06 Mar Weekly E-bulletin

ACA Repeal/Replace/Repair Moves Forward This Week

Barring even more unforeseen turmoil in GOP ranks, the House Ways and Means and Energy and Commerce Committees are likely to mark up ACA repeal and replace legislation this week.　 Proposed bills have not yet been released for public review but portions have been leaked and are similar to a draft that was leaked a couple of weeks ago. The key issues remain Medicaid reforms　and private insurance tax credits that are sought by Republicans. Click here for details. From various reports and our own contacts on Capitol Hill, the latest versions would:

• Allow states to keep their current Medicaid expansions, including new enrollments, through January 1, 2020; however, disproportionate share payments cuts to hospitals in those states would begin October 1, 2017 – those cuts have so far been delayed by Congress;

• States would have the option of per-capita caps or block grants;

• States would move to per-capita caps starting in 2018, with their traditional Medicaid populations in 2015 serving as the baseline for calculating their rate;

• The legislation is expected to continue to provide age-adjusted tax credits, but will　 hold down costs through means-testing – perhaps a bit higher than the current cut-off at 400 percent of the poverty level; and

• It’s likely all the ACA taxes would be repealed.

If these committees successful agree to legislation this week, the Budget Committee is expected to act the following week, then the Rules Committee the following week with　House floor action the week of March 27.

GOP Governors Request Medicaid Protections in Proposal to Lawmakers

A coalition of Republican governors is advising lawmakers to increase federal Medicaid funding for non-expansion states in order to make the system equitable for all and request Congress to guarantee an “appropriate transition period” while restructuring Medicaid. In the proposal, states would be able to roll back income eligibility of the expansion population to any level below 100 or 138 percent of poverty while keeping the enhanced federal funding mandated by current law for expansion beneficiaries. Click here for the proposal.

• One key senator has a politically correct take on the Obamacare/ACA. Click here.

MedPAC Preparing Major Recommendations to Congress on Six Different Payment Systems

The Medicare Payment Advisory Commission is considering recommendations to Congress that would require significant changes to the new physician payment system, the post-acute payment system, Part B drug payment program and other major payment systems.　 In meetings last week, commissioners reviewed staff recommendations　that would impact six major health programs.　 For an excellent Strategic Health Care summary, including links to MedPAC’s slide presentations, click here.

UNOS Liver Redistribution Planned Will Not Proceed

A controversial proposal to change the way life-saving organs are allocated across the country for transfers will not advance in its current form. Instead, the contractor in charge of developing the plan is tasked to present several possible alternatives at a meeting in May. The United Network for Organ Sharing in 2014 released a concept document detailing a proposal to transition the current organ redistribution system from the current 11-region model to a new eight-district model. A final proposal was released for public comment in August 2016. Critics, who largely included Southern and Midwestern hospitals, denounced the plan and argued it would favor states with lower liver donation rates. Click here to read the proposal.

Insurers Pay Double the Selling Price of Knee, Hip Implants: Study

The average price insurance companies pay for knee and hip replacements is roughly double the cost of the device itself, according to a new study.　 Across over 63,000 patients in the study population, researchers found average selling prices of $5,023.01 for knees and $5,619.75 for hips, compared to mean insurance payments of $10,604.52 and $11,751.25, respectively. In total, the implants cost insurers roughly $425 million more than the price of the devices themselves.　 Click here to see the research published in JAMA.

200 Members of Congress Urge CMS To Support Medicare Advantage

As health care reform rages, the future of Medicare Advantage continues to be high on the agenda of the nation’s health insurers. There are currently 19.6 million private Medicare enrollees — or nearly twice the number of individuals who signed up for coverage through Obamacare exchange markets for this year. That translates into roughly $200 billion in annual revenue for insurers. The number of private Medicare customers increased by 7.6 percent over the last year and has more than doubled during the past decade.　 More than 200 bipartisan members of Congress sent a letter to CMS urging the agency to increase payment support.　 Click here for the letter, which was led by Rep. Brett Guthrie (R-KY).

Physician Organizations Urge CMS to Stop 2015 CEHRT

Dozens of physician organizations last week called for 2015-edition EHR to not be required starting next year, citing the lack of readiness by EHR vendors. HHS Secretary Tom Price was extremely sympathetic to providers’ health IT concerns as a member of Congress.　 Click” here “:http://t.congressweb.com/l/?WSIYAZJXQUPZULQfor the letter they sent to CMS.

