19 Sep Weekly E-bulletin

All But One State Cuts Hospital Readmission Rate

CMS announced last week that 49 states and the District of Columbia have cut hospital readmission rates for Medicare enrollees since 2010, with nearly a dozen states cutting avoidable readmission rates by more than 10 percent. The agency partly credited the decline to the Hospital Readmissions Reduction Program created by the Affordable Care Act. Hawaii, New Jersey, Illinois and South Dakota were the states that saw the largest reductions, according to CMS. Vermont was the only state that did not see a reduction, with its readmission rate increasing by 0.7 percent over the five-year period. Click here for the CMS report.

2-Midnight Rule Audits Restarted

Quality Improvement Organizations re-started reviews of short inpatient hospital stays last week after CMS said the contractors completed re-training on the two-midnight hospital admissions policy. In early May, CMS temporarily paused the QIOs’ initial patient-status reviews after hospitals told the agency there were procedural problems, such as not enough time to implement education and improvement activities between rounds of audits and delays in hospitals receiving review results. For more from CMS, click here.

Uncompensated Care Fell by Almost $5 Billion in Medicaid Expansion States

The Medicaid and CHIP Payment and Access Commission (MACPAC) now reports that uncompensated care fell by around $4.9 billion in states that have expanded Medicaid, whereas it increased slightly ($0.3 billion) in states that have not expanded Medicaid. They also found that the current Medicaid DSH allotment reduction formula will have a greater impact on states that have expanded Medicaid as 1/3 of the reductions are based on the number of uninsured in the state. To view the MACPAC slide presentation on this issue, click here.

Process Outlined to Develop New Advanced Payment Models for Physicians

The Physician-Focused Payment Model Technical Advisory Committee (PTAC) held a public forum last week to outline how it will work with providers to approve new Alternative Payment Models for physicians. Notably, the PTAC’s review process will not be finalized until the MACRA final rule is published. To view the latest draft of the RFP principles, proposed submission process, and the presentation provided during the forum (to be released this week under the “meetings” tab), click here.

MACRA Rules Almost Final

CMS has sent the final physician payment system (MACRA) rule to the Office of Management and Budget for a final review before publishing. The agency is required by statute to publish the rule, Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models in Medicare Fee-for-Service, by November. The previous week CMS announced it would offer more flexibility in its quality reporting programs under MACRA, which take effect January 1 and will reshape the agency’s payment and bonus policies for doctors. Click here for the notice on the OMB website.

Strategic Health Care Launches APM Plus

Hospitals and health systems can accelerate their review of MIPS, APMs and Medicare bundles with the help of a newly launched advisory group, APM Plus. Comprised of physician, actuarial, legal, data, health plan, policy and operations experts, APM Plus can analyze hospitals’ current plans to move from volume to value, make data-centered recommendations and propose and implement the most financially and clinically　beneficial alternatives. Click here for the APM Plus website for more information.

“Unfair” CJR Needs Risk Adjustment: Study

The Comprehensive Care for Joint Replacement (CJR) model, a mandatory Medicare bundled-payment program, is financially flawed and will unfairly penalize hospitals that treat medically complex patients, University of Michigan researchers say. In a study published in Health Affairs, researchers call on CMS to risk-adjust CJR’s financial performance reward-and-penalty mechanism to reflect the high costs of treating frail patients.　 Click here to access the study.

President Meets with Insurers; “Simple Choice Plans” Coming

President Barack Obama met with insurers and administration officials last week at the White House to discuss preparations for the upcoming 2017 open-enrollment season. Among those attending were top officials from America’s Health Insurance Plans, the Blue Cross Blue Shield Association, Humana, Cigna and Molina Healthcare. The President also sent a letter to insurers selling exchange plans in 2017 that acknowledged some of the law’s early troubles. Click here for the letter to insurers. For more on the meeting and the letters from CNBC, click here.

• The U.S. government is encouraging insurers to offer “simple choice plans” in states that use the federal website, healthcare.gov, during the upcoming open enrollment period from Nov. 1 to Jan. 31. The health insurance plans will fit into six standardized plan designs, falling under the bronze, silver and gold levels, as well as three additional silver options.　 This is similar to what has been underway in California since 2014.　 Click here for details.

