Search

Strategic Health Care News Update 11/18/19

Updated: Dec 1, 2019

CMS Releases Final Price Transparency Rule for Hospitals; Proposes Rule for Insurers; Hospitals Will Sue Hospitals and insurers would be forced to disclose their secret negotiated rates for the first time under a far-reaching plan released Friday by the Trump administration. Administration officials said the final rule will compel hospitals in January 2021 the rates they negotiate with individual insurers for all services, including drugs, supplies, facility fees and care by doctors who work for the facility. The administration also proposed extending the disclosure requirement to health insurers. Insurance companies and group health plans that cover employees would have to disclose negotiated rates, as well as previously paid rates for out-of-network treatment, in file formats that are computer-searchable, officials said. The American Hospital Association, the Federation of American Hospitals, Association of American Medical Colleges and the Children’s Hospital Association have already announced they will sue to stop the regulations claiming the proposal will decrease competition and lead to less access for patients. The rules are part of an overall effort by the Trump Administration to increase price transparency in hopes of lowering health care costs on everything from hospital services to prescription drugs and is seen as the as the central health policy for Trump’s presidential campaign. Click here for the Washington Post story. Click here for the fact sheet on the CMS final hospital rule, and here for the 331-page rule.Click here for the CMS fact sheet on the proposed rule for health plans, and here for the 219-page proposed rule.


Interestingly, while there is an up-to-$300-a-day penalty on hospitals for non-compliance, there is no penalty outlined for health plans for non-compliance.  There will likely be many suggestions for such during the open comment period on the proposed health plan rule.  The hospital rule is a final rule because CMS had previously proposed it as part of the 2020 outpatient prospective payment system rule, taken public comments and then finalized it last week.


Stents, Bypass Surgery No More Effective than Drugs for Stable Heart Disease: Study Some of the most common invasive heart procedures in America are no better at preventing heart attacks and death in patients with stable heart disease than pills and lifestyle improvements alone, according to a massive federally fundedstudy designed to resolve a long-standing controversy in cardiology. Researchers found that invasive procedures to unclog blocked arteries — in most cases, the insertion of a stent, a tiny mesh tube that props open a blood vessel after artery-clearing angioplasty — were measurably better than pills at reducing patients’ chest pain during exercise. But the study, called ISCHEMIA, found no difference in a constellation of major heart-disease outcomes, including cardiac death, heart attacks, heart-related hospitalizations and resuscitation after cardiac arrest. There was no benefit to an invasive strategy in people without chest pain.Click here for the study.  Click here for the Washington Post story.


CDC:  ‘We Are in the Post-Antibiotic Era’ Every 15 minutes, one person in the US dies because of an infection that antibiotics can no longer treat effectively. That’s 35,000 deaths a year. This striking estimate comes from a major new report, released last week by the CDC. Although the report focuses on the US, this is a global crisis: 700,000 people around the world die of drug-resistant diseases each year. Drug resistance is what happens when we overuse antibiotics in the treatment of humans, animals, and crops. When a new antibiotic is introduced, it can have great, even life-saving results — for a while. Click here for the CDC report.  Click here for news coverage.


Trump Administration’s Newest Drug Pricing Plan Cuts Even Further According to HHS Secretary Alex Azar, use of the International Pricing Index to reduce the cost of prescription drugs is no longer the central idea of Trump’s drug pricing plan. The IPI prices drugs at a comparable rate of other countries, but Trump feels that prices will still be too high in this case and would like prices to be lower than in other countries; therefore, HHS suggests lowering the 180% premium above other countries to 150%. It is unclear when the proposal will go into effect. The IPI has Republican opposition and Democratic support, although Democrats still believe the proposal will not lower the cost enough and will not benefit people with private insurance. To read more, click here. The WHO announced a pilot program that will increase insulin access in low- and middle-income countries intended to increase pressure on the international market to reduce costs across the world, click here.


Caring for Aging Americans Increasingly Burdensome, House Committee Told The House Ways and Means Committee held a hearing last week about the burdensome costs of long-term care for patients and their families. Six witnesses shared stories and expertise about possible solutions, Kristina Brown, a medical student and caregiver, told the story of her mom, who is too young for Medicare and Social Security and makes too much for Medicaid and therefore cannot get the financial or physical help she needs. Kristina was forced to become her caregiver at a young age, which has had an impact on her mentally and financially. The Committee expressed the need to close the gap between age and income, as long-term care is needed for more than just the elderly and for providing financial and physical support for unpaid caregivers. Addressing flaws in long-term care for the disabled and aging population has clear bipartisan support. To read witness testimonies, click here and to watch the hearing, click here.


