Category Archives: Hospital Industry

President Trump’s budget cuts target Medicaid, Medicare

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https://www.healthcarefinancenews.com/news/president-trumps-budget-cuts-target-medicaid-medicare?mkt_tok=eyJpIjoiWVRnM01UZzNaR0V6TTJFNSIsInQiOiJ6aXpsQnNCRjhHdCs4SnN0UytlZnJVUlZUeFdreEZyQ2V6RWE0YklvYmFMOGJnbWpXT3ZHeG0rOHMwNkJPcE9rMUlGb3NzVkpId3NrZHNkZmR2VlZISXZCVGgrbU94cFV3aVlNR1NYamlhazF1R1kzaXd3RXVISm9OSGJoYmVrVCJ9

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Blueprint includes cuts for care in hospital outpatient departments, teaching hospitals and post-acute care providers, AHA says.

President Trump’s proposed $4.8 trillion budget slashes billions of dollars from Medicaid, food stamps and other safety net programs in an attempt to shrink the federal deficit.

Medicaid and the Affordable Care Act see about $1 trillion in cuts over the next decade, according to The Hill. The budget eliminates the enhanced federal match for Medicaid expansion enrollees. An additional $150 billion is expected to be shaved off of Medicaid from the implementation of work requirements, which is expected to result in people losing their healthcare coverage.

The “President’s health reform vision” to ax the Affordable Care Act takes $844 billion over 10 years from the ACA, the report said.

The decrease in federal spending on Medicare would total about $750 billion over 10 years, but that includes shifting two programs out of the budget. After accounting for those changes, the reduction is just over $500 billion, according to CNN. Much of that cut comes from reducing payments to providers.

The budget needs Congressional approval and is not expected to get past a Democratic-controlled House without changes.

House Speaker Nancy Pelosi tweeted: “The budget is a statement of values. Once again, the #TrumpBudget makes it painfully clear how little the President values the good health, financial security and well-being of America’s hard-working families.”

Ways and Means Committee Chairman Richard E. Neal, D-MA, said, “When I saw the President’s proposed budget today, I felt an immense sense of relief – relief that there is absolutely no chance of his ruthless cuts to critical programs ever becoming law. Slashing billions from Medicare and Medicaid will only make it harder for Americans to access the healthcare they need.

Cutting nutrition assistance and Social Security benefits for the disabled won’t enable people to get back on their feet financially.”

Senator Lamar Alexander, R-Tenn said, “Under the Constitution, it is Congress’ job to set spending priorities and pass appropriations bills, and as a member of the Senate Appropriations Committee, my priorities will continue to be making sure our national defense, national laboratories, the National Institutes of Health and national parks have the resources they need. I am encouraged to see the president is calling to end surprise medical billing.”

The budget adds money to the National Institutes of Health. The NIH will invest $50 million for new research on chronic diseases, using AI and related approaches, according to the White House briefing. It adds $7 billion over 10 years to fight opioid abuse and for mental health in the Medicaid program.

WHY THIS MATTERS

Cuts to Medicare and Medicaid mean uncompensated care to providers, or a reduction in the government payments.

The American Hospital Association said, “The budget request, which is not binding, proposes hundreds of billions of dollars in reductions to Medicare and Medicaid over 10 years.”

AHA President and CEO Rick Pollack said, “Every year, we adapt to a constantly changing environment, but every year, the Administration aims to gut our nation’s healthcare infrastructure. The proposals in this budget would result in hundreds of billions of dollars in cuts that sacrifice the health of seniors, the uninsured and low-income individuals. This includes the one in five Americans who depend on Medicaid, of which 43% of enrollees are children.

“In addition to the hundreds of billions in proposed reductions to Medicare, the blueprint includes cuts we strongly oppose for care in hospital outpatient departments, teaching hospitals and post-acute care providers. These cuts fail to recognize the crucial role hospitals serve for their communities, such as providing 24/7 emergency services. Post-acute cuts threaten care for patients with the most medically complex conditions.”

 

30 latest hospital credit rating downgrades

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https://www.beckershospitalreview.com/finance/30-latest-hospital-credit-rating-downgrades.html

OR Efficiencies

The following 30 hospital and health system credit rating downgrades occurred in the past six months. They are listed below in alphabetical order.