22% of Generic Drugs Billed to Medicare Saw Dramatic Price Increases

According to a new GAO report, more than 300 generic drugs, or about 22 percent, billed to Medicare Part D had at least one price increase of 100 percent or more between 2010 and 2015. Large price hikes of generic products have also become more common in recent years. Click here for the report.

17th Co-Op Collapses in the Garden State

Health Republic Insurance of New Jersey will shut down at the end of this year due to financial problems, becoming the 17th co-op to collapse. Health Republic’s 35,000 members will have coverage through the end of this year, but they will need to find a new insurer when the open enrollment period begins Nov. 1st. For more information, click here.

Experts Urge New Elder Care Strategy

A new report by the National Academies of Sciences, Engineering, and Medicine, says the next President must take immediate action to better support elderly patients and their caregivers. The report states that HHS should lead this effort by developing a national strategy in collaboration with other federal agencies that would help the health care system and increase workplace support for family caregivers. The report also suggests that CMS should develop, test and implement provider payment reforms that will encourage health care providers to engage with family caregivers. Click here read the report.

25+% of Seniors Not Taking Blood Pressure Meds: CDC

At least one in four Medicare Part D enrollees aged 65 or older are not taking their blood pressure medicine or skipping doses, increasing their risk of heart disease, stroke, kidney disease and death, according to a new CDC report. About 70% of U.S. adults aged 65 or older have high blood pressure, and only about half have it under control. Among other actions, CDC recommends health care providers prescribe generic blood pressure medications and simplify treatment, for example by prescribing 90-day refills and combination medicines and coordinating pill refills for the same date. Click here for the report.

Census Bureau Confirms: Uninsured Rate Has Fallen

According to new data from the U.S. Census Bureau, the rate of uninsured Americans dropped to 9.1 percent last year, a 1.3 percentage point decrease from 2014. A total of 29 million Americans were uninsured all of last year, a drop of 4 million from 2014. It’s the second straight year in which the Current Population Survey recorded a significant drop in the share of Americans without health care coverage. For more from the Census Bureau, click here.

Health Centers Awarded $87 Million in IT Funding

HHS has announced more than $87 million in funding for 1,310 health centers in every U.S. state, the District of Columbia, Puerto Rico, the Virgin Islands and the Pacific Basin. The funding will support health information technology enhancements to accelerate health centers’ transition to value-based models of care, improve efforts to share and use information to support better decisions, and increase engagement in delivery system transformation. Click here see where the funds are going.

Choosing Wisely Cancer Recommendations May Need Financial Incentives

Choosing Wisely recommendations aimed at reducing overuse of newer and expensive anti-nausea and vomiting medications in cancer patients had only a short-term effect on doctors prescribing behavior, a new JAMA Oncology study finds. The results suggest that voluntary measures aren’t yielding change and steps such as financial incentives may be needed to reduce unnecessary and wasteful use. Examination of health insurance type and health plan design might also be useful as the study found some evidence that these factors can affect the likelihood of overuse. Click here the study.

FDA, Industry Reach Deal on Biosimilar User Fee

FDA and the drug industry have agreed to a deal for the next Biosimilar User Fee Agreement, the agency announced in the federal register last week.　 The agreement, to take effect in FY2018, allows FDA to collect fees from industry for reviewing biosimilars – cheaper alternatives to branded biologics – in return for agreeing to review the applications in a certain period of time and providing other support to companies. Under the new agreement, the FDA and industry increased the time FDA has to review biosimilars by 60 days. Click here to read the FDA announcement.

Pokémon GO Hazardous to Your Health

A new study in JAMA Internal Medicine finds that the smart phone game Pokémon GO was apparently responsible for over 100,000 incidents in a 10-day period last summer. A team of researchers used Twitter to figure out how many accidents were linked to Pokémon GO over a 10-day period in July 2016. They found that a third of the tweets made reference to a passenger, driver or pedestrian getting distracted by the game. The research showed nearly 114,000 incidents over the 10 days. Click here for the JAMA article.