October 9, 2017

October 9, 2017


Trump Confirms His ACA Deal Proposal To Democrat Schumer

President Trump tweeted Saturday that he had reached out to the Senate Democratic leader in hopes of brokering a deal for a “great HealthCare Bill.” Trump said that he had called Senate Minority Leader Charles E. Schumer (D-NY) on Friday to ask whether Democrats would work with him on health care — and Trump indicated that he had not been entirely rebuffed. Click here for the story.

  • President Trump is expected to sign an executive order this week to start lifting some insurance rules set by the ACA, according to Sunday press reports. The order is aimed at expanding insurance options for Americans who buy coverage on their own or work for a small employer, as well as looking at three specific areas of health insurance. Click here for the WSJ report.

Trump Reportedly Kills Iowa’s 1332 Waiver; Administration Cuts ACA Support Programs

As some states work to stabilize their insurance markets using Section 1332 waivers, the Trump Administration – and reportedly Trump himself –  is moving against even “red” state governors.  Many Obamacare programs that drive enrollment into coverage provided by exchanges have been scaled back or eliminated.  Open enrollment begins November 1.  Click here for more.  Click here for a good WSJ report on which states have waivers that have been approved, under consideration or rejected and how the process works.

  • Health insurers are aggressively increasing prices next year for individual policies sold on the exchanges, with some raising premiums by more than 50 percent.  Click here for details.
  • The number of Medicare Advantage plans that will be in effect in 2018 is 10% higher than the 2017 total, according to CMS. Enrollment in the program is poised to reach 20 million, a 9% increase. Click here.
  • The American College of Physicians is urging Medicare Advantage plans to promote more transparency and alignment between MA plans. Click here for the ACP’s new policy paper.

MedPAC Wants MIPS Repealed and Replaced

The Medicare Payment Advisory Commission last week indicated that it would recommend to Congress repealing and replacing the Merit Incentive Payment System (MIPS) for physicians. Click here for a summary of MedPAC’s discussion to “repeal and replace” MIPS. Note that MedPAC will consider final recommendations at its December meeting, with a vote to occur in January.  Also, a new analysis (click here) projects that physician specialists would see a far wider variation – as much as +/-16% for 2018 — in their value-based pay under CMS’ proposed changes to MIPS. The current range is +/-5 percent. That difference is driven by CMS’ plan to include Medicare payments for Part B drugs in its compensation calculation under MIPS, since certain specialists bill for more of those drugs.  CMS’ proposed rule for the physician payment system (the Quality Payment Program) Year 2 is at the Office of Management and Budget for final review.
Hospital Readmission Penalty Program “Backfiring”: Analysis

An Affordable Care Act initiative that was meant to lower hospital readmission rates is backfiring, according to physician researchers writing in the Journal of the American College of Cardiology. The cardiologists say that the program, which tracks whether Medicare patients return to a hospital within 30 days and fines those facilities with high readmission rates, doesn’t take into account factors beyond hospitals’ control, such as the patient’s socioeconomic status, and isn’t necessarily related to the quality of care that hospitals provide. They argue the program unfairly penalizes institutions that care for unhealthier populations, such as safety-net hospitals and academic institutions. They say the program could be forcing doctors to delay admitting patients, even when necessary, potentially causing more deaths. Click here for their report.


Dramatic Increase in Number of Patients with High Medication Costts

The number of people with high annual prescription costs of $50,000 or more is relatively small but but increasing rapidly, according to a new Express Scripts analysis. From 2014 to 2016, the number of patients in that group increased by 35 percent to 870,000 people. They accounted for 20 percent of prescription spending in 2016.  Click here to read the study.


CDC: 40% of Cancers Are Linked to Excessive Weight

13 types of cancers associated with being overweight or obese account for about 40 percent of all cancers diagnosed in the United States in 2014, according to the CDC. And while the overall rate of new cancer cases has decreased since the 1990s, the increases in overweight- and obesity-related cancers are likely slowing this progress. In 2013-2014, about 2 out of 3 adults in the U.S. were overweight or obese, and about 630,000 people in the U.S. were diagnosed with a cancer associated with these risk factors. To read more from the CDC, click here.


Bipartisan Group Introduce Bill To Expand Community Mental Health

Sens. Roy Blunt (R-MO) and Debbie Stabenow (D-MI) along with Reps. Leonard Lance (R-NJ) and Doris Matsui (D-CA) introduced legislation to expand funding for community mental health services as part of the Excellence in Mental Health Act. The new bill would add another year to a demonstration program for eight states to create a certified community behavioral health center that’s required to provide robust mental health and substance abuse services. The legislation would also allow 11 additional states to participate in the program. Click here for more from the sponsors, and here for bill text.


Bill To Help Infants with Hearing Loss Headed to President’s Desk 

The House last week passed he Early Hearing Detection and Intervention (EHDI) Act of 2017 (S. 652), introduced by Senators Rob Portman (R-OH) and Tim Kaine (D-VA).  Brett Guthrie (R-KY) and Doris Matsui (D-CA) introduced the companion bill (H.R. 1539) in the House. The bill reauthorizes funding for important EHDI programs over the next five years and will expand access to critical resources for deaf and hard-of-hearing newborns and young children. It will also boost training of health care professionals in helping these young patients, and ensure they in turn can help educate the patient’s family members. The EDHI Act is headed to the President for signature. For a summary of the bill and to review the text, click here.