1. Altru Health System (Grand Forks, N.D.) — from “A-” to “BBB” (Fitch Ratings); from “Baa1” to “Baa2” (Moody’s Investors Service)

2. Augusta (Ga.) University Health System — from “Baa1” to “Baa3” (Moody’s Investors Service); from “BBB” to “BBB-” (S&P Global Ratings)

3. Bibb County Medical Center (Centreville, Ala.) — from “BBB+” to “BB” (S&P Global Ratings)

4. Boone Hospital Center (Columbia, Mo.) — from “Baa2” to “Ba1” (Moody’s Investors Service); from “A-” to “BBB” (Fitch Ratings)

5. Covenant Health (Tewksbury, Mass.) — from “BBB+” to “BBB” (Fitch Ratings)

6. Delta (Colo.) County Memorial Hospital — from “BB+” to “BB” (S&P Global Ratings)

7. Erlanger Health System (Chattanooga, Tenn.) — from “Baa2” to “Baa3” (Moody’s Investors Service)

8. Excela Health (Greensburg, Pa.) — from “A3” to “Baa1” (Moody’s Investors Service)

9. Fairfield Medical Center (Lancaster, Ohio) — from “Baa3” to “Ba2” (Moody’s Investors Service)

10. Hospital Sisters Health System (Springfield, Ill.) — from “AA-” to “A+” (S&P Global Ratings)

11. Indiana (Pa.) Regional Medical Center — from “Ba1” to “Ba2” (Moody’s Investors Service)

12. Integris (Oklahoma City) — from “A1” to “A2” (Moody’s Investors Service)

13. Mercy Medical Center (Des Moines, Iowa) — from “A” to “A-” (S&P Global Ratings)

14. Methodist Hospitals (Gary, Ind.) — from “BBB” to “BBB-” (S&P Global Ratings)

15. Murray (Ky.) Calloway County Hospital — from “Baa3” to “Ba2” (Moody’s Investors Service)

16. Nicklaus Children’s Hospital (Miami) — from “A+” to “A” (S&P Global Ratings)

17. OSF HealthCare (Peoria, Ill.) — from “A2” to “A3” (Moody’s Investors Service)

18. Parmer County (Texas) Hospital District — from “Baa1” to “Baa2” (Moody’s Investors Service)

19. Princeton (W.Va.) Community Hospital — from “BBB+” to “BBB” (S&P Global Ratings)

20. ProMedica Health System (Toledo, Ohio) — from “Baa1” to “Baa3” (Moody’s Investors Service); from “BBB+” to “BBB” (Fitch Ratings)

21. Regional West Health Services (Scottsbluff, Neb.) — from “BBB” to “BB+” (Fitch Ratings)

22. Sanford Health (Sioux Fall, S.D.) — from “A1” to “A2” (Moody’s Investors Service)

23. South Nassau Communities Hospital (Oceanside, N.Y.) — from “Baa1” to “Baa2” (Moody’s Investors Service)

24. Southeastern Regional Medical Center (Lumberton, N.C.) — from “A-” to “BBB+” (Fitch Ratings)

25. Sparrow Health System (Lansing, Mich.) — from “A1” to “A2” (Moody’s Investors Service)

26. St. John’s Riverside Hospital (Yonkers, N.Y.) — from “B-” to “CCC+” (S&P Global Ratings)

27. St. Luke’s Hospital (Chesterfield, Mo.) — from “A+” to “A” (S&P Global Ratings)

28. Tower Health (West Reading, Pa.) — from “A” to “BBB” (Fitch Ratings); from “A3” to “Baa2” (Moody’s Investors Service)

29. University of Chicago Medical Center — from “A1” to “Aa3” (Moody’s Investors Service)

30. Winkler County Memorial Hospital (Kermit, Texas) — from “AA” to “BB+” (S&P Global Ratings)

 

 

 

Bipartisan Ways and Means leaders unveil measure to stop surprise medical bills

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https://thehill.com/policy/healthcare/481985-bipartisan-ways-and-means-leaders-unveil-measure-to-stop-surprise-medical?utm_source=&utm_medium=email&utm_campaign=27536

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The bipartisan leaders of the House Ways and Means Committee on Friday released their legislation to protect patients from getting massive, surprise medical bills as congressional action on the subject intensifies.

