White and $282 Million To Clinicians and Students

The Health Resources Services Administration last week announced approximately $2.36 billion in Ryan White HIV/AIDS Program grants awarded to cities, counties, states, and local community-based organizations in fiscal year 2017. This funding supports a comprehensive system of HIV primary medical care, medication, and essential support services to more than half a million people living with HIV in the United States. Click here. HRSA also announced nearly $282 million in awards to primary health care clinicians and students through the National Health Service Corps (NHSC) and NURSE Corps Scholarship and Loan Repayment Programs.  Click here for details.


Increase in Number of EHR-Related Malpractice Suits 

The number of closed medical malpractice claims that had EHRs as a contributing factor has increased significantly over the past 10 years, according to a new study by The Doctors Company. The study compared 66 claims made from July 2014 through December 2016 with the results of a previous study of 97 claims from January 2007 through June 2014 and found 43 percent of EHR-related claim events occurred in hospital clinics/physician offices – the most of any practice setting. Additionally, system factors, such as failure of drug or clinical decision support, were present in 33 of the 66 EHR-related claims and User factors, such as copying and pasting progress notes, were present in 38 of the claims. To read the study, click here.


IRS to Begin Rejecting Tax Returns without Report of Health Coverage Status

The IRS has announced that they will not accept electronically filed tax returns during the 2018 filing season from taxpayers who don’t state whether they had health insurance as required by the Affordable Care Act, and the agency said it may “suspend” paper returns that lack the information. It will be the first time the IRS will reject returns that omit the information stating. Around 4.3 million taxpayers did not report their health insurance status during the 2016 tax filing season. Click here for the IRS announcement.


Research Suggests 340B Data Should be Reported and Eligibility Criteria Changed

Congress should make hospitals report revenue generated by 340B drug discounts and change the criteria that determines which hospitals get those discounts, according to researchers. The researchers say that anecdotes fuel the 340B debate because the Disproportionate Share Hospitals that get the discounts aren’t required to report the revenue they generate from the sale of those drugs or how that revenue is used. They state, “Our analysis suggests that anecdotes are not sufficient to understand the program; DSH hospitals that participate in 340B are in actuality quite diverse. Our results suggest the arguments of opponents and proponents of proposed reform might hold some merit.” Click here for their analysis.

CDC: Overdose Rate Higher in Rural Areas than Urban

The latest CDC Morbidity and Mortality Weekly Report shows that while the number of people dying from drug overdose has been consistently higher in metropolitan areas, the rate of death in rural areas – that is, the number of deaths per 100,000 people – surpassed urban areas in 2015. Researchers state the need for a greater understanding of the differences between rural and urban areas in order to identify, monitor, and prioritize responses for the epidemic. To read the full report, click here.

The Uninsured Rates at its Highest Since ACA Implementation

The percentage of U.S. adults without health insurance has hit its highest point since 2014, a big change for from the steady coverage increases after the Affordable Care Act. According to a Gallup-Sharecare poll, the uninsured rate reached 12.3 percent during the third quarter of this year – up 1.4 percentage points since the end of 2016. This equals about 3.5 million more Americans without insurance since President Donald Trump was elected in November. Gallup states that the lack of competition and rising premiums could be convincing more people to go without insurance.The coverage losses over the last year were concentrated largely among middle-aged Americans, racial minorities and lower-income individuals. Click here for the poll results.


House CHIP and Health Center Reauthorization Bills Save Billions

The Congressional Budget Office has estimated the House legislation to fund community health centers and several other public health programs another two years will provide $1.4 billion in savings by shortening the grace period for paying Obamacare insurance premiums and cutting the Prevention and Public Health Fund. CBO also provided an estimate of $1.1 billion in savings from House legislation to fund the Children’s Health Insurance Program for five years, which would be paid for by cutting hospital pay, charging rich beneficiaries higher Medicare premiums and counting lottery winnings as income when determining Medicaid eligibility. To read the CBO report for the Community Health Centers bill, click here, and the CHIP reauthorization legislation, click here.

Rural Hospitals Find Innovative Funding Sources While Expanding Services
Hospitals in Indiana have taken advantage of Medicaid funding provided to nursing homes owned or leased by counties. The additional Medicaid funding for those county hospitals owning or leasing a nursing home can be split at the administrator’s discretion between their hospital and nursing home. For more information, click here.

  • North Sunflower Medical Center of Ruleville, Missouri, a Critical Access Hospital, developed sources of revenue outside of the core hospital and now has more than tripled the size of its staff. Read more about their journey from financial struggle to thriving here.
  • The CAH Coalition supports programs that help provide access to care for communities, including assisting CAHs in accessing additional revenue streams. You can learn more about the CAH Coalition here.
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