Weekly E-bulletin

  • Growing Number of GOP Senators Don’t Want “Repeal and Delay”

What’s significant about this growing group of GOP senators is that, if they want, they can thwart the immediate repeal of Obamacare. Republicans have 52 senators, so losing three or four of them would be enough. It’s not clear how most of these members will actually vote, but there appears to be a growing possibility that Obamacare won’t be repealed right away. Republicans have floated the idea of a three- or even four-year delay to give themselves time to craft a replacement.  Click here for a report from the Washington Post.

  • House Passes Rules Package to Aide in ACA Repeal

Republicans last week approved a rules package that will pave the way for legislation to repeal the Affordable Care Act. The package, approved by a party-line vote of 234-193, includes a provision exempting any ACA repeal or reform measures from congressional rules limiting how much legislation can increase direct spending. That should allow the House to roll back the health law even if its repeal legislation is projected to add to the deficit. It is likely that it will take many more months to finalize the repeal process. To read the rules package, click here.

  • Senate Releases Budget Bill that will Repeal ACA

Senate Republicans took their first step to repeal the Affordable Care Act last week when the Senate unveiled a budget targeting the health law and agreed, on a near party-line 51-48 vote, to begin debate on a budget resolution that will be used to target the ACA. A Floor vote on the resolutions is expected this week. The Senate will spend 50 hours of debate on the budget. All of that debate will push a final vote on the budget into next week, where Senate Republicans can pass it with a simple majority. Click here to view the Senate Budget Resolution.

  • Rural Hospitals Significantly Impacted by ACA Repeal

Rural hospitals would likely take a huge hit should Obamacare be repealed, according to new reports, particularly those in states that have expanded their Medicaid programs. Click here for the story.

  • Study: 2.9 Million Jobs On The Line with ACA Repeal

Repealing the Affordable Care Act could cost 2.6 million jobs nationwide in 2019, according to a new study by The Commonwealth Fund. The report found that California stands to lose nearly 334,000 jobs in 2019, assuming federal payments are pulled back under repeal for Medicaid expansion and premium tax credits. Gross state products, a key indicator of economic health, could drop by $207 million by 2023. Researchers found that Florida would be second in the number of employment losses, with 181,000 jobs eliminated in 2019. Click here for the study.

  • AMA Urges Replacement Before Repeal

The American Medical Association is urging Congress to hold off on repealing the Affordable Care Act, saying last week that lawmakers should first come up with a plan to replace the health law. AMA CEO James Madara, in a letter to Congressional Leadership, pushed for an outline of any official plans for maintaining health insurance coverage, arguing that the public should be able to compare any replacement package against Obamacare’s existing provisions. Click here for the letter.

  • Health Industry Leaders Urge Stabilization of ACA Insurance Markets

The Healthcare Leadership Council, a coalition of health industry executives, is pushing for adjustments to the Affordable Care Act’s insurance marketplaces that they say are necessary to smooth the transition between the repeal and eventual replacement of the health law. In a letter to President-elect Donald Trump and Congressional Leadership, the Council urges the incoming Administration to preserve the ACA’s cost-sharing subsidies and provide additional money to cover high-cost enrollees as Republicans phase in a new health reform package. To read the letter, click here.

CMS Issues Guidance for Off-Campus HOPDs

CMS has issued two new guidances for the implementation of the new legislation for off-campus hospital outpatient departments (HOPD).  The first guidance (click here) is in regards to HOPDs that were in “mid-build” prior to Nov. 2, 2015 – the date that the Bipartisan Budget Act of 2015 was enacted. The mid-build provision allows facilities that had a written agreement for constructing a new off-campus PBD as of that date to qualify for payment under the outpatient prospective payment system (OPPS), rather than at the lower “site-neutral” rate.  The second guidance (click here) is about the process and information required for hospitals to request an “extraordinary circumstances” exception for a grandfathered off-campus HOPD that has relocated (as established in the calendar year 2017 OPPS final rule). CMS intends to release additional guidance at a later date.

More Groups Propose Alternative Payment Models for Physicians

Mostly unnoticed over the past several months is the new MACRA process that allows any organization to pursue the creation of its own Advanced Alternative Payment model for physician payment. The Physician-Focused Payment Model Technical Advisory Committee (PTAC) received two additional proposals – Project Sonar (submitted by the Illinois Gastroenterology Group and SonarMD, LLC) and The Comprehensive Colonoscopy Advanced Alternative Payment Model for Colorectal Cancer Screening, Diagnosis and Surveillance (submitted by the Digestive Health Network). PTAC was created to make recommendations to HHS on proposals for physician-focused payment models submitted by individuals and stakeholder entities. To view the proposals or to comment on them, click here.

