Weekly E-bulletin

House GOP Health Care Showdown on Thursday

The House is expected to vote Thursday on the GOP ‘repeal and replace’ legislation, according to House Speaker Paul Ryan (R-WI).  It is still uncertain whether there are enough votes to pass the legislation, the American * Health Care Act. Assuming that all Democrats will vote against the bill, Republicans can lose only 21 GOP votes and pass the legislation.  However, a number of changes are likely to be made to the bill before the vote in an effort to draw more GOP support.  Click “here”:http://www.businessinsider.com/paul-ryan-details-gop-changing-health-care-bill-2017-3 for a report on some of the changes under consideration. Here’s a second report on what may be in the bill.

  • Whether Congress is successful in passing this legislation or not, the new HHS Secretary is planning to use his regulatory authority to make substantial changes.  Click “here”:http://www.cnbc.com/2017/03/17/heres-what-hhss-tom-price-can-do-to-dismantle-obamcare.html for that report.
  • “Here’s”:http://www.washingtonpost.com/news/wonk/wp/2017/03/18/republicans-threaten-to-deny-poor-people-medical-care-if-they-arent-working/?hpid=hp_rhp-top-table-main_wb-healthcare-202pm%3Ahomepage%2Fstory&utm_term=.9e3461bd8dcb a more detailed Washington Post story on the possibility that the new bill will have work requirements for beneficiaries.
  • States are beginning to release their own assessments of the impact of the AHCA on their Medicaid programs.

* Click here for Colorado.
* Click here for Massachusetts.
*Click “here”:http://hbex.coveredca.com/pdfs/Bringing_Health_Care_Coverage_Within_Reach.pdf and  “here”:http://hbex.coveredca.com/pdfs/Preliminary_Analysis_of_AHCA.pdf for California.

  • GOP governors from Ohio, Michigan, Arkansas and Nevada oppose the AHCA.  Read their letter “here”:https://strategichealthcare.net/wp-content/uploads/2017/03/032017-GOP-Govs-Letter-on-AHCA.pdf.
  • The current AHCA passed the House Budget Committee last week by one vote.  Reps. Brat (R-VA), Palmer (R-AL), and Sanford (R-SC), conservative members of the House Freedom Caucus, voted against the legislation. Click “here”:http://budget.house.gov/hearingschedule/reconciliation-markup.htm to view the markup session in the Committee.
  • In defiance of the GOP majority, House Democrat Leadership hosted its own hearing on the AHCA. The hearing addressed the impact of the bill on access to quality health care. To view the hearing, click here.
  • A week ago today, the Congressional Budget Office released its analysis of the AHCA.  The headline focused on 24 million people projected to lose their health care coverage if the legislation becomes law.  Click “here”:http://www.cbo.gov/publication/52486 for the CBO report.
Trump’s First Budget Makes Deep Cuts to HHS Spending

The Trump Administration last week released it’s first budget for FY2018.  It proposes adding $54 billion in military spending and slashing HHS by 18 percent, a decline of roughly $15 billion from 2017.  Medical research directed by the National Institutes of Health is targeted for $5.8 billion cut and health workforce training programs received a $403 million cut. Many programs, like Meals on Wheels, would be eliminated.  OMB Director Mick Mulvaney said the budget doesn’t touch Medicare and Social Security. Click here to read the Trump Budget Blueprint.

  • Supporters of Meals on Wheels are fighting the proposal and are seeing their financial donations jump.  Click here for details.
MedPAC Says Hospital Medicare Margins To Continue Falling

The Medicare Payment Advisory Commission says overall hospital Medicare margins dropped to -7.1% in 2015 and by the end of 2017 are expected to be -10%.  This is only one conclusion reached by MedPAC in its annual March Report to Congress released last week.  This year’s report includes recommendations to update hospital payments (1.85 percent) and implement post-acute care (PAC) payment reform in addition to a status update on Medicare Advantage.  MedPAC also recommended that Congress and CMS act to reform PAC payments by implementing a unified PAC payment system that would base payments on patient characteristics and redistribute payments more equitably across PAC settings. MedPAC estimates that implementing its current short-term recommendations – which include eliminating market basket updates for SNFs and LTCH payment rate increases under the current PPS for FY 2018 – would reduce spending by $30 billion over the next 10 years.  Click “here”:http://medpac.gov/docs/default-source/reports/mar17_entirereport.pdf?sfvrsn=0 for the full report and here for the fact sheet.

Seema Verma Confirmed as New CMS Administrator

The Senate has confirmed Seema Verma to become the Centers for Medicare and Medicaid Services Administrator. Verma will take the helm with a clear goal of making it easier for states to try new approaches in aiding low-income and disabled people.  Click “here”:http://www.cms.gov/About-CMS/leadership/ for the new Administrator’s bio on the CMS website. 

Price, Verma Send Letter to Governors Urging Redesign of Medicaid Programs

HHS Secretary Tom Price and new CMS Administrator Seema Verma wrote to governors last week stating that Medicaid expansion is “a clear departure from the core, historical mission” of the program, and urged states to revamp their programs.  They also urged states to shift to private insurance models, and use 1115 and 1332 waivers to encourage employment for Medicaid-eligible, low income adults.  They also said HHS will review all managed care regulations and put off enforcing the 2014 home and community-based services rule. Click “here”:http://www.hhs.gov/sites/default/files/sec-price-cms-admin-verma-ltr.pdf for the letter and “here”:http://https://www.hhs.gov/about/news/2017/03/14/secretary-price-and-cms-administrator-verma-take-first-joint-action.html for the HHS announcement.

