Monthly Archives: November 2019

CMS retains 340B, site-neutral payment cuts in final hospital payment rule

Posted on by • Posted in American Hospital Association (AHA), Center for Medicare and Medicaid Services (CMS), District Court, District Court of Appeals, Health Policy, Health System, Hospital, Hospital Industry, Medicaid, Medicare, Medicare 340B Drug Discount Program, Medicare Site Neutral Payment, Outpatient Prospective Payment System (OPPS), Safety Net Hospitals, Safety-Net Providers • Leave a comment

https://www.fiercehealthcare.com/hospitals-health-systems/cms-retains-340b-site-neutral-payment-cuts-final-hospital-payment-rule?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiWTJZd1pqWXpZbVUwWTJKbSIsInQiOiJLV2JJQWM1clQ3OVBiaURjdFVUUUg2K093U21XZm0zVHNPa1hTUjdTWEdxSWZpYklsako0TVMrZFYxazVGZHFkOHJ3M1pWNlwvYW5pVWpPcjM1TEtVRnErOWgxU3NKc1dcLzk3TnZTc1pLZVI0Ymcrb0V1ZEZ2eDh1djFwa1FlaW50In0%3D

billing statement from a doctor's office

The Trump administration finalized a hospital payment rule Friday that retains proposed cuts to off-campus clinics and the 340B drug discount program. 

The changes outlined in the hospital Outpatient Prospective Payment System (OPPS) rule come despite both cuts being struck down in legal challenges and amid major pushback from providers.

Site-neutral payments

The agency decided to move ahead with the two-year phase-in of the cuts to outpatient services for clinic visits furnished in an off-campus hospital outpatient setting. The goal is to bring payments to off-campus clinics in line with standalone physicians’ offices.

“With the completion of the two-year phase-in, the cost sharing will be reduced to $9, saving beneficiaries an average of $14 each time they visit an off-campus department for a clinic visit in [calendar year] 2020,” the Centers for Medicare & Medicaid Services (CMS) said in a fact sheet.

However, the two-year project that was supposed to start in 2019 has been halted because of a federal court ruling.

CMS decided to move forward with the cuts for off-campus clinics.

“The government has appeal rights, and is still evaluating the rulings and considering, at the time of this writing, whether to appeal the final judgment,” the agency said.

The American Hospital Association (AHA) said that the site-neutral payment rule was misguided and that CMS ignored the recent court ruling. 

“There are many real and crucial differences between hospital outpatient departments and the patient populations they serve and other sites of care,” said Tom Nickels, executive vice president of the AHA, in a statement.

CMS also finalized a proposed cut for the 340B program that cuts payments by 22.5% in 2020.

CMS has installed prior cuts in 2018 and 2019 to the program that requires drug companies to provide discounts to safety-net hospitals in exchange for getting their products covered on Medicaid.

However, a court ruling has struck down the cuts, and CMS is currently appealing the decision.

CMS said that it hopes to conduct a 340B hospital survey to collect drug acquisition cost data for 2018 and 2019, and the survey will craft a remedy if the appeal doesn’t go their way.

“In the event the 340B hospital survey data are not used to devise a remedy, we intend to consider the public input to inform the steps we would take to propose a remedy for CYs 2018 and 2019 in the CY 2021 rulemaking,” the agency said.

Hospital groups commented that CMS should drop both the 340B and site-neutral cuts because of the legal challenges.

Several groups weren’t happy that the cuts were still there.

“The agency also prolongs confusion and uncertainty for hospitals by maintaining unlawful policies it has been told to abandon in clear judicial directives,” said Beth Feldpush, senior vice president of policy and advocacy for America’s Essential Hospitals, in a statement Friday.

The hospital-backed group 340B Health added that CMS needs to stop this “unfunny version of ‘Groundhog Day’ and restore Medicare payments for 340B hospitals to their legal, statutory level.”

 

 

 

Warren bets the White House on Medicare for All

Posted on by • Posted in 2020 Election Issues, Health Policy, Medicare, Medicare for All • Leave a comment

https://www.axios.com/elizabeth-warren-medicare-for-all-plan-reaction-13aa5d21-f489-4c8b-b834-77d742d74148.html

Image result for Medicare for All

Elizabeth Warren, who rose to the top with big liberal bets, is banking a big slice of her presidential run on full-throated support for Medicare for All. 

Why it matters: Warren is taking a beating on social media after claiming middle class Americans won’t pay higher taxes to fund health care coverage fully paid for by taxpayers, according to data from NewsWhip provided exclusively to Axios. At the same time, her poll numbers nationally are slipping.

The bigger picture: Numerous prominent Democrats have told us Trump will feast on Warren’s plan to eliminate private insurance to force everyone onto Medicare. They worry she has no wiggle room to backtrack if she wins the nomination because her entire reputation is wrapped around not buckling on big debates like health care. 