The legislation is backed by the panel’s chairman, Rep. Richard Neal (D-Mass.), and its top Republican, Rep. Kevin Brady (Texas). It would protect patients from getting bills for thousands of dollars when they go to the emergency room and one of their doctors happens to be outside their insurance network.

Surprise billing is seen as a rare area of possible bipartisan action this year and has support from President Trump.

But the effort has been slowed by varying approaches and intense lobbying from doctor and hospital groups.

The Ways and Means bill is a rival approach to the bipartisan bill passed out of committee last year by the House Energy and Commerce Committee.

The divide between those two committees will have to be overcome for any bill to move forward.

Neal and Brady said in a statement Friday that their approach “differs” from others because “we create a more balanced negotiation process.”

“Our priority throughout the painstaking process of crafting our legislation has been to get the policy right for patients, and we firmly believe that we have done that,” Neal and Brady said. “We look forward to working with our Democratic and Republican colleagues in Congress, as well as the Administration, to advance this measure swiftly.”

The Ways and Means Committee is planning to vote on the legislation next week.

While all sides in the surprise billing fight agree the patient should be protected, the main dispute has been how much the insurer will pay the doctor once the patient is taken out of the middle. 

Doctors and hospitals have lobbied hard against the Energy and Commerce approach, which they fear would lead to damaging cuts to their payments. That approach sets the payment based on the median rate in that geographic area, with the option of going to arbitration for some high-cost bills.

The Ways and Means approach has generally been seen as more favorable to doctors and hospitals, but industry groups have not yet responded to the details on Friday morning.

The Ways and Means bill gives the decision on how much the insurer should pay the doctor to an outside arbiter, although that arbiter will have to consider the median rate usually paid for that service in making its decision.

The House Education and Labor Committee is also planning to vote on legislation next week, and released a bill on Friday that closely reflects the Energy and Commerce and Senate Health Committee legislation, isolating Ways and Means.

Shawn Gremminger, senior director of federal relations at the liberal health care advocacy group Families USA, said it is “disappointing” that Ways and Means is using an approach that will not lower health costs as much, but he said it is good the process is moving forward.

The Energy and Commerce leaders, along with leaders of the Senate Health Committee, who also back their bill, released a conciliatory statement on Friday about the Ways and Means bill.

“Protecting innocent patients has been our top goal throughout this effort, and we appreciate that the other two House committees share this priority,” said Reps. Frank Pallone Jr. (D-N.J.) and Greg Walden (R-Ore.) and Sens. Lamar Alexnader (R-Tenn.) and Patty Murray (D-Wash.). “We look forward to working together to deliver a bill to the president’s desk that protects patients and lowers health care costs for American consumers.”

 

 

Patients Caught In Crossfire Between Giant Hospital Chain, Large Insurer

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Patients Caught In Crossfire Between Giant Hospital Chain, Large Insurer

After Zoe Friedland became pregnant with her first child, she was picky about choosing a doctor to guide her through delivery.

“With so many unpredictable things that can happen with a pregnancy, I wanted someone I could trust,” Friedland said. That person also had to be in the health insurance network of Cigna, the insurer that covers Friedland through her husband’s employer.

Friedland found an OB-GYN she liked, who told her that she delivered only at Sequoia Hospital in Redwood City, California, a part of San Francisco-based Dignity Health. Friedland and her husband, Bert Kaufman, live in Menlo Park, about 5 miles from the hospital, so that was not a problem for them — until Dec. 12.

That’s the day Friedland and Kaufman received a letter from Cigna informing them their care at Sequoia might not be covered after Jan. 1. The insurance company had not signed a contract for 2020 with the hospital operator, which meant Sequoia and many other Dignity medical facilities around the state would no longer be in Cigna’s network in the new year.

Suddenly, it looked as if having their first baby at Sequoia could cost Friedland and Kaufman tens of thousands of dollars.

