September 25, 2017

New Repeal Bill Aims to Gain Support of Holdouts

A new version of the Obamacare repeal and replace legislation was released late yesterday and it is clearly intended to meet the objections of holdout GOP senators – with new help for Alaska and Maine.  Click here and here for the story.  Click here for the sponsors’ analysis of the state-by-state impact.  Click here for the text.


Cruz, McCain Say NO to Senate Repeal and Replace Bill; Repeal Effort May Be Dead

Senator Ted Cruz (R-TX) said Sunday he doesn’t support the Obamacare repeal plan drafted by Sens. Bill Cassidy (R-LA) and Lindsey Graham (R-SC).  He suggested the Senator Mike Lee (R-UT) may also be opposed.  On Friday, Senator John McCain (R-AZ) said he would vote against the Cassidy-Graham bill.  Senator Rand Paul (R-KY) has announced his opposition, because he says the bill doesn’t actually repeal Obamacare. Senator Susan Collins (R-ME) says she’s leaning against the bill.  She voted against the previous repeal and replace bill.  Alaska Senator Lisa Murkowski is also holding out, saying she has serious concerns with the bill.  Some senators still want to put the bill on the floor for a vote this week and try to work out the objections raised by GOP senators.  No national health care group has publicly announced its support for the legislation.

  • President Trump hasn’t given up as he continues to pressure several GOP senators.  Click here.
  • Cassidy-Graham is considered the most far reaching repeal and replace bill yet.  Click here to see why.
  • Click here to see a comparison of how Cassidy-Graham compares with the previous repeal bills.
  • Kaiser’s state-by-state analysis shows generally that “red” states gain while “blue” expansion states lose.  Click here.  Avalere’s impact analysis, also state-by-state, can be reviewed here.
  • Some health care systems and their patients are weighing-in publicly against the bill.  Click here to see Henry Ford Health System with it’s congressional delegation late last week.
  • In an effort to persuade Senator Lisa Murkowski (R-AK), a likely NO vote, senators are offering to sweeten the package for her.  Click here to see how.
  • With McCain’s announcement, it appears that some senators are ready to move on.  Click here.
  • Why does the GOP press forward on repeal, some say it’s pure politics and that big campaign contributors are withholding donations to protest lack of achievements.  Click here.
  • Graham and Cassidy are set to face Sen. Bernie Sanders (I-VT) and Sen. Amy Klobuchar (D-MN) in a town-hall style event tonight to debate the GOP’s latest Obamacare repeal bill. Click here for details.
  • Lest we forget…the ACA has built in options for states to dramatically change their health care programs.  Click here for a refresher.

Cassidy-Graham Bill’s Only Hearing Monday

Senate Finance Chair Orrin Hatch (R-UT) scheduled a hearing on the health care bill by Sens. Bill Cassidy (R-LA) and Lindsey Graham (R-SC) today at 2:00 p.m.  According to the notice, the purpose of the hearing is “to learn more about the Graham-Cassidy proposal.”  Under the budget reconciliation rules that would allow the bill to pass with just 50 votes plus a tie-breaking vote cast by Vice President Mike Pence, both the Senate and House would have to bring it to the floor before Sept. 30. Click here for hearing information.

  • Some conservative groups say Cassidy-Graham would give states the authority to create their own single payer systems and want changes to the legislation to prevent it.  Click here.

CHIP Funding Expires Friday; Senate Trying to Pass Extension

The Senate Finance Committee has released legislation to extend funding for the Children’s Health Insurance Program for five years. The legislation would keep the Affordable Care Act’s 23 percent increase in federal matching funds to states for two years before it begins to wind down in 2020 when funding will decline to 11.5%, and will be completely eliminated in 2021, returning states to the traditional levels of federal funding they received before the ACA was enacted. The Keeping Kids’ Insurance Dependable and Secure (KIDS) Act (S. 1827), also makes tweaks to the ACA requirement that prevented states from rolling back eligibility for children enrolled in the program as of March 2010. Federal funding for CHIP expires on Sept. 30 unless Congress acts, but the chances of lawmakers clearinglegislation before the deadline are growing exceedingly remote. The House has yet to unveil a bill. Click here for more from the Finance Committee and here for the legislation.