Seema Verma Nomination Moves Forward and She Answers More Questions

After a 24-hour delay, the Senate Finance Committee advanced Seema Verma’s nomination to lead CMS in a 13-12 vote along party lines, last week, clearing the way for a vote on the Senate floor. Verma is expected to be confirmed as early as this week. Click here to view the debate in Committee. Verma responded in 82 pages of questions and answers for the record from the Senate Finance Committee. She stated she is open to block grants, per-beneficiary caps and “other innovative ideas,” but said Medicaid reform is up to Congress and that CMS would merely offer technical assistance. She went further to say that making the process of getting waivers transparent and consistent would be one of her top priorities. To view the 82-page document, click here.

Drug Spending in Exchanges Surpassed Other Payers

According to a new report released by Express Scripts, drug spending growth in the Affordable Care Act’ health insurance marketplaces increased at a much higher rate than employer plans, Medicare and Medicaid last year. The data provided by the country’s largest pharmacy benefits manager shows that drug spending in the exchanges climbed by 14 percent in 2016, after accounting for rebates and discounts provided by drug companies. Click here for the full report.

LTCH & IRF Quality Reporting Program Preview Reports Available

CMS has announced that Inpatient Rehabilitation Facility (IRF) and Long-term Care Hospital (LTCH) Quality Reporting Program (QRP) Provider Preview Reports are now available. Providers are encouraged to review their performance data on each quality measure based on Quarter 2 – 2015 to Quarter 2 – 2016 data, prior to the June 2017 LTCH Compare refresh when the data will be publicly displayed. Providers have until the end of the 30-day preview period (March 30, 2017) to review their data. Providers are able to request a CMS review during the preview period if they believe their data is inaccurate.? Click here for the LTCH QPP webpage, and here for the IRF QPP webpage.

House Committee Considers Health Insurance Legislation

The House Education and the Workforce Committee held a hearing March 1st to examine three bills related to health insurance. Debate of the policies in the legislation predictably broke down along party lines as Republicans pursue broader changes to the health insurance system. The hearing focused on a bill (H.R. 1101) that would establish a system for association health plans, which would allow the smallest employers to join together into a single insurance-providing entity through trade or professional organizations. The other bills, still in draft form, are more narrowly focused. One relates to employee wellness plans and another to insurance for self-insured employers who protect against extreme expenses. To review the legislation, read testimony, and watch the hearing, click here.

Curious How Healthy, or Unhealthy, Your Neighborhood Is?

Now you can look at smoking rates, obesity prevalence, and binge drinking habits in your area, thanks to the CDC.　You can even see how many of your neighbors are going for an annual dental visit. The 500 Cities Project has a new interactive map that pulls health data on 27 chronic disease measures and breaks it down both by city and by neighborhood. Click here.

CDC Releases Healthy People 2020 Midcourse Review

The CDC last week released the Midcourse Review of the 10-year initiative for tracking and reporting on the nation’s health goals – Health People 2020. The report on the progress that has been made focused on four overarching goals: high-quality/longer life, elimination of health disparities, healthy social and physical environments, and healthy behaviors across all life stages. Sleep habits and social determinants of health were added as new areas of study to the list of topics and objectives for this decade. Data tables on page 16 of the midcourse overview show that populations in metropolitan areas meet 64% of health disparity objectives set by the HP2020 plan, while in rural areas that rate is 34%. Click here for the report.

Bacteria in Hospital Sinks May Spread Infection: Study

A new study published in Applied and Environmental Microbiology, shows that bacteria can thrive in p-traps, the “U bends” below sink drains that collect everything from errant earrings to lost toothpaste tube caps. It can be a huge problem in hospitals where sinks have been linked to a slew of bacterial outbreaks. The researchers intend to continue the study by tracing how bacteria make the leap from sinks to patients. To read the report, click here.

Only 20% of Physicians Engage with Hospital Leadership: Survey

According to athenahealth’s 2016 Physician Leadership and Engagement Index, only 20 percent of physicians are engaged with hospital leadership. Athenahealth collected responses in January 2016 from more than 2,000 practicing physicians for the survey. The survey found that physician engagement varied with gender : 22 percent of male physicians are engaged compared to 16 percent of women physicians. Physician engagement also varied based on clinicians’ workplace: 32 physicians in physician-owned, independent medical groups or practices are engaged compared to 17 percent of those in hospital- or health system-owned groups, according to the survey. Click here to view the entire survey.