“I was honestly shocked that this could even happen because it hadn’t entered my mind as a possibility,” Friedland said.

She and her husband are among an estimated 16,600 people caught in a financial dispute between two gigantic health care companies. Cigna is one of the largest health insurance companies in the nation, and Dignity Health has 31 hospitals in California, as well as seven in Arizona and three in Nevada. The contract fight affects Dignity’s California and Nevada hospitals, but not the ones in Arizona.

“The problem is price,” Cigna said in a statement just before the old contract expired on Dec. 31. “Dignity thinks that Cigna customers should pay substantially more than what is normal in the region, and we think that’s just wrong.”

Tammy Wilcox, a senior vice president at Dignity, said, “At a time when many nonprofit community hospitals are struggling, Cigna is making billions of dollars in profits each year. Yet Cigna is demanding that it pay local hospitals even less.”

In 2018, the most recent full year for which earnings data is available, Cigna generated operating income of $3.6 billion on revenue of approximately $48 billion. Dignity Health reported operating income of $529 million on revenue of $14.2 billion in its 2018 fiscal year.

It’s possible Cigna and Dignity can still reach an agreement. Both sides said they will keep trying, though no talks are scheduled.

Disagreements between insurers and health systems that leave patients stranded are a perennial problem in U.S. health care. Glenn Melnick, a professor of health economics at the University of Southern California, said such disputes, which are disruptive to consumers, are often settled.

Melnick believes Dignity is using an “all or nothing” strategy in contract negotiations, meaning either all its facilities are in the insurer’s network or none are.

“This allows them to increase their market power to get higher prices, which is not necessarily good for consumers,” Melnick said.

Dignity replied in an emailed statement: “We do not require payers to contract with all or none of Dignity Health’s providers. We do try to make sure patients have access to the full range of Dignity Health services and facilities in each of our communities.”

Dignity faces a number of legal and financial challenges while it works to implement a February 2019 merger with Englewood, Colorado-based Catholic Health Initiatives that created one of the nation’s largest Catholic hospital systems — known as CommonSpirit Health.

California Attorney General Xavier Becerra approved the deal with conditions, including that Dignity’s California hospitals spend $10 million in the first three years on services for people experiencing homelessness and offer free care to more low-income patients.

The requirement to treat more poor patients at no charge followed a period, from 2011 to 2016, in which Dignity’s charity care declined about 35% while its net income was $3.2 billion.

Last October, CommonSpirit announced an operating loss of $582 million on revenue of nearly $29 billion for the 2019 fiscal year, its first annual financial statement after the merger took effect. Much of the loss was due to merger-related costs and special charges.

The same month, Dignity completed a five-year “corporate integrity agreement” with the U.S. Office of the Inspector General following an investigation into how it billed the government for hospital inpatient stays. Dignity said it “fully complied” with the agreement.

Dignity is also defending itself in a class-action lawsuit alleging that it bills uninsured patients at grossly inflated rates even though it claims to provide “affordable” care at “the lowest possible cost.”

More recently, an appeals court judge ruled Dignity could not charge higher prices — often a lot higher than state-set rates — for treating enrollees of L.A. Care’s Medi-Cal health plan at its Northridge Hospital Medical Center.

Dignity disagreed with the court’s ruling in that case, saying that although the Northridge facility did not have a contract with L.A. Care, many of the health plan’s enrollees who initially sought emergency treatment there stayed in the hospital for additional care after they had been stabilized. The hospital “seeks appropriate reimbursement for providing this care,” Dignity said.

If Dignity does not reach an agreement with Cigna, its hospitals, outpatient surgery centers and medical groups in most of California will soon be out-of-network for many Cigna enrollees. In-network coverage for Open Access (OAP) and Preferred Provider (PPO) ended Feb. 1, and for HMO patients it is set to end April 1.

Peter Welch, president and general manager for Cigna in Northern California and the Pacific Northwest, said Cigna can provide “adequate access” to other hospitals and doctors.

Certain Cigna enrollees can apply to continue visiting Dignity facilities and doctors under California’s Continuity of Care law, enacted in 2014. Eligible enrollees include patients with chronic conditions, those already scheduled for pre-authorized services, people in need of emergency care and pregnant women in their third trimester.