FTC Commissioner Says Health Care Needs More Competition

The FTC could become a little more aggressive against hospital, pharma and physician practice mergers if one of its commissioners has her way.  Commissioner Terrell McSweeney says “By any reading of the evidence, there is less competition in the health care market today than 10 or 20 years ago. Since 1998, more than 1,400 hospitals have merged. Half of all hospital markets are now highly concentrated. Large health systems are rapidly acquiring formerly independent physician groups.” Click here to read more of her views.

Story Asserts that CHS Acquisitions and Debt Causing Serious Problems

Four doctors from Lutheran Hospital in Fort Wayne, Ind., showed up at parent company Community Health Systems Inc. in May with a message for Chief Executive Officer Wayne Smith and his board. Physicians were in widespread revolt, they said. Facilities were cash-strapped and crumbling. Powerful locals wanted CHS to reinvest or leave. Clickhere for the story from Bloomberg.

State Attorneys General Push Insurers Help to Cut Back Opioid Use

37 attorneys general are pressing Marilyn Tavenner, who heads America’s Health Insurance Plans, to encourage health care providers to prioritize anti-inflammatory drugs, physical therapy and other forms of non-opioid pain management over opioid prescriptions for the treatment of chronic, non-cancer pain. “Although the amount of pain reported by Americans has remained steady since 1999, prescriptions for opioid painkillers have nearly quadrupled over the same timeframe,” the AGs state in the letter. Click here for the letter.

  • Organ donations are at an all time high because of opioid overdoses, according to a new report.  Click here.

CMS’ 340B Proposal Could Cause Increase in Drug Spending; 180+ Reps Urge CMS to Withdraw Reg

CMS’ proposed rule to reduce Medicare Part B payments for 340B hospitals and clinics was intended to save money on medicines. However, according to a Pew analysis, it could cause the hospitals that receive the steep 340B discounts to spend more on drugs. If the proposal is finalized, some 340B facilities may opt to purchase drugs outside the program at their normal list price. To read the whole report, click here.

  • More than 180 bipartisan House members have signed a letter to CMS urging the agency to withdraw its 340B pricing proposal.  A senate letter is now circulating for signatures.

Novel Legal Effort Designed to Increase Medicaid Payments

Civil rights lawyers suing the state of California over low Medicaid payments say advocates elsewhere should pay attention to a potentially novel legal tactic — accusing the Golden State of racial discrimination in order to increase funding — but some health law experts and even sympathetic observers say they’re watching with some skepticism. A group of five individual Medicaid beneficiaries in July sued the state of California, arguing that the program’s health services for the poor are so bad that they amount to discrimination against the largely Hispanic population that relies on the program.  Click here for details.

White House Counsel OKs Recommendations for New Antibiotic Development

The White House’s council on Combating Antibiotic Resistant Bacteria approved new recommendations for encouraging the development of drugs, diagnostics and vaccines to combat antibiotic resistance. One suggestion would be to ensure companies have a more predictable return on investment when bringing drugs to market, such as by providing grants for research, transferrable tax credits and government-funded milestone payments during development. Another suggestion would be to offer market-entry rewards after a product is introduced, such as an agreed-upon lump sum for delivery of an antibiotic to the marketplace, benchmarked to reflect the public health need. Click here to read the full report.

Hospitals Owe Medicare $52 Million; CMS Outlines Repayment Plan

A new government report finds that Medicare improperly paid acute care hospitals for outpatient services they provided to patients who were inpatients at other facilities. And now Medicare wants the money back. CMS has agreed to claw back the $51.6 million and require hospitals to refund patient co-pays and deductibles. The HHS OIG audited Medicare payments made between Jan. 1, 2013, and Aug. 31, 2016, and found that in that window CMS made $51.6 million in improper payments to hospitals for outpatient services provided to patients who were inpatients at long-term care facilities, critical access hospitals, inpatient rehabilitation facilities and inpatient psychiatric facilities. Click here for the OIG report.

Grassley Says Non-Profit Hospitals Not Doing Enough Charity Care

One of the Senate’s senior members, Charles Grassley (R-IA), is saying that tax exempt, 501(c)(3), hospitals are not doing enough to provide charity care and have been lax at their accounting of those services.  Grassley says “The IRS is right to monitor compliance with the law and consider enforcement actions where appropriate. For the provisions to have the positive effects that Congress intended, hospitals need to know that consequences exist for failing to comply.” Click here to read more from Grassley.


