12 Dec Weekly E-bulletin

115 Hospitals Named to Leapfrog’s Best in 2016

The Leapfrog Group named its Top Hospitals of the year last week, and 115 hospitals made the list in four categories: children’s hospitals, general hospitals, teaching hospitals and rural hospitals. The Leapfrog Group considers several quality metrics when making its list, including safety, surgical outcomes, maternity care and leadership. The group uses data from the Leapfrog Hospital Survey data to determine the recipients — about 1,800 hospitals completed the survey this year. To see the lists of all the Top Hospitals, click here.

Hospitals Can Expect a Small Medicare Payment Increase in FY18: MedPAC

Hospitals can expect a market basket payment update of 1.85% in FY18, according to a new report from the Medicare Payment Advisory Commission released last week. MedPAC also released the following finding about hospitals based on Medicare’s fee for service numbers:

• There was a 2% average spending increase from 2014 to 2015 for inpatients
• Outpatient services saw a 7% increase
• There was an average 19% drop in uncompensated care
• The overall Medicare payment margin was -7.1% in 2015, the third straight year of decline.

Click here to review MedPAC’s hospital presentation slides.

MedPAC members expect to vote next month in favor of a recommendation that would increase Medicare Advantage pay, but they also plan to consider other policies, including those affecting star ratings, that would lead to pay cuts. To view all of MedPAC’s slide presentations from last week, click here.

Senate Committee Says More Oversight Needed for Surgeries at Teaching Hospitals

The Senate Finance Committee said additional federal monitoring is needed to ensure physicians are complying with Medicare billing restrictions and ensuring patient safety, in a new report on overlapping surgeries at teaching hospitals released last week. The findings were issued by Committee Chair Orrin Hatch and top Democrat Ron Wyden after the Committee sent letters to 20 teaching hospitals across the country. The report concludes that CMS has not routinely monitored or audited teaching hospitals to see if they are complying with overlapping surgery billing restrictions, among other things. To review the report, click here.

House GOP Seeking Help from States on ACA Reform

House Republican Leaders sent letters to governors and state insurance commissioners asking for input on potential regulatory and legislative changes that would help stabilize the health insurance market as Congress looks to replace the Affordable Care Act. The lawmakers are looking to greater use of the ACA’s state innovation waivers by requesting state officials describe the status of any waiver activity, whether a coordinated process between the Medicaid 1115 and Section 1332 waivers would be helpful, and whether states would be interested in expedited reviews of waivers. Lawmakers asked state officials to respond by Jan. 6. Click here for the letter.

Surgeon General Endorses Goals of Root Cause Coalition

The Root Cause Coalition received a hearty endorsement for the Surgeon General last week during the Coalition’s first national summit on the social determinants of health. The Coalition, which was started last year by ProMedica, a Toledo-based health system, and AARP, is focused on working with any organization focused on combating hunger and other social issues that impact the long-term effects caused by conditions in the environments in which people are born. Click here for the story. Click here for the Coalition’s website.

A Big Pharma Company Commits to Keeping Price Increases Low

The world’s largest insulin maker, Novo Nordisk, has pledged to limit any future list price increases on its drugs to less than 10 percent annually. This announcement is part of the company’s three-point pricing plan outlined last week. The commitment to single-digit yearly price increases will help payers better anticipate and budget for price hikes. The company also said it will reduce out-of-pocket expenses, citing its patient assistance and co-pay support programs. Click here to read the announcement.

Global Drug Spending Could Go Up to $1.5 Trillion by 2021

Worldwide spending on pharmaceuticals is expected to climb 33 percent from 2016 levels to a total $1.5 trillion in 2021, according to a new study. The report predicts spending increases will “moderate” from a high of 9 percent in 2014 and 2015 to 4 percent to 7 percent in coming years, despite what’s expected to be a high number of new drug launches thanks to a robust research and development pipeline. However, the growth rate in the U.S. pharmaceutical market slowed this year to about half of the rate last year, which they linked the “notable slowing of list price increases” for drugs to “congressional inquiries and media exposure.” Click here for the report.