Friedland and Kaufman applied, hoping she would be able to continue seeing her Dignity-affiliated OB-GYN at in-network rates.

On Jan. 22, less than a month from Friedland’s Feb. 15 due date, they received written confirmation that their request had been approved. They wouldn’t have to shop for a new doctor or face stiff medical bills after all.

Early Tuesday evening, Friedland gave birth to a baby girl, Eliza, who entered the world 11 days earlier than expected, weighing in at 7 pounds, 3 ounces.

“While the ordeal was stressful, and the communication fraught, we were happy to receive confirmation of continuity of care and that it ended in the best possible way — with the birth of our healthy baby daughter with the provider where we established care,” Kaufman said. “For the sake of those caught in the middle and now having to start relationships with new health care providers, we hope the two sides can come to an agreement.”

 

 

 

Payers, providers urge CMS to scrap rule targeting supplemental Medicaid payments

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https://www.healthcaredive.com/news/payers-providers-urge-cms-to-scrap-rule-targeting-supplemental-medicaid-pa/571573/

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Dive Brief:

  • Payer and provider lobbying groups are urging CMS to pull back a proposed rule that aims to clamp down on supplemental Medicaid payments in order to contain spending growth.
  • The American Hospital Association wants CMS to withdraw the rule, warning it would “severely curtail the availability of health care services to millions of individuals,” according to comments it submitted in response to the proposal.
  • The insurance lobby wants CMS to start with a “more limited initial step” and focus on gathering data so it can “fully assess the current landscape of state Medicaid funding and payment mechanisms,” America’s Health Insurance Plans said in its comments. The Association for Community Affiliated Plans also asked the agency to withdraw the rule.

Dive Insight:

A sharp rise in these supplemental Medicaid payments caught the attention of CMS as spending has continued to increase and much of the growth has come from the federal share of the program, according to the agency.

These supplemental payments from the federal government to the states have risen from 9.4% of all other payments in fiscal year 2010 to 17.5% in 2017. This growth comes with “an urgent responsibility to ensure sound stewardship and oversight of the Medicaid program,” CMS said in November as it rolled out the proposed rule called Medicaid Fiscal Accountability Regulation.

A 2015 Government Accountability Office report found that states are increasingly relying on providers to help them finance the state’s portion of Medicaid funding. “A small number of providers supplied funds to the state for the nonfederal share, generally through intergovernmental fund transfers or provider taxes, and in turn received large supplemental payments, enabling states to obtain billions of dollars in additional federal matching funds,” according to the report.

CMS argues the proposed rule, which calls for states to provide more detailed information on these supplemental payments, including provider-specific payment data, would help beef up its oversight of the program.

AHA warned, however, the rule could cut Medicaid payments to hospitals by up to $31 billion annually, or nearly 17% of total hospital program payments. The group also argued the changes violate the Administrative Procedures Act and due process protections in the Constitution.

The Association of American Medical Colleges also opposed the rule, saying it would “limit the federal government’s congressionally mandated responsibility to the Medicaid program and could result in reductions in coverage, access, and quality care for the millions of vulnerable patients who rely on this critical program.”

CMS and the GAO report have noted a lack of data about these payments once they reach the states, making it hard to do any sort of analysis. In fact, GAO complained that the state of California did not have data on these payments for the agency to do an assessment.

 

First Case of Coronavirus Lands in U.S.

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Health System, Hospital, Hospital Industry, Infection Control, Infectious Virus, Novel Coronavirus, World Health Organization (WHO) • Leave a comment

https://www.medpagetoday.com/infectiousdisease/publichealth/84458?xid=NL_breakingnewsalert_2020-01-21&eun=g885344d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=VirusUpdateAlert_012120&utm_term=NL_Daily_Breaking_News_Active

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The first travel-related case of the novel coronavirus has been detected in the U.S. in a man from Washington state, CDC officials said on Tuesday.