MACRA Final Rules Under Review at OMB

The White House Office of Management and Budget is reviewing the final rule that outlines Medicare’s Quality Payment Program (MACRA) for next year.  CMS’ proposed rule, published in late June, was intended to give practitioners greater flexibility to meet government requirements than the previous regulations offered for the program. That measure would leave only about a third of clinicians, around 500,000 individuals, subject to the program. Overall, provider groups approved of the CMS proposal in that it slowed the federal government’s push to overhaul the way doctors are paid under Medicare. For the OMB notice, click here. For the proposed rule, click here, and the fact sheet of the proposed rule, click here.

Employer-Sponsored Health Premiums Increase 3 Percent

Premiums for employer-sponsored family plans increased by only 3 percent this year, according to a new Kaiser analysis. This continues the trend since 2012, as family premiums have increased by an average of 19 percent. By comparison, they increased by 30 percent from 2007 to 2012, and spiked by 51 percent in the five years prior to 2007. As for employer-sponsored Individual plans, premiums also had a modest increase of 4 percent this year. The modest rate hikes stand in stark contrast to Affordable Care Act’s marketplace plans, which saw average premium increases of 20 percent for 2017. Click here for the survey.

CMS Pushes Innovation Center In New Direction

CMS has announced that its Medicare Innovation center (CMMI), which is focused on delivery reform, is asking for input on “a new direction to promote patient-centered care and test market-driven reforms that empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, reduce costs and improve outcomes.”  Click here for CMS Administrator Seema Verma’s WSJ op-ed.  Created by the Affordable Care Act, CMMI has been the major power behind many of the care delivery models shifting the health care system away from fee-for-service towards accountable care organizations and bundled payments. The request lists eight focus areas: drug models; “advanced” alternative payment models that are part of the new Medicare physician pay system; consumer-directed care and market-based models; specialty-physician models; Medicare Advantage models; state- and local-based models, including those focused on Medicaid; mental- and behavioral-health models; and models to curb fraud and abuse. Comments are due to CMS by Nov. 20, 2017. To read more from CMS on the request for information and the direction they hope to take, click here.

ONC Pulls Back on EHR Certification Requirements

The Office of the National Coordinator for Health IT is significantly pulling back on EHR certification attestation requirements, a move that will reduce the burden on users and developers and provide more bandwidth to advance interoperability, according to federal officials. ONC officials outlined two key changes to the EHR certification program in a post last week. For 30 of the 55 EHR certification criteria, developers will be allowed to “self-declare” that their product meets requirements. Previously, vendors were required to conduct a visual demonstration with an ONC Accredited Testing Laboratory or submit documentation. The change covers “functionality-based certification criteria,” which officials say will allow developers to devote more time to interoperability.  Click here for details.

CVS to Limit Painkiller Prescriptions to Seven Days

CVS announced late last week that it will restrict opioid prescriptions to seven days for certain conditions beginning early 2018, the first of major national retailers to restrict painkiller drugs to customers. CVS said its pharmacies will limit the supply for certain prescriptions for patients who are new to the therapy, restrict the daily dosage based on strength, and require the use of immediate-release versus extended-release opioids. The program will cover commercial, health plan, employer and Medicaid clients. CVS will also strengthen its counseling programs to help ensure patients are aware of the dangers of opioid addiction. The company will also donate $2 million to federal community health centers to expand access to treatment and recovery services. Click here for the announcement.

Another Rural Hospital Shuts its Doors; More At Risk

Another Critical Access Hospital closed its doors last week, leaving Patrick County, Virginia, with no hospital, following the closure of 82 rural hospitals since 2010, 28 of which were Critical Access Hospitals. The hospital, Pioneer Community Hospital, filed bankruptcy two years before their closing. With 1 in 10 rural hospitals at high risk of financial distress, more hospitals are likely to close. The CAH Coalition advocates for Critical Access Hospitals in Washington to fight for regulatory and financial changes that help rural hospitals at risk. Click here for more on the CAH Coalition. Click here for more on the closure of Pioneer Community Hospital.

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