October 30, 2017

October 30, 2017


House to Vote on CHIP Reauthorization this Week

House Republican leadership is expected to bring the CHIP Reauthorization legislation to the Floor for a vote this week. The bill would extend funding for the Children’s Health Insurance Program for five years and continue money for community health centers for two years. The vote on H.R. 3921, the HEALTHY KIDS Act, will come about a month after the current federal funding for CHIP expired on Sept. 30, and over objections from Democrats concerned about the pay-for provisions that would raise costs for wealthier Medicare beneficiaries and cut the ACA’s Prevention and Public Health Fund. Click here for more information on the bill and here for the Committee markup of the bill and here for a media report.  Click here for a report on how many states are dealing with the lack of CHIP funds.


Senate Committee Drafting Favorable Bill for Medicare Extenders

A legislative discussion draft shows the Senate Finance Committee is considering extending a number of Medicare payment programs for between two and five years, including: the Geographic Practice Expense Index (GPCI) Floor, ambulance add-on payments, low-volume hospital adjustments, the Medicare Dependent Hospital program, home health rural add-on, funding for quality measures, the Maternal, Infant and Early Childhood Home Visiting Program, and outreach and assistance funding for low-income programs. The discussion draft also includes provisions that would repeal the Medicare therapy caps and delay aspects of the Bipartisan Budget Act of 2013 related to Medicaid third-party liability. Click here to view the draft document.


Key Committees Reach Deal To Repeal Medicare Therapy Caps

The House Ways & Means and Energy & Commerce committees, and the Senate Finance Committee, unveiled a bipartisan framework to repeal Medicare therapy caps that is based off the targeted manual medical review process that appears to be working smoothly. The policy would repeal the Part B outpatient therapy caps, which are currently set at $1,980 for speech and physical therapy and $1,980 for occupational therapy, with an exceptions process that is set to expire at the end of the year.  Claims above the cap are marked with a modifier, and although the framework released on Thursday would repeal the caps starting in 2018, it would still require what House lawmakers call an “appropriate modifier” on medically necessary claims over the current exceptions threshold. Click here for more.


CMS Boosts Dialysis Payments in Final Rule

Providers treating patients with kidney disease will get a slight pay bump from Medicare next year, CMS said in a final rule published Friday. The agency increased the reimbursement rate for hospital-based facilities by 0.7 percent for 2018, while increasing pay for freestanding facilities by half a percent. That equals about $60 million in additional Medicare spending. CMS had proposed about $100 million in June, but decided to reduce that amount in the final rule. Click herefor the rule, which takes effect January 1, 2018.


CVS May Buy Aetna in $66 Billion Deal

CVS Health Corp. is in talks to buy Aetna for more than $66 billion as the drugstore giant scrambles to fortify itself against looming competition from Amazon amid a continuing reordering of the health-care industry. CVS has made a proposal to buy the health insurer for more than $200 per share, according to media reports. The talks may not lead to a deal, but in a sign of their seriousness, the companies’ respective chief executives have met multiple times over a period of roughly six months, according to media reports. Click here for the WSJ story.  Meantime, Anthem’s 3rd quarter revenue increased significantly.  Click here for details.

  • Walgreens plans to close about 600 stores over an 18-month period beginning next year, according to reports The company made the announcement in the wake of its purchase of the Rite Aid drugstore chain. Under an agreement that received regulatory approval in September, Walgreens is buying 1,932 Rite Aid stores, three distribution centers and inventory for $4.38 billion.  Click here for the story.

House and Senate Chairmen Offer Different Exchange Subsidies Plan

Senate Finance Chairman Orrin Hatch and House Ways and Means Chairman Kevin Brady announced last week that they had developed a separate plan to fund the cost-sharing reduction payments for Marketplace Exchange Plans. In addition to funding CSRs through 2019, the bill will also overturn the individual and employer mandates and increase the maximum contribution limit for health savings accounts. These additions mirror changes that the White House requested be made to the Alexander-Murray bill. For more on the agreement from the Committee, click here.