New Senate Bill Would Stop Sale of Consumer Health Data from Wearable Devices Sens. Jacky Rosen (D-NV) and Bill Cassidy (R-LA) introduced a bipartisan bill to stop the sale of health data from wearable devices such as fitbits and Apple Watches after Google was given access to millions of patient health records. Ascension Health system sold millions of patients’ records to Google without consent from doctors or patients, infuriating the public. The HHS Office for Civil Rights is investigating the arrangement under HIPAA, but many say it is legal since the arrangement was believed to improve risk prediction and patient care. The proposed bill would require HHS to enforce HIPAA compliance in these situations. To view the bill language, click here. For more on Google’s “Project Nighingale,” click here. Apple has launched an app that will allow users to take part in three multi-year, longitudinal health studies in partnership with several government and private organizations. Enrolled participants will be able to contribute health data by using their iPhones and Apple Watches, click here.


CMS Cracks Down on Medicaid Supplemental Payments In an effort to ensure transparency in Medicaid payments and improve program integrity CMS has proposed the Medicaid Fiscal Accountability Rule (MFAR). CMS Administrator Seema Verma says the proposal stemmed from an increase in “proliferation of payment arrangements that circumvent the rules…” The proposal attempts to increase transparency around state supplemental payments that have increased from 9.4% to 17.5% of Medicaid payments in sum between 2010 and 2017.  In dollars, CMS states supplemental payments increased between 2001 and 2016 by $16.4 billion.  The proposal would essentially redefine Medicaid “base” and “supplemental” payments which would allow CMS to better monitor and enforce statutory requirements.   To read the full statement from CMS, click here. To view the proposal, click here.


Pharma Funded Group Steps Up Attack on 340B Rx Discount Program A new report from the Alliance for Integrity and Reform, a group funded by drug manufacturers, analyzes and reports on charity care levels at 340B disproportionate share hospitals in FY2017 that raises questions regarding 340B’s qualification criteria and Congress’ goal of increasing access to prescription drugs. The report found that 29 percent of 340B hospitals provide charity care that represents less than 1% of their total patient costs and that the program has grown from $6.9 billion in discounted sales in 2012 to $24.3 billion in discounted sales in 2017. To read the report, click here.


GAO: Medicare Hospice Patients Not Receiving Care in Final Days The Government Accountability Office released a report found that 83 providers, 80 for-profits, and 3 non-profits did not have hospice staff care for Medicare beneficiaries within their last three days. A higher number of each were found to have a high rate of discharging beneficiaries when they should have been receiving palliative care. The report indicates poor quality of care and encourages CMS to work to identify quality of care in its hospice oversight survey. GAO also recommends that Congress give CMS authority to establish enforcement remedies for hospice centers that do not meet federal requirements. To read the full report, click here.


Fight Over Surprise Billing Highlights Difficulty in Making Changes in Health Care Despite bipartisan support for protecting patients from the crippling out-of-pocket costs associated with surprise billing, no legislation has been passed. Many observers say that it shows how difficult it is to make even small changes to health care policy. With talks of “Medicare for All” at the forefront of the 2020 presidential election, legislators and experts are questioning the likelihood that a significant health care system overhaul could occur. Public pressure and bipartisan agreement should have been more than enough to end surprise billing, but industry opposition has delayed it and the industry is already lobbying against Medicare for All.  For a good analysis of the politics behind these issues, click here.


CMS: Nearly 755,000 Enrolled During Second Week of Open Enrollment According to CMS, 754,967 people enrolled in health care plans on HealthCare.gov during week two of open enrollment. Nearly 200,000 of those were new consumers with the rest renewing existing coverage. 38 states use the HealthCare.gov platform for the individual market Exchange. CMS will continue to provide weekly platform snapshots displaying plan selections, consumers, call center volume, and more during the open enrollment period. To view the report from CMS, click here.


More GOP-Controlled States May Expand Medicaid While some states favor the expansion of Medicaid, other conservative states still remain resistant. Thirty-six states and Washington D.C. have opted to expand Medicaid under the Affordable Care Act. Increasing efforts in Missouri, Kansas, North Carolina, and Oklahoma could cause the four states to take part in the expansion — three have adopted the expansion program, but have not yet implemented it. The remaining states have not implemented the program. Support for the expansion program ranges in the 14 states, with some policymakers expressing opposition and voters showing support. Click here to read more.


