September 24, 2018

Investigation Shows Hospital Systems Use Secret Contract Terms to Dominate Market: WSJ
Dominant hospital systems use an array of secret contract terms to protect their turf and block efforts to curb health-care costs, according to a Wall Street Journal investigation.  As part of these deals, hospitals can demand insurers include them in every plan and discourage use of less-expensive rivals. Other terms allow hospitals to mask prices from consumers, limit audits of claims, add extra fees and block efforts to exclude health-care providers based on quality or cost.  The WSJ identified dozens of contracts with terms that limit how insurers design plans, and that leading hospital systems use secret contract terms to protect their regions and services as well as block efforts to curb health-care costs overall. To read the full investigative report, click here.
Senators Tackle “Surprise” Medical Bills
A group of U.S. senators, led by Republican Bill Cassidy of Louisiana, is working on a draft bill that would prohibit out-of-network hospitals and doctors from “balance billing” patients and would force health insurers to pay providers a negotiated amount. Patients who get emergency care would not have to pay anything more than regular copays or other cost-sharing. Instead, health insurers would have to pay the out-of-network hospitals and doctors 125% of the usual in-network rate, which is determined by payment data housed by a nonprofit third party like FAIR Health or the Health Care Cost Institute.  Sens. Tom Carper (D-DE), Todd Young (R-IN), Claire McCaskill (D-MO), Michael Bennet (D-CO) and Chuck Grassley (R-IA) are also supporting the legislation. Click here for a draft of the legislation.  Click here for the story.
Opioid Package Passes Senate; Compromise Is Close
The Senate last week passed its version of the large Opioid package that encompasses over 70 bills from five Committees. Almost immediately, House and Senate staff began meeting to work through the differences in their legislation. Several outliers still remain but will most likely be resolved by next week for a vote.  Those include a Medicare Part D provision that the pharmaceutical industry is pushing for that would reduce manufacturers costs under the program, and a bill passed by the House that would allow for more sharing of substance abuse records of patients. Click here for the Senate bill summary, and here for the House bill summary.

  • Pew Charitable Trust looks at the outcomes at emergency rooms that treat addiction, click here.
  • HHS to work with Opiant Pharmaceuticals of Santa Monica, California, to develop a fast-acting, long-lasting intranasal, potentially improved form of an opioid overdose drug, click here.
  • Drug researchers that submit false or incomplete data for clinical trials could face fines of $10,000 plus an additional $10,000 per day of noncompliance after the initial fine, according to new guidance released by the FDA, click here.
  • In support of its Five-Point Opioid Strategy, HHS awarded over $1 billion in opioid-specific grants, click here.
  • Seniors hospitalized with opioid-related diagnoses increased more than 50 percent and opioid-related ED visits increased more than 100 percent between 2010 and 2015, click here.

Medicaid Spending Will Be Over $1 Trillion in Eight Years

In a new report released last week, spending on Medicaid was close to $600 billion in 2017 and is set to be well over $1 trillion in the next ten years. The annual Medicaid outlook report, by the CMS Office of the Actuary, projects that the program will cost $1.005 trillion by 2026, bumping up from 3.1 percent of the nation’s total market value to 3.7 percent. The Medicaid program covered about 73.8 million people in 2017 at a price tag of about $592.2 billion, up 2.6 percent in costs and 2.1 percent in enrollment from 2016. Most of the new enrollees were covered under the ACA’s Medicaid expansion, according to the actuary’s office. To read the full report, click here.


CMS Announces Awards To Develop New QPP Quality Measures

CMS announced last week that it has awarded agreements to seven organizations to assist the agency with developing, improving, updating, or expanding quality measures for Medicare’s Quality Payment Program (QPP). Organizations such as the American Psychiatric Association and American Academy of Hospice and Palliative Medicine Inc. will work with the agency to develop and implement measures that offer the most promise for improving patient care. The work is intended to fill gaps in the QPP measure set and involve removing measures with limited value and adding others that are more clinically appropriate, increase value, reduce provider burden, and enhance patient care. Click here to view the full list of awardees and the specific work they will do.

  • CMS has discovered it made a mistake processing quality scores for doctors participating in the Merit-based Incentive Payment System under QPP possibly resulting in underpayments to about 621,700 providers, click here for the fact sheet, and here for how to request a targeted review.