  • Alexander-Murray subsidies plan will cut the federal deficit by $3.8 billion and would not substantially change the number of people with health coverage according to CBO, click here.
  • A federal judge denied a request to immediately force the Trump administration to continue making the Obamacare insurance subsidy payments. Click here.

$39 Billion a Year Spent on Regulatory Compliance: AHA

Hospitals, health systems and post-acute care providers spend nearly $39 billion a year on administrative activities related to regulatory compliance, according to a study released today by the AHA. The average-sized hospital spends $7.6 million annually to comply with federal regulations, equal to $1,200 every time a patient is admitted, and dedicates 59 full-time equivalents to the task, more than one-quarter of whom are health professionals who would otherwise be caring for patients. Click here for the AHA study.


Two Major For-Profit Health Systems Reveal Third Quarter Losses

Dallas-based Tenet Healthcare ended the third quarter with a net loss, but the 77-hospital chain is launching a $150 million cost reduction plan with an aim of improving its financial picture. According to a preliminary earnings statement released Friday, Tenet anticipates revenues of $4.59 billion in the third quarter of 2017, down from revenues of $4.85 billion in the same period of the year prior. Click here for the Tenet announcement.  Brentwood, Tenn.-based LifePoint Health’s net income dipped 30 percent in the third quarter of this year as patient volume declined. LifePoint recorded revenues of $1.58 billion in the third quarter of this year, down slightly from $1.59 billion in the same period of the year prior. LifePoint’s financials were impacted by lower patient volume in the most recent quarter. Click here for LifePoint’s announcement.

  • Tenet and Community Hospital System are facing challenges as their investors are growing restless with losses, according to published reports.  Click here.

179 Bipartisan Representatives Push Speaker to Pass Medical Device Tax Repeal

A large group of House lawmakers last week urged Speaker Paul Ryan to work with the Ways & Means Committee to repeal the medical device tax, which is set to go back into effect in the new year. “This looming tax increase will impact medtech innovation and job creation, threatening this industry and the constituents we serve,” they wrote in a letter to Ryan. The Congressional Budget Office previously said that the repeal of the medical device tax would cost the government $19.6 billion over 10 years. Click here for the letter.


Committee Grills Agencies on Response to Opioid Crisis; Trump Issues Opioid Declaration

House Energy and Commerce Committee members hammered Federal agency officials, particularly the DEA, last week as Republicans and Democrats expressed frustration over an ongoing investigation of painkiller dumping in West Virginia and lack of answers from the Administration. The Committee also delved into potential fixes to a controversial law after the Washington Post and 60 Minutes revealed the legislation created obstacles for taking action against drug makers amid the opioid crisis. To view the hearing, read written testimony and background memo from the Committee, click here.

  • The President declared the opioid crisis a public health emergency last week, click here for the declaration.
  • Medicaid and CHIP Payment and Access Commission (MACPAC) last week examined approaches to combat and treat substance use disorders, such as incorporating substance use disorder care with physical care, expanding treatment options in rural areas, and eliminating the institutions of mental disease (IMD) exclusion, the latter of which was advocated by Trump later in the day. For more on MACPAC, click here.

Inspector General: Canceling Ads Depresses Enrollment, Costs Millions

A new HHS OIG report found that the abrupt cancellation in January of ads and outreach tied to the ACA’s open enrollment cost the Administration at least $1.1 million — and prompted mass confusion within HHS. The investigation found that Trump transition officials ordered federal health staff to cut off outreach within days of officially taking over the government, despite warnings that ending the activity could cost millions and depress enrollment during the last week of ACA sign-ups. Click here to read the HHS OIG report.


Medicaid Covered ED Visits Skyrocketing, Private Insurance Visits Drop: AHRQ

From 2006 to 2014, the number of emergency department visits covered by Medicaid increased by 66 percent while the number covered by Medicare rose by 29 percent, according to a new report from the Agency for Healthcare Research and Quality. ED visits covered by private insurance, meanwhile, decreased by 10 percent. Click here.