Bi-Partisan CHRONIC Care Bill Introduced in the Senate

A bipartisan group of senators introduced the CHRONIC Care Act (S. 3504) last week, which the Senate authors hope will improve Medicare handling of patients with chronic conditions. The final bill increases Medicare’s coverage of telemedicine for stroke care and home kidney dialysis therapy, and for Medicare Advantage and accountable care organizations. Other parts of the bill expand Medicare’s Independence at Home demonstration and change how patients are assigned to ACOs. Click here for a summary bill, which will be introduced again next year.

CMS Innovation Center Announces Two New Patient Engagement Models

The CMS Innovation Center last week announced two Beneficiary Engagement and Incentives Models that will test different approaches to shared decision making regarding treatment options. The Shared Decision Making Model (click here) will test a specific approach to integrate a four-step decision making process into the clinical practice of practitioners who are participating accountable care organizations. The Direct Decision Support Model (click here) will test an approach to shared decision making provided outside of the clinical delivery system by an organization that provides health management and decision support services. Letters of Intent to participate are due March 5.

• Health care professionals have until 5 p.m. Dec. 19 to comment on the Quality Payment Program’s Merit-based Incentive Payment System and advanced alternative payment models under MACRA. The agency is seeking comments on various factors related to virtual groups, MIPS scoring, advanced APMs and the All-Payer Combination, among others. Click here for more.

Investigative Report Causes UHS Shares to Tumble

Shares of King of Prussia, Pa.-based Universal Health Services fell 12 percent to $111.30 last Wednesday after BuzzFeed published an investigative story alleging the company’s psychiatric hospitals put profits ahead of patients, according to news reports. BuzzFeed’s story, which is based on internal documents and interviews with 175 current and former UHS staff and more than 120 patients, government investigators and other experts, was the result of a yearlong BuzzFeed News investigation. It alleges UHS psychiatric hospitals kept patients longer than necessary and against their will to maximize reimbursement from insurers. Click here for the BuzzFeed Story. Click here for more news from Barron’s.

Court Orders HHS To Clear Claims Backlog by 2021

The U.S. Department of Health and Human Services will have to eradicate its million-claim backlog of Medicare billing appeals by 2021, after a D.C. federal judge last week approved the American Hospital Association’s proposed timeline in a suit over the appeal delays. Click here for the story. Click” here”:http://http://www.mcknights.com/guest-columns/hhs-racs-not-the-primary-source-of-the-medicare-appeals-backlog/article/578068/ for the court’s final ruling.

Government Funded Through April in Continuing Resolution

The full first year of 21st Century Cures Act funding is included in the Continuing Resolution to fund the government. The bill, which funds the government through April 28, includes $872 million for fiscal year 2017 Cures activities and it passed Congress Friday. The bill also will provide additional dollars for a variety of urgent needs like overseas war operations, natural disaster relief, and water infrastructure repairs in Flint, Mich. To review the bill, click here.

New Zika Infections in Texas, Florida No Longer a Problem

Four more locally transmitted Zika infections have been confirmed in Brownsville, TX, state health officials announced last week. They were identified during an investigation following the first confirmed local infection. All five patients live near each other and none of them are pregnant women. In Florida, mosquitoes are no longer actively spreading the virus. But state health officials are pushing people to remain on alert. For the Texas announcement, click here, and for Florida, click here.

Kid Sizes Too Big at Restaurants?

A new RAND Corporation study has found that most kids’ menu items from the top 200 restaurant chains still have portions that are too big and too high in calories — typically 147 percent more calories than an expert panel recommended. The biggest caloric item: French fries. One exception, McDonald’s keeps its kids portions of fries at the recommended 100 calories. The findings are published in the journal Nutrition Today. To read the study, click here.