The man tested positive for the novel coronavirus via laboratory testing, CDC officials said. According to Washington health officials, he arrived without symptoms on an “indirect” flight into Seattle-Tacoma International Airport on Jan. 15, prior to implementation of the new screening procedures at other U.S. airports. Described as “an astute gentleman,” the passenger was aware of the virus and promptly shared information with his provider when his symptoms developed.

Currently, the patient is hospitalized “out of an abundance of caution,” but not because of severe illness. He reported he did not visit any of the implicated markets in the Wuhan area.

A statement released by the CDC details how the man sought care at a nearby medical facility, where health professionals suspected novel coronavirus, and based on the patient’s travel history and symptoms, sent specimens out for testing. CDC confirmed the diagnosis on Monday.

Washington health officials emphasized that this was one of the hospitals that had “done a drill” about this type of illness, including how to transport a patient in an ambulance and what type of isolation is needed. They said that the patient here is “isolated and poses low risk to staff or to the general public.”

Julie Fischer, PhD, of Georgetown University in Washington, D.C., told MedPage Today that this looks to be a similar pattern for human-to-human transmission as SARS, where currently most cases of this novel coronavirus “are probably close contacts,” including healthcare workers. Chinese health officials announced that 14 healthcare workers had been infected.

“This is a big heads up to the rest of the world to go ahead and start preparing your healthcare workers and make sure they have proper equipment,” she said. “It’s a reminder of what we already knew was a risk.”

Fischer said that in addition to taking precautions to avoid infection (such as personal protective equipment), clinicians should “pay attention to evolving guidance.”

The CDC had already decided to step up screening at two additional U.S. airports prior to this case being reported, with additional screening being added at both Hartsfield-Jackson Atlanta International Airport (ATL) and Chicago O’Hare International Airport (ORD) this week. In addition, passengers from Wuhan will be “funneled” into airports with enhanced screening measures, CDC officials said.

“The long incubation period [for the virus] also makes early detection much harder, especially as we do not know how many passengers have flown abroad and how many will do so in the coming weeks,” Stratfor Senior East Asia analyst Zhixing Zhang said in a statement.

Fischer added that screening will be especially challenging, given that this is in the middle of increased flu activity in the U.S. and that clinicians must rely on a “non-specific, place-based case definition” (based on travel) until new diagnostics emerge.

She emphasized the importance of “a good diagnostic test,” saying that only a handful of labs are capable of testing for the virus now. Once molecular testing is available, such as a polymerase chain reaction (PCR) test, the CDC will figure out how best to optimize it and share it more widely, Fischer said.

Indeed, CDC officials said that they are having “active conversations” about diagnostics, as well as research into vaccines.

Over the weekend, the case count for the novel coronavirus rose to over 300, with 6 deaths, according to news reports. The World Health Organization (WHO) is scheduled to meet on Wednesday about whether this virus constitutes an international health emergency.

 

 

MedPAC: 340B hospitals spent more on lung, prostate cancer drugs compared to other facilities

Posted on by • Posted in Government Accountability Office, Health System, Hospital, Hospital Industry, Lung Cancer, Medicare 340B Drug Discount Program, Medicare Payment Advisory Commission (MedPAC), Pharmaceutical Industry, Prostate Cancer, Safety Net Hospitals, Safety-Net Providers • Leave a comment

https://www.fiercehealthcare.com/hospitals-health-systems/medpac-340b-hospitals-spent-more-cancer-drugs-compared-to-other-facilities?mkt_tok=eyJpIjoiTTJaaE5EY3lZMlEzTVdZdyIsInQiOiI1UEZJUjBpbldUSVBteFl3OGpnd0FPRnIxMFJFUXIzSjE1YUJDMVdDSSsrdDlibDI1KzU5bXZsU1RIUjBZUWNPR2s1OTdwQXV5ZVY2cUhuWXkzYnpDWE55akhCczMxOVEyRWdpdkNYK1hKcjdIV01qNTdPemxyWkFVK1pDUmNzNyJ9&mrkid=959610

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Hospitals in the 340B drug discount program spent more on drugs for prostate and lung cancers compared to facilities not in the program, a new analysis found.