Senate Committee Looks at Price Transparency in Health Care

Leaders from four different organizations testified last week before the Senate Health Committee on the need for transparency to lower health care costs. Senators questioned how the government should be involved in healthcare price transparency and whether Congress can change the incentives to encourage more patient shopping. Witnesses largely agreed that everyone in the system, from hospitals to physicians to the patients, need to know the actual price and need better access to quality data. But spelling that out through federal mandates could prove elusive. To view the hearing and read the written testimony, click here.


Move to Population Health Is Costing Hospitals: Fitch

According to a new report by Fitch Ratings, the move away from fee-for-service medicine and into population health is working to the detriment of U.S. hospitals. While many would argue that the move to value-based care is a good thing and health insurers and the government are increasingly moving away from fee-for-service medicine to these payment models, researchers at Fitch state that the transition to population health and at-risk contracting will continue to challenge providers’ operating margins. “Median profitability levels dropped, with median operating and operating EBITDA margins of 1.9% and 8.5%, respectively, compared with 2.8% and 9.5%, respectively, the prior year, “ Fitch said in its report. To read the full report, click here.


Senator Looking for More from CMS on Nursing Home Quality

Following reports from the Government Accountability Office that they found an increase in consumer complaints about nursing home quality, Senate Judiciary Chairman Chuck Grassley (R-IA) sent a letter to CMS expressing concern that the agency isn’t doing enough to oversee nursing home quality, and asks when the agency plans to evaluate its new electronic survey of nursing home deficiencies as well as what steps the agency is taking to improve the collection of data needed to track nursing home quality. Grassley requests a response from the agency by October 3rd. To read the letter, click here.


Hospice Payment Model Fails

A federal evaluation found that the Medicare hospice payment model did not succeed in its first year after more than a quarter of those that agreed to participate abandoned the program before the year’s end, click here.


Death Rates Rise for Five Leading Causes of Death; Life Expectancy Drops

Death rates rose for five of the twelve leading causes of death in the United States from 2000 to 2016, according to a new CDC report.. The CDC’s Annual Report on the Nation’s Health says the five are  1) unintentional injuries (including drug overdoses), 2) Alzheimer’s disease, 3) suicide, 4) chronic liver disease and 5) septicemia. The report has a special feature on mortality that shows in the time period looked at, the suicide death rate increased 23 percent, from 11 deaths per 100,000 residents to 13.5.  The rate of deaths from drug overdoses increased 72 percent as the opioid epidemic escalated. Overall, this leads to a decrease in life expectancy at birth again, about .1 years between 2015 and 2016, in large part due to the uptick in drug overdose deaths. Click here for the full report.

  • CDC report shows that four percent of adult Americans do not know that they have diabetes, click here.

New Quality Measures for Rural Hospitals
The National Quality Forum (NQF) released its latest rural health report, A Core Set of Rural Relevant Measures. In this report, NQF recommends to CMS measures that should be included in federal quality reporting and improvement activities. “NQF identified a core set of best available quality measures that would address key challenges rural residents and providers face,” including the availability, accessibility, and affordability of care. Click here to read the full report.

  • The Critical Access Hospital Coalition advocates for the health of rural communities. Click here to learn more.

New FDA Campaign About E-Cigarettes Targets Youth
Due to the epidemic level of America’s youth using e-cigarettes, the FDA last week announced a new campaign named “The Real Cost”. The goal is to teach and warn youth about the dangers of e-cigarettes. There are about 10.7 million 12 to 17 year olds who either use e-cigarettes or are open to trying them. 80% of the youth see e-cigarettes as not very harmful since they are not “real” cigarettes. The also have an image of being cool and fun. Click here to read more from the FDA.


Playing at Parks in Childhood can Decrease Respiratory Problems in Adulthood
Researchers from the European Respiratory Society International Congress found that children who have access to green spaces close to their homes have fewer respiratory problems, like asthma, in adulthood. In contrast, researchers found that children’s exposure to air pollutants, such as particulate matter and nitrogen dioxide, can increase their chances of developing respiratory problems. These findings emphasize the importance green spaces, especially in cities. To read the full study, click here.

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