  • Six strategic objectives have been developed for the Quality Payment Program (under MACRA) that aim to minimize clinician burden and build a foundation for better innovation, connected care and intuitive health care technology, according to CMS. Click here for the document
CMS Innovation Center Releases Report on 39 Payment Models

CMS’ Innovation Center has released its third Report to Congress that focuses on activities between October 1, 2014 and September 30, 2016, but also highlights a number of important activities started during that time period that were announced between September 30, 2016 and December 31, 2016. During this period, the CMS Innovation Center has tested or announced 39 payment and service delivery models and initiatives authorized under section 1115A authority. To improve care and value, these model tests are designed to focus on reducing program expenditures while improving the quality of care. Click here for the report. Click here for CMS’ Dr. Patrick Conway’s post summarizing the report.

  • Bundled payment models for joint replacement appear to be achieving desired results at reducing costs, according to a new JAMA study. Click here.
Healthcare.gov Sign-Ups Increase Over Last Year: CMS

8.8 million Americans have signed up for coverage through HealthCare.gov since Open Enrollment began on November 1st.  This compares to about 8.6 million plan selections last year at this time.  Total plan selections as of December 31st, which include auto reenrollments, consist of 2.2 million new consumers and 6.6 million returning consumers. Among returning consumers, two thirds, or 4.4 million, actively selected a plan, an increase from last year’s already high levels of consumer engagement. Click here for more from CMS.

CMS Announces Opioid Epidemic Strategy

CMS last week announced its strategy in response to the opioid epidemic.  This is an ongoing CMS strategy, as part of the HHS Opioid Initiative launched in March 2015, to combat misuse and promote programs that support treatment and recovery support services. The CMS effort includes four priority areas: 1) Implement more effective person-centered and population-based strategies to reduce the risk of opioid use disorders, overdoses, inappropriate prescribing, and drug diversion; 2)  Expand naloxone use, distribution, and access; 3) Expand screening, diagnosis, and treatment of opioid use disorders, with an emphasis on increasing access to medication-assisted treatment; and 4) Increase the use of evidence-based practices for acute and chronic pain management. Click here for the CMS strategy document.

CMS Calls for Public Input on PACE Programs

CMS last week released Request for Information that seeks public input on potential adaptations of the Programs of All-Inclusive Care for the Elderly (PACE) models of care for new populations, including individuals with physical disabilities. The PACE Innovation Act gives CMS the authority to test application of PACE-like models for additional populations, including populations under the age of 55 and those who do not qualify for a nursing home level of care, under the Social Security Act. To review the RFI, click” here”:http://http://t.congressweb.com/l/?SKQKHXZVLQDRPQM.

A Decade of Cancer Drugs – Some Good, Some Not So Good

Of the more than 50 new cancer drugs approved by the FDA and European Medicines Agency between 2003 and 2013, one in three was not associated with any benefit in prolonging life. And one in five didn’t extend life or improve quality or safety, according to a new study. The authors say the findings raise important questions about value-for money in oncology. While some of the drugs offer benefits that may justify the large and growing expenditures, others appear to offer little to no health benefits. Click here to read the study.

New 340B Regs Penalize Drug Makers Who Overcharge

The Health Resources and Services Administration finalized a 340B rule that deals with setting prices under the drug discount program, firming up the so called “penny pricing policy” that is opposed by pharmaceutical manufacturers and laid out a formula for manufacturers to use when estimating the 340B price of a new drug. Under the final rule, pharmaceutical companies would reimburse 340B providers that overpaid for products and would be subject to fines of up to $5,000 per instance if the companies overcharged “knowingly and intentionally.” Click here to view the final rule. Click here for more on the 340B program from HRSA.

Medicare Part D Sustainability Threatened by High-Cost Drugs – OIG

High-cost pharmaceuticals were largely responsible for a large jump in Medicare Part D “catastrophic” spending over the past five years, putting the program’s future at risk, according to a new HHS OIG report. Federal payments for catastrophic coverage exceeded $33 billion in 2015; more than triple what the government spent in 2010. Drugs costing more than $1,000 per month accounted for two-thirds of the spending, with just 10 drugs accounting for one-third of those payments. Click here for the report.

Quality Standards for Patient Education Released

The National Quality Forum has released national standards for decision aids – the essential tools for shared decision making between patients and doctors. Decision aids, which include videos and online guides, are evidence-based tools designed to help patients make health care choices. According to the NQF, national standards to evaluate decision aids are critical to ensuring that these resources offer accurate information to patients so they can evaluate healthcare choices that reflect their goals, values, and preferences. Click here view the decision aids documents.

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