Physician Payment Program Problems Outlined by MGMA

We are three months into the new Medicare physician payment system and serious problems are emerging for the new Merit-Based Incentive Payment System (MIPS).  The Medical Group Management Association has sent a letter to CMS outlining immediate clarifications that are needed for physicians to be in compliance with the program.  Click “here”:http://www.mgma.com/Libraries/Assets/MGMA-letter-2017-MIPS-eligibility-notice.pdf?ext=.pdf to read their letter.

Physician Shortage Projected to Increase: AAMC

The nation faces a shortage of between 40,800 and 104,900 physicians by 2030, according to updated projections from the Association of American Medical Colleges. The projected shortfalls range between 7,300 and 43,100 for primary care, and between 33,500 and 61,800 for non-primary care specialties. Click “here”:http://aamc-black.global.ssl.fastly.net/production/media/filer_public/a5/c3/a5c3d565-14ec-48fb-974b-99fafaeecb00/aamc_projections_update_2017.pdf for the AAMC report.

Record Number of Medical School Grads Matched to Residency Positions

A record 30,478 medical school seniors and graduates were matched to U.S. residency positions last week through the National Resident Matching Program, 906 more than last year. A record 31,757 positions were offered. Applicants include students and graduates of U.S. and international medical schools.  Click “here”:http://www.nrmp.org/wp-content/uploads/2017/03/2017-Match-by-the-Numbers.pdf for a 1-page detailed summary.

GAO Says Few Patients Accessing Their Own EHRs

Since 2009, HHS has invested over $35 billion in health information technology, including efforts to enhance patient access to and use of electronic health information. Program data for 2015 show that health care providers that participated in the program (3,218 hospitals and 194,200 health care professionals such as physicians) offered most of their patients the ability to electronically access health information. However, the analysis shows that relatively few patients electronically access their health information when offered the ability to do so. Click “here ”:http://www.gao.gov/assets/690/683388.pdffor the GAO report.

At Least 7 States Tackling “Surprise Medical Billing”

Seven state legislatures are pursuing legislation to mitigate the practice of surprise medical billing. Surprise billing refers to instances where patients receive an unanticipated bill from a medical provider. This most often occurs when patients are treated by out-of-network physicians who don’t have pre-determined payment contracts with the respective payer. Out-of-network physicians may bill patients for any outstanding balance on their hospital bill once the patient’s insurer submits its payment — which is typically less than the equivalent Medicare rate. Click“ here ”:http://www.beckershospitalreview.com/finance/7-states-addressing-surprise-medical-billing-so-far-in-2017.htmlto review the legislation from these states.

Observation Notification Now Required at Hospitals

Under a new federal law, hospitals across the country must now alert Medicare patients when they are getting observation care and why they were not admitted — even if they stay in the hospital a few nights. For years, seniors often found out only when they got surprise bills for the services Medicare doesn’t cover for observation patients, including some drugs and expensive nursing home care. Click “here”:http://mobile.nytimes.com/2017/03/17/health/cholesterol-drugs-repatha-amgen-pcsk9-inhibitors.html?emc=edit_nn_20170319&nl=morning-briefing&nlid=58480377&te=1&referer for details.

New Cholesterol Drug Significantly Reduces Heart Attack, Stroke in High-Risk Patients

The first major test of an expensive new drug that radically lowers cholesterol levels found that it significantly reduced the chance that a high-risk patient would have a heart attack or stroke, according to reports last week. These were men and women who had exhausted all other options. The results of the study, which was paid for by Amgen, the maker of the drug, were published last week in The New England Journal of Medicine. Click here for the report.

Medicare Advantage Enrollment Booming

Medicare Advantage business continues to experience significant growth with a surge in the aging Baby Boomer generation increasing demand for MA plans, according to government reports. Medicare Advantage enrollment continues to climb and this trend is expected to continue through 2017 and forward. As of February 1, 2017, total Medicare Advantage membership stood at 19,593,341, with a net gain of 1,389,665 members, year-over-year.
CMS says 34% of the 58 million people eligible for Medicare are enrolled in MA plans. Click here for details.

  • A new study shows that health plans that are owned by hospitals and other health care providers get much higher grades from their customers.  Click “here”:http://www.nytimes.com/2017/03/13/upshot/lousy-customer-service-a-better-way-in-health-care.html?_r=0.


GAO Accepting Nominations for HIT Advisory Committee

The 21st Century Cures Act established the Health Information Technology Advisory Committee to provide recommendations to the National Coordinator for Health Information Technology on policies, standards, implementation specifications, and certification criteria relating to the implementation of a health information technology infrastructure. The Government Accountability Office (GAO) is accepting nominations of 14 individuals for the Committee.  To read the call for nominations in the Federal Register, click here

Opioid Abuse Drug May have Opposite Effect – Pulled From the Market

FDA  advisers last week voted to pull OPANA ER off the market due to safety concerns.  FDA Advisers were concerned that the opioid reformulated to deter abuse would actually decrease opioid abuse or made matters worse by producing excessively harmful side effects. FDA considered the strength of the data it’s collected on OPANA ER, including a shift in patterns of abuse as users increasingly ingest the drug via injection. This has led to reports of HIV transmission and a rare but serious blood disorder that may be caused by OPANA ER’s inactive ingredients. For more from USA Today, click “here”:http://www.usatoday.com/story/news/politics/2017/03/14/federal-advisory-panels-agree-opanas-risks-outweigh-benefits/99166100/. 

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