04 Sep September 4, 2018

CMS: Medicare ACOs Saved $314 Million in 2017

CMS has released updated data on the 472 accountable care organizations that shows that ACOs netted $314 million in savings for the government. This data comes three weeks after CMS proposed stricter regulations on the Medicare Shared Savings Program and consolidate its three current tracks into just two. The evidence in this data suggests that ACOs, which are paid based on whether they meet certain spending and quality targets rather than on the volume of services they provide, get better and save more money over time. This is the first year the program generated net savings. To view the data, click here, and for the CMS fact sheet on the proposed rule, click here.

• The first cohort of accountable care organizations in the Next Generation model reduced Medicare spending by 1.7% in their first year, about $100 million, according to an annual report released by CMS.  Click here and here for additional background information from CMS.

CMMI Says CJR Program an Early Success

CMS’ Innovation Center has released its first annual report on the Comprehensive Care for Joint Replacement (CJR) model that tests episode-based bundled payment and quality measurement for an episode of care for lower extremity joint replacements.  Despite its short tenure, CMMI says the CJR model achieved a statistically significant reduction in total episode payments due to reductions in institutional post acute care use. At the same time, quality of care, as measured by readmission rates, emergency department visits, and mortality, was maintained. Interviewees from CJR participant hospitals reported that they chose to respond to the model by beginning planning earlier, educating patients about discharge to less intensive PAC settings, and coordinating with PAC providers. Click here for the report.

 

HHS Inspector General Seeking Comments on Stark Law

The HHS Inspector General issued a request for information looking for  feedback on how to coordinate the anti-kickback and physician self-referral, or Stark, laws. The HHS OIG is also seeking comment on how to set up safe harbors to help alternative pay models and the possibility of letting providers waive co-pays or provide other incentives to beneficiaries as a way to promote care engagement, as well as where exceptions to the self-referral law shouldn’t have corresponding anti-kickback safe harbors. The request for information on the anti-kickback laws was released on the same day feedback was due to CMS on possible changes to the Stark law. Stakeholders have told both HHS and lawmakers that the anti-kickback and Stark laws should be modernized in concert. Click here for the request in the Federal Register.

 

170 Organizations Send Letter Opposing E/M Changes in Physician Fee Schedule

Medical organizations, led by the American Medical Association, sent a comment letter opposing CMS’ proposal to simplify evaluation and management coding. The change to the codes, contained in the proposed 2019 Physician Fee Schedule, would result in reduced paperwork but an overall cut in payments for office visits for many doctors. Stakeholders also fear that due to the cuts, physicians will be compelled to have patients come to multiple visits instead of just a single one. To read the letter, click here.

 

More Than Half of Americans Have Received a Surprise Medical Bill : Survey

57% of Americans with health insurance received a surprise medical bill in the past 12 months, according to a new analysis. The survey of more than 1,000 Americans showed that the surprise charges were most often for physician services (53%) – 20% coming from physicians out of network –  followed closely by laboratory tests (51%). Surprise medical bills are commonly associated with out-of-network healthcare providers, where services may only be partially covered or not covered at all. When asked which groups are most responsible for surprise medical bills, 86% of survey respondents said insurance companies, compared to 82% who said hospitals were, and 71% blaming doctors. Click herefor the survey results.

 

House Committee Leaders Tell MedPAC To Investigate Hospital Mergers

Energy & Commerce Committee Chairman Greg Walden (R-OR) along with Subcommittee Chairmen Gregg Harper (R-MS) and Michael Burgess (R-TX), sent a letter the Medicare Payment Advisory Commission telling commissioners to conduct research on whether hospital mergers are leading to patients “paying higher prices due to consolidation for no identifiable benefits to the beneficiary.” The seven page letter makes specific requests including trends in patient costs, how different markets are impacted, and whether the 340B drug program has an impact on consolidation. To read the letter, click here.

 

Committee Leaders Tell HRSA To Issue 340B Regulations

Energy & Commerce Committee bipartisan leaders sent a letter last week to HRSA urging the agency to promulgate delayed regulations on 340B program for resolving certain 340B-compliance disputes, imposing civil monetary penalties against manufacturers that “knowingly and intentionally” overcharge a covered entity, and defining standards of methodology for calculating 340B ceiling prices, click here.

• A NY Times story last week detailed the fight over the future of 340B.  Click here.

New Report Suggests Cutting LTCH Payments; Nursing Homes Investigated

A working paper published last week by the National Bureau of Economic Research proposes that changing the payment structure (and severely cutting payments) to long-term acute care hospitals would save Medicare $4.6 billion. They authors also state that changing the payment for LTCHs would not harm beneficiaries. However, stakeholders contend that the study does not take into account acuity levels, severity of patient illness, or setting outcomes. Click here for the study.

• The House Energy & Commerce Oversight Subcommittee will hold a hearing Sept. 6th, to review abuse, neglect and substandard care in nursing homes, and federal efforts to make sure residents are safe, click here.