By the numbers: Of the 50 biggest stories over the last two weeks about Elizabeth Warren’s plan to pay for Medicare for All, 70% were negative, according to NewsWhip data.

  • Criticism around how to pay for the plan has been accompanied by a rapid descent in the polls. After briefly overtaking Joe Biden atop the 2020 Democratic polling average on Oct. 8, Warren has tumbled and now trails Biden by 7.2 points.

Between the lines: The blowback against Warren is a natural consequence of her emergence as a top threat in the race, illustrated by the incoming she faced in the October debate.

  • It is a reversal of a trend we saw in the summer, in which Warren was the beneficiary of glowing stories and subsequently climbed in polling.
  • The criticism picked up following the debate after she danced around questions of whether the plan would require a middle-class tax hike.

Between the lines: While not explicitly about Warren, a Yahoo Finance article from late October that calculates the taxes necessary to pay for Medicare for All was the biggest article associated with Warren in 2019 on social media with 820k interactions (likes, comments, shares).

  • According to NewsWhip data, the criticism picked up steam in the wake of her announcement of how to pay for the plan, which requires an additional $20.5 trillion of federal spending.

The top negative stories in the last two weeks:

  1. The Democratic plan for a 42% national sales tax (Yahoo) — 820k interactions
  2. Warren agrees Medicare-for-All could result in two million jobs lost: ‘This is part of the cost issue’ (Fox News) — 43k
  3. Warren says health insurance workers laid off under ‘Medicare-for-all’ can work in auto, life insurance (Fox News) — 42k
  4. Elizabeth Warren Says Massive Job Loss Is Part of the Cost of Medicare-For-All (IJR) — 40k
  5. Elizabeth Warren Wants To Pay for Medicare for All With a $9 Trillion Tax That Will Hit the Middle Class (Reason) — 40k

Our 2020 attention tracker is based on data from NewsWhip exclusively provided to Axios as part of a project that will regularly update throughout the 2020 campaign.

 

 

 

 

Today’s health problems are tomorrow’s health crises

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Chronic Care Management, Chronic Conditions, Chronic Diseases, Diabetes, Health Policy, Heart Disease, Hepatitis C, Obesity, Opioid Epidemic, Population Health, Preventative Care, Primary Care • Leave a comment

https://www.axios.com/public-health-crisis-trends-future-c24f9720-4657-45f2-ab73-05a8bb9a4d3e.html

Image result for Today's health problems are tomorrow's health crises

The health troubles we’re seeing now — especially among young people — will continue to strain the system for years and even decades to come.

The big picture: Rising obesity rates now will translate into rising rates of type 2 diabetes and heart disease. The costs of the opioid crisis will continue to mount even after the acute crisis ends. And all of this will strain what’s already the most expensive health care system in the world.

By the numbers: 18% of American kids are now obese, according to new CDC data. So are roughly 40% of adults. And it’s projected to get worse.

  • That helps explain why diabetes rates are also rising, and why roughly 30% of adults have high blood pressure.

Why it matters: More obese children means there will be more adults down the road with chronic conditions like diabetes — which can’t be cured, only managed — and these diseases in turn increase the risk of further complications, such as kidney disease and stroke.

  • Diabetes roughly doubles your lifetime health care bills, according to the CDC, and costs the U.S. a total of $245 billion per year.
  • As the price of insulin continues to skyrocket, the disease only gets harder for patients to manage, if they can afford treatment at all.

We’re only beginning to see the full costs of the opioid crisis, even though it has raged for years.

  • A White House report earlier this week pegged the cost of the epidemic at a staggering $696 billion last year alone, including the cost of productivity lost to addiction.
  • The tide has only barely begun to turn on overall overdose deaths — they still numbered around 68,000 last year.
  • And many survivors of the epidemic will face long-term health costs. Addiction recovery can be a lifelong process requiring sustained investments. It has also led to skyrocketing rates of Hepatitis C — some states have seen their infection rates rise by more than 200% over the past decade.

Groundbreaking new treatments offer the first-ever cure for Hepatitis C, but at price tags so high that states are experimenting with entirely new ways of paying for the drugs, fearing the status quo simply can’t bear these costs all at once.

The bottom line: The flaws in the U.S. health care system compound one another.

  • They reward doctors and hospitals for performing more treatment on sick people, and those treatments are expensive. That leaves big gaps in prevention, which drives the need for more expensive treatment.
  • That’s how we ended up with the world’s most expensive health care system, but without a particularly healthy population to show for it. And that trajectory isn’t changing.