CDC: Flu Picking Up Across U.S. The CDC’s FluView Report shared that outpatient visits for flu-like illness increased from 1.9% the week before to 2.1% the week ending on November 2. The report found in that same week, 3.2% of respiratory specimens tested in clinical laboratories were positive for influenza viruses. Four weeks ago, 1.9% were tested as positive. Additionally, data on the most recent week reported, ending November 9, have reported high levels of flu activity in Louisiana, moderate levels in five states and Puerto Rico, low levels in nine states, and minimal activity in the remaining thirty-five states. Click here for the FluView Report.


Labor Department Blames Health Care Costs for Increased U.S. Inflation Consumer prices have experienced significant increases since October, according to a report from the Labor Department, which showed that the cost of health care has increased by the greatest amount within the past three years. Within the past month, health care costs increased by 1 percent and by 4.3 percent on a year-to-year basis. Other areas that experienced increases in costs include energy and gasoline. To read the full report, click here. Kaiser is out with the latest summary of 2017 American Hospital Association data that shows the state-by-state adjusted hospital expenses per inpatient day. It is organized by hospital type in each state, click here. Hospitals are failing to meet their own cost-cutting goals, according to the RAND Corp. Hospital costs accounted for a third ($1.1 billion) of what the United States spent on healthcare in 2017, click here.


HHS to Launch Novel Diagnostic Technology The new technology is designed to read the immune system’s gene expression patterns and identify whether an infection is caused by bacteria or a virus; it will also determine how severe the infection is within minutes of reading. This new technology will be used in both inpatient and outpatient settings. With the ability to identify what type of pathogen causes an infection, healthcare professionals will be able to make more informed decisions on what type of treatment they should use. The Biomedical Advanced Research and Development Authority (BARDA) will assist in developing and testing the technology as part of a $6 million contract with Inflammix Inc., To read the full report, click here.


Senate Democrats want answers from CMMI on Maternal Mortality Sen. Elizabeth Warren (D-MA) and Rep. Lisa Blunt Rochester (D-DE) led a letter written to HHS’ Alex Azar and CMS’ Seema Verma pushing for information on how the CMS Innovation Center will address maternal mortality. They question how the center will include payment models with the goal of reducing maternal mortality and the health disparities that also occur. The legislators write that CMMI “can play a critical role” in addressing the high maternal mortality rate in the United States. Click here for the letter.


Poverty as a Risk Factor of Congenital Heart Disease A recent study by the American Heart Association concluded that social determinants of health are influential risk factors of congenital heart disease (CHD).  As it is difficult to distinguish the impact that economic and environmental factors have individually, the factors were evaluated together. The study found that a lower socioeconomic position and greater pollutants precede other CHD risk factors for infants born in California. To read the study, click here.


New Studies Show Temperature Effects Mental Health Colder temperatures have fewer mental illness-related ER visits, suicides, and self-reported poor mental health days in comparison to warmer temperatures, according to a new study. The improvement of mental health remained significant when studied in areas with higher and lower average temperatures. To review the complete study, click here. Report from The Lancet shows climate change to have adverse effects on children’s health as children born today will experience an earth that is 4 degrees Celsius warmer than Earth’s temperature during the pre-industrial age, click here.


Study: Doctors Grade EHRs an “F” Healthcare professionals rate electronic health records, an innovation intended “to improve the quality and efficiency of healthcare,” with a grade of ‘F’. The Yale-led study reports that physicians tend to spend two hours working on electronic health records for every hour they work with a patient. The study also notes that low ratings of electronic health records correlates with physician burnout, with physicians who experience more symptoms of burnout to be more likely to rate electronic health records lower. For the Yale summary click here, for the study click here.


Cigarette Smoking Among Adults at All-Time Low in US The CDC says the percentage of adults smoking cigarettes in 2018 was 13.7-percent, an all-time low. According to the study, cigarettes are still the most used tobacco product, with e-cigarettes being used by 3.2-percent of adults. The data showed that tobacco use was highest with adults 25-44 years old, adults whose highest level of education is a GED, uninsured or publicly insured adults, and adults living with a disability. Additionally, it was found that from 2017-2018, electronic cigarette usage increased from 2.8-percent to 3.2-percent. Since cigarette smoking is still the leading cause of preventable death in the U.S. To read the full statement from the CDC, click here.



4 views0 comments

Recent Posts

See All

614-228-9131

©2019 by Strategic Health Care Managed Care Solutions. Proudly created with Wix.com