FDA Revamping Opioid and Pain Medication Guidance

FDA Commissioner Scott Gottlieb has announced that the agency plans to withdraw a 2014 guidance document for developing pain medicines in favor of a more focused approach to spur non-opioid drugs. The statement outlines how the agency plans to withdraw its 2014 analgesic guidance document, which called for drug manufacturers to undertake broad studies of treatments for chronic pain in favor of at least four new guidance documents over the next six to 12 months.  The new documents will promote a more focused and efficient approach that allows the companies to focus on specific kinds of pain instead. Click here for the FDA statement.

• FDA last week warned four online networks, operating a total of 21 websites, that are illegally marketing potentially dangerous, unapproved, and mis-branded versions of opioid medications, click here.

Southeastern States Highest Percentage of People with Pre-Existing Conditions

West Virginia, Alabama, Kentucky and Mississippi are among the states with the highest percentage of adult residents affected by pre-existing conditions, which could make it difficult for those residents to obtain health insurance, according to a new Kaiser Family Foundation analysis. New Jersey, Utah and Washington, D.C., have the lowest percentage of adult residents with pre-existing conditions based on a review of selected metropolitan and micropolitan statistical areas. Overall, an estimated 27 percent of adults ages 18-64 have a pre-existing condition, a previous Kaiser analysis found. That analysis extrapolated 2015 data from the CDC to make the estimate. To read the review, click here.

 

Number of Uninsured Decline in 2018

The number of uninsured people in the United States declined to 28.3 million in the first quarter of 2018, or 12.5 percent of the population, according to the Centers for Disease Control and Prevention, down from 29.3 million last year and 48.6 million in 2010, when the ACA became law. About 20 percent of the insured population was covered by a public plan, while 70 percent was covered by a private plan.  Click here for details.

 

California Wins Right to Move Forward with Drug Transparency Law

A federal judge has dismissed the lawsuit filed by the pharmaceutical industry against California’s new drug transparency law which went into effect this year. The law does not directly affect drug prices, instead it requires pharmaceutical manufacturers to give major purchasers notice before significantly raising their prices as well as require the manufacturers to justify such changes. The industry says the law violates the Constitution by attempting to “dictate national health care policy” when it comes to drug prices. A district judge ruled that the industry failed to produce enough facts to substantiate the claims and gave PhRMA 30 days to amend the complaint. Click here to view the law and here for the decision.

• CMS issued a memo to Medicare Part D plans, which cover prescription drugs that beneficiaries pick up at a pharmacy, offering health plans new tools and flexibility aimed at expanding choices and lowering drug prices for patients, click here.

Record STD Rates in 2017: CDC

Nearly 2.3 million cases of chlamydia, gonorrhea and syphilis were diagnosed last year – surpassing the previous record set in 2016 by more than 200,000, or almost 10 percent, according to the CDC. For the fourth year in a row, the country is seeing sharp increases in cases of those particular sexually transmitted diseases, and experts are concerned a lack of proper resources will exacerbate the problem. “We are sliding backward,” said Jonathan Mermin, M.D., M.P.H, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “It is evident the systems that identify, treat, and ultimately prevent STDs are strained to near-breaking point.” Click here for the study.

 

With Inadequate Reimbursement, 44 Percent of Rural Hospitals Operate at a Loss
Demographic shifts and improper reimbursement have rural hospitals facing increased risks of shutdown and bankruptcy as bad debt has risen by 50 percent. “The reason why hospitals are closing at such a rapid rate is they really are subsidizing the cost of care that they’re providing…. They are no longer getting fair reimbursement rates both in the private sector and significantly through the public sector, through the Medicare program, and Medicaid.” Click here to read more.

• The Critical Access Hospital Coalition advocates for the financial viability of CAHs. Read more about the CAH Coalition here.

CMS Will Pay Two States $468 Million for Loss of CSR Payments

CMS will pay $468.5 million to New York and Minnesota combined after both states brought forth cases against the Trump administration in response to losing funding for Affordable Care Act programs that provide health care to low-income residents. The elimination of cost-sharing reductions by the administration reduced funding for the states’ Basic Health Programs, and CMS issued an administrative order to make payments of $422,206,235 to New York and $46,276,090 to Minnesota for the first three quarters of 2018 to compensate for the loss of the CSR payments. Click herefor more.

 

New Study Links Pregnant Mothers’ Opioid use with Child Learning Disabilities
A recently released study in the journal Pediatrics, shows opioid use by pregnant women can lead to learning disabilities in their children. The study found that around 2,000 out of 7,200 children in Tennessee’s Medicaid program between the ages 3 to 8 were born with newborn abstinence syndrome (NAS). NAS is a disease that results from opioid use by pregnant women. In addition, the study indicated that around 1 in 7 of the children with NAS required support services for learning disabilities in school as compared to about 1 in 10 children who do not have NAS. The study highlights the importance of detecting this condition early and providing support immediately. Click here for the study.