But the preliminary analysis from the Medicare Payment Advisory Commission (MedPAC) couldn’t find that the controversial program incentivizes hospitals to pursue higher-priced drugs. The analysis, released Friday as part of MedPAC’s monthly meeting, was requested by Congress on the program, which has faced major cuts by the Trump administration.

Some lawmakers have argued that 340B, which offers safety-net hospitals discounts on drugs, has not worked as intended and led to hospitals specifically choosing higher-priced drugs to get a big discount.

So MedPAC looked at the spending from 2013 to 2017 of 340B and non-340B hospitals as well as physicians’ offices for five types of cancers: breast, colorectal, prostate, lung and leukemia and lymphoma.

MedPAC’s analysis found that 340B hospitals spent between 2% and 5% higher on average on cancer drugs than non-340B hospitals. But there were mixed results when 340B hospitals were compared to physicians’ offices, with 340B facilities spending 1% lower to 7% higher than physicians’ offices on cancer drugs.

The reason 340B hospitals spent more on cancer drugs than hospitals not in the program was linked to two types of cancer: lung and prostate.

For lung cancer, a possible reason for the higher spending is that a larger share of patients in 340B hospitals received new immuno-oncology therapies that are more expensive, MedPAC said. Prostate cancer also had higher drug prices per unit for both drugs in Medicare Part B, which reimburses for physician-administered drugs, and Part D.

However, MedPAC staff cautioned they couldn’t conclude 340B is incentivizing the spikes in spending.

The reason is “we lack access to the discount data,” said MedPAC staffer Shinobu Suzuki at the commission’s meeting Friday in Washington, D.C.

MedPAC also didn’t find that gaining 340B status led to a spike in average cancer drug spending, suggesting that 340B discounts “may not have had any effects on them,” the report said.

The analysis also found that the higher cancer spending would likely have a small, if any, impact on cost sharing for Medicare patients depending on the type of cancer and supplemental coverage.

The study will be finalized and likely included in MedPAC’s March report to Congress. It comes with some caveats, including a small sample size and that it did not examine the impact of a 22.5% cut to 340B payments that went into effect in 2018.

The hospital industry has been fighting the Trump administration in court over the cuts, which the industry claims are unlawful.

Despite the caveats, MedPAC’s findings could play a major part in lawmaker deliberations on the program, which some Republicans claim has gotten too big and led to hospitals bilking the federal government.

The pharmaceutical industry has also led an extensive campaign to shed more light on the program. 340B requires pharmaceutical companies to provide discounts to safety-net hospitals in exchange for participating in Medicaid.

The Government Accountability Office has also called for greater oversight of 340B.

340B industry group 340B Health praised the findings.

“The thoughtful analysis MedPAC presented today sheds important light on the role 340B hospitals play in treating people living with cancer,” said Maureen Testoni, 340B Health president, in a statement.

 

MARTIN LUTHER KING JR.’S HEALTHCARE JUSTICE ADVOCACY MAKES AMERICA’S HOSPITALS BETTER TODAY

Posted on by • Posted in American Medical Association (AMA), Brown vs Board of Education, Children's Health, Children's Health Insurance Coverage, Children's Hospital, Civil Rights Act of 1964, Health Insurance Coverage Adequacy, Health Policy, Health System, Hospital, Hospital Industry, Martin Luther King, Medicaid, Medicare, Standard of Care • Leave a comment

Martin Luther King Jr.’s Healthcare Justice Advocacy Makes America’s Hospitals Better Today

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Every January, the United States celebrates the lasting legacy of Dr. Martin Luther King Jr. Not widely known is how his civil rights advocacy made a lasting impact on modern-day hospitals, including children’s hospitals.

Today in 170 Children’s Miracle Network Hospitals, every young patient is treated regardless of their race or background. CMN Hospitals are deeply committed to offering world-renowned treatment to all kids in need and that’s why donations to your local hospital can make such a difference for families facing health crises.

Unfortunately, certain hospitals in America were still segregated in the not too recent past. When Brown vs. Board of Education passed in 1954, schools began to desegregate, and this paved the way for institutions like hospitals to follow suite. King’s healthcare justice advocacy advanced health care access in particular for the African American community.