U.S. Preterm Birth Rate Up in 2016

The nation’s preterm birth rate increased in 2016, earning the U.S. a “C” on the March of Dimes Premature Birth Report Card. The rate increased to 9.8 percent from 9.6 percent, after nearly a decade of decline. Preterm birth is the largest contributor to infant death, with more than 380,000 babies born in the U.S. each year before 37 weeks of pregnancy. Click here for the report.


Record Number of Americans Support Legal Marijuana

64 percent of Americans recently polled by Gallup said they support the legalization of marijuana, up 4 percentage points from October 2016. The number of Gallup respondents who support legalization has climbed consistently since 2012, when 48 percent of those polled said they supported it. Marijuana remains illegal under federal law but the drug has been legalized by eight states and the District of Columbia and other states allow varying degrees of medical marijuana. Of the Republicans polled, 51 percent said they support legalization, a 9 point increase over last year. It is the first time a majority of Republicans have expressed support for marijuana legalization in Gallup polling. To see all the poll results, click here.


Administration Seeks to Increase Role of Faith-Based Organizations in Health Care

HHS is looking to roll back restrictions on faith-based organizations to receive federal funding and participate in public health programs. Last week, HHS issued a request for information on ways to reduce regulatory hurdles for religious groups, citing the integral role they play in their communities. Additionally, HHS is requesting comment on ways religious groups are required to act contrary to their beliefs, and how regulations bar them from state and local programs. To view the RFI in the Federal Register, click here.


Team Care Model Growing as Physician Role Changes

Physicians’ roles are evolving as they are more likely today to manage teams of caregivers.  Insurers — including state Medicaid programs — are putting hospital systems, doctors’ offices and providers under pressure to provide better care at a lower cost. And it’s expected to accelerate in the coming decades, as the patient population grows older. Many older patients suffer from chronic diseases that need monitoring but not necessarily the expensive attention of a physician at every visit. Click here for a good report about this changing landscape from the PEW organization.


NIH Study Finds Possible Link Between Heartburn Medicine and Chronic Liver Disease

A new NIH funded study found that blocking stomach acid can lead to an overgrowth of intestinal bacteria that likely contributes to liver inflammation and damage. The findings suggest that some widely used acid reflux (heartburn) medications may worsen chronic liver disease. The researchers from University of California San Diego School of Medicine found that mice lacking stomach acid had higher levels of intestinal bacteria as well as imbalances among the microbes. Click here for more from NIH.


Fewer Americans Suffering with High Cholesterol: CDC

Since 1999, the number of Americans suffering from high total cholesterol has declined from 18.3 percent to 12.4 percent in 2016, according to a new report from the CDC.  Health experts attribute the positive results to several key factors: the public’s growing awareness of high cholesterol’s dangers, more people’s health-conscious diets, the phaseout of artificial trans fats in the food supply and the use of cholesterol-lowering statin medications.  Click here for details


Critical Access Hospital Finds Innovative Way to Help Community

Union General Hospital in Farmersville, Louisiana noted in their Community Health Needs Assessment an increase of bullying and suicide rates in youth. Using this information, the Critical Access Hospital partnered with the Union Parish Sheriff’s Office, Crime Stoppers, and the Union Parish School District to create the Together We Can Be Bully Free initiative as part of their Drug and Suicide Prevention Program. Over 2,500 students have participated in the program, with the Union Parish Sheriff’s Office reporting receiving an average of 20 phone calls a month for bullying-related cases. The program has been recognized as the 2014 Outstanding Rural Health Program of the Year Award from the Louisiana Rural Health Association, and the 2015 Program of Promise by Jackson Healthcare’s National Hospital Charitable Services Awards. Read more about how Union General Hospital is making a difference here.

  • The CAH Coalition works to support innovative Critical Access Hospitals that serve unique purposes in their communities. Learn more about the CAH Coalition here.
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