 

 

 

 

Doctors try CRISPR gene editing for cancer, a 1st in the US

Posted on by • Posted in Academic Medical Center, Biotech, Cancer Treatment, DNA, DNA CRISPR, Immunotherapy • Leave a comment

https://apnews.com/40211902a28946fe89f3f92b3c084e51

The first attempt in the United States to use a gene editing tool called CRISPR against cancer seems safe in the three patients who have had it so far, but it’s too soon to know if it will improve survival, doctors reported Wednesday.

The doctors were able to take immune system cells from the patients’ blood and alter them genetically to help them recognize and fight cancer, with minimal and manageable side effects.

The treatment deletes three genes that might have been hindering these cells’ ability to attack the disease, and adds a new, fourth feature to help them do the job.

“It’s the most complicated genetic, cellular engineering that’s been attempted so far,” said the study leader, Dr. Edward Stadtmauer of the University of Pennsylvania in Philadelphia. “This is proof that we can safely do gene editing of these cells.”

After two to three months, one patient’s cancer continued to worsen and another was stable. The third patient was treated too recently to know how she’ll fare. The plan is to treat 15 more patients and assess safety and how well it works.

“It’s very early, but I’m incredibly encouraged by this,” said one independent expert, Dr. Aaron Gerds, a Cleveland Clinic cancer specialist.

Other cell therapies for some blood cancers “have been a huge hit, taking diseases that are uncurable and curing them,” and the gene editing may give a way to improve on those, he said.

Gene editing is a way to permanently change DNA to attack the root causes of a disease. CRISPR is a tool to cut DNA at a specific spot. It’s long been used in the lab and is being tried for other diseases.

This study is not aimed at changing DNA within a person’s body. Instead it seeks to remove, alter and give back to the patient cells that are super-powered to fight their cancer — a form of immunotherapy.

Chinese scientists reportedly have tried this for cancer patients, but this is the first such study outside that country. It’s so novel that it took more than two years to get approval from U.S. government regulators to try it.

The early results were released by the American Society of Hematology; details will be given at its annual conference in December.

The study is sponsored by the University of Pennsylvania, the Parker Institute for Cancer Immunotherapy in San Francisco, and a biotech company, Tmunity Therapeutics. Several study leaders and the university have a financial stake in the company and may benefit from patents and licenses on the technology.

Two of the patients have multiple myeloma, a blood cancer, and the third has a sarcoma, cancer that forms in connective or soft tissue. All had failed multiple standard treatments and were out of good options.

Their blood was filtered to remove immune system soldiers called T cells, which were modified in the lab and then returned to the patients through an IV. It’s intended as a one-time treatment. The cells should multiply into an army within the body and act as a living drug.

So far, the cells have survived and have been multiplying as intended, Stadtmauer said.

“This is a brand new therapy” so not it’s not clear how soon any anti-cancer effects will be seen. Following these patients longer, and testing more of them, will tell, he said.

 

 

 

Health insurers eat higher medical costs

Posted on by • Posted in ACA, Essential Health Benefits, Health Insurance Coverage Adequacy, Health Insurance Industry, Health Policy, High Deductible Health Plans, High Premiums, Medical Loss Ratio (MLR), Operating Performance, Out of Network, Out of Pocket Expenses, Preexisting Conditions, Underinsured • Leave a comment

https://www.axios.com/newsletters/axios-vitals-b6a8b813-d93a-43d6-9080-bc9ee9606440.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

Image result for 2. Health insurers eat higher medical costs

Almost all of the major health insurance companies are spending more on medical care this year than they have in the past, Axios’ Bob Herman reports.

The big picture: Rising prices and more services for some sicker patients are among the many reasons why this is happening. That uptick in spending has freaked out Wall Street, even though insurers are still quite profitable.

Driving the news: Almost all of the eight major publicly traded insurers have shown their medical loss ratio — the percentage of premium revenues they’re spending on medical claims — is rising this year.

  • UnitedHealth Group, the largest insurer in the country, said its loss ratio was 82.4% in the third quarter this year compared with 81% in the same period a year ago.
  • But these companies are handling billions of premium dollars, so any increase in medical claims equates to hundreds of millions of dollars in additional spending, which they don’t want.

Between the lines: Medical loss ratios are often higher for health plans that cover more older adults, the disabled and the poor, because those groups typically need more care or are in the hospital more frequently.

But costs have been climbing in some commercial markets, too.

  • Anthem executives admitted on their earnings call that the company is dumping some employers with workers who had medical needs and costs that were too high.
  • CVS Health, which now owns Aetna, previously said some middle-market clients had employees that it thought were getting too many services and drugs.
  • CVS “intensified our medical management in those geographies,” an executive said on the earnings call.

The bottom line: Health insurance companies closely track their medical loss ratios and aim to hit those targets most often by charging higher premiums, denying care, forcing people to use lower-priced providers or declining to cover people they deem to be too expensive.