House and Senate Committees Pass CHIP Reauthorization Legislation

The Senate Finance Committee last week advanced a bipartisan funding package for the Children’s Health Insurance Program (CHIP) after funding for the program expired September 30. The bill, S. 1827, funds CHIP for five years and preserves the Affordable Care Act’s funding boost for the program for two years before winding it down. The House Energy and Commerce Committee also passed its CHIP funding legislation on the same day with Members arguing over offsets for the legislation and funding for Puerto Rico’s Medicaid program, and the ranking Democrat on the committee stating the handling of the offsets could delay funding for the Children’s Health Insurance Program. Click here for the Senate Committee Markup information, and here for the House Committee.


CDC: Stores in Urban Food Deserts Promote Unhealthy Foods

The most common healthy options in some urban food deserts? Canned vegetables, diet soda, and fruit juice. A new report out from the CDC looked at every place where people can buy food, from grocery stores to gas stations, in two Ohio neighborhoods where more than 40 percent of the population lives below the federal poverty line. Those stores were also often plastered with advertisements for unhealthy foods, tobacco, or alcohol. For almost every store studied, more than half of the advertisements displayed in the store were for tobacco or alcohol. On the flip side, just 6 percent of stores had ads posted for health-related behaviors like getting a flu shot or preventing high blood pressure. Click here for the CDC report.


Patients’ Out-of-Pocket Costs Are Growing Rapidly: Kaiser Analysis Out-of-pocket health care costs are growing significantly faster than the total costs of coverage, and both are growing a lot faster than wages, according to a new Kaiser Family Foundation analysis. Employers aren’t just shifting more costs to their employees overall — they’re picking plan designs that make employees especially sensitive to the cost of care. the average deductible for people with employer-provided health coverage rose from $303 to $1,505 between 2006 and 2017.  Click here for the Kaiser report.
CMS Announces Interactive APM Participant Look-Up Tool for Clinicians

CMS last week announced the results of the first Qualifying APM Participant (QP) determinations based on eligible clinician participation in the 2017 Advanced Alternative Payment Models (APMs). Additionally, the agency unveiled an interactive, online look-up tool for 2017 Advanced APM participants to find their QP status based on calculations from claims with dates of service between 1/1/17 and 3/31/17 for the first QP snapshot. Under the Quality Payment Program, QPs identified based on the 2017 performance year will receive a 5 percent lump sum Medicare incentive payment in 2019. Click here to view the new “look-up” tool.


House Continues 340B Probe, Hearing this Week; Moody’s Warns of 340B Cut
The House Energy and Commerce Oversight and Investigations Subcommittee will continue its investigation into the 340B drug discount program with another hearing Wednesday on how providers use the program. This follows the letter to 19 340B providers from the Committee requesting detail on how they use the savings they receive from the program, how the savings are used, and who the drugs go to. Witnesses include Sue Veer, president and CEO of Carolina Health Cares, Inc.; Mike Gifford, president and CEO of AIDS Resource Center of Wisconsin; Dr. Ronald Paulus, president and CEO of Mission Health Systems, Inc.; Charles Reuland, executive vice president and chief operating office at Johns Hopkins Hospital; and Shannon Banna, director of finance and system controller at Northside Hospital, Inc. For information on the hearing click here, to read the letters sent to providers, click here.

  • Moody’s says CMS’ proposed change to 340B would hurt not-for-profit hospital margins.  Click here.


House To Vote on Bill To Reduce Provider EHR Use Burden

The Energy and Commerce Committee has passed legislation to remove a requirement from the HITECH Act that increases the stringency of meaningful use standards for EHR use overtime. The bill, H.R. 3120, is designed specifically “to reduce the volume of future electronic health record-related significant hardship requests.” The bill was designed to reduce administrative burden on providers and allow hospitals to focus more attention on delivering high-quality patient care rather than meeting federal requirements. Click here for the text of the bill, and here for the committee markup information.

  • Primary care physicians spend more than one-half of their workday, nearly 6 hours, interacting with the EHR during and after clinic hours, according to a new study.  Click here.

Sliding Fee Scale Discount Guide Updated for CAHs and RHCs The National Rural Health Resource Center published a guide to help critical access hospitals and rural health clinics develop a Sliding Fee Scale Discount Program. The guide is also supposed to help CAHs and RHCs understand how the sliding fee scale discount programs “relate to Internal Revenue Code Section 501( r ) compliance and participation in the National Health Service Corps (NHSC).” You can view all the content here. The CAH Coalition in Washington, D.C. advocates on behalf of critical access hospitals to ensure that they are able to continue to provide high quality health care to their communities. Learn more about the CAH Coalition here.

  • The state of Washington is working to find ways to preserve its rural hospitals.  That’s why it created the Washington Rural Health Access Preservation project (WRHAP). WRHAP is testing new ways of making Medicaid payments. Read more about it here.

Some Medicare Lab Fees Will Be Cut

Recent legislation significantly revised the Medicare payment methodology for certain clinical diagnostic laboratory tests paid under the Clinical Laboratory Fee Schedule (CLFS). CMS published regulations based on this legislation that will dramatically impact clinical lab fees however, only certain labs will be impacted. Click here for a one-page memo that details which labs will see the lower clinical lab fees.

  • The top 25 tests by Medicare payments totaled $4.3 billion and represented 60 percent of all Medicare payments for lab tests in 2016, according to a new HHS OIG report.  Click here.

House Members Call for Examination of Drug Rebates

A group of more than 50 House Members sent a letter to HHS Acting Secretary Don Wright and CMS Administrator Seema Verma requesting to look into the use of rebates and fees that are traded between drug manufacturers, insurance companies, pharmacies, and pharmacy benefit managers in the Medicare Part D program. Pharmacy benefit managers, or PBMs, often collect prescription drug rebates and pharmacy fees after a senior buys medicine. While CMS does account for the payment adjustments after the fact, the consumer doesn’t share in the savings at the pharmacy counter. Click here to view the letter.


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