A History of Unequal Healthcare

When patients enter a hospital, they expect to receive a standard of care that will improve their lives regardless of who they might be. That expectation, unfortunately, has not always been backed up by medical institutions across the United States. African Americans, in particular, experienced a history of receiving substandard care and outright abuse within the framework of medical science.

Notable examples of this include:

While the details of those specific examples weren’t publicly known in the 1960s, African Americans were certainly aware that they received care that was inferior to white patients. Doctors and hospitals continued perpetuating this double standard even after the passage of the Civil Rights Act in 1964. The disparity in treatment quality was so egregious that Dr. Martin Luther King Jr. spoke out against it, calling for an awakening in the conscience of the United States.

Desegregating Hospitals

King uttered his famous words on healthcare while addressing the press before attending the annual meeting of the Medical Committee for Human Rights, an organization formed because the American Medical Association was segregated at the time. “Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death,” said King.

The Civil Rights Act of 1964 isn’t typically associated with healthcare. However, at that point in history, it was well known that some hospitals and medical institutions were resisting the push for desegregation, a practice which hospitals used to provide less than adequate care to African American patients. Hospitals would continue to hold onto such discriminatory practices unless something was done.

Legal Gains for Equality in Hospitals

The reason King spoke out so vehemently in 1966 was due to the passage of Medicare and Medicaid in 1965, something that was only possible due to the efforts of the Medical Committee for Human Rights and its head, W. Montague Cobb. The organization made use of the non-violent protest strategies of King and the Civil Rights Movement. The passage of the Social Security Act, which created Medicare and Medicaid brought federal funding into every hospital and medical institution in the United States, forever binding each facility to the Civil Rights Act, a stipulation of which was that any organization receiving federal funding could not discriminate on the basis of race.

From that point onward, hospitals that clung to the old ways of discrimination were subject to lawsuits from mistreated African Americans and pressure from activists like King and the Medical Committee for Human Rights. This gave King the legal ground to stand on when calling on hospitals to abandon the evil practice of systemic discrimination in 1966 with those now famous words from that 1966 conference.

While we know there’s more work to be done to promote equal healthcare access to every child in need across North America, we’re proud that our non-profit children’s hospitals can be a part of the solution.

Thank you, King.

 

 

 

 

MedPAC recommends 3.3% payment boost for hospitals in 2021

Posted on by • Posted in Health Policy, Health System, Hospital, Hospital Industry, Medicare, Medicare Payment Advisory Commission (MedPAC) • Leave a comment

https://www.beckershospitalreview.com/finance/medpac-recommends-3-3-payment-boost-for-hospitals-in-2021.html?utm_medium=email

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The Medicare Payment Advisory Commission voted unanimously Jan. 16 to recommend a 3.3 percent raise in Medicare payments for hospitals next year.

The commission said it wants to give hospitals a 2 percent boost overall and tie the other 1.3 percent to quality metrics to motivate hospitals to reduce mortality and improve patient satisfaction.

CMS has scheduled a 2.8 percent increase in 2021 Medicare payments.

MedPAC said it is recommending the payment boost to reduce the disparity in payments at different care sites and is part of a larger effort to introduce site-neutral payments.

Congress is not required to implement the recommendation.

 

 

 

The health care debate we ought to be having

Posted on by • Posted in 2020 Election Issues, Cost Management, Health Policy, Health System, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Hospital, Hospital Industry, Market Consolidation, Market Failure, Market Power, Medicare, Medicare for All, Out of Network, Out of Pocket Expenses, Pharmaceutical Industry, Private Equity, Status Quo • Leave a comment

https://www.axios.com/what-matters-2020-health-care-costs-7139f124-d4f7-44a1-afc2-6d653ceec77d.html

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Americans worry a lot about how to get and pay for good health care, but the 2020 presidential candidates are barely talking about what’s at the root of these problems: Almost every incentive in the U.S. health care system is broken.

Why it matters: President Trump and most of the Democratic field are minimizing the hard conversations with voters about why health care eats up so much of each paycheck and what it would really take to change things.

  • Instead, the public debate focuses on ideas like how best to cover the uninsured and the relative virtue of health care “choice.”

The U.S. spent $3.6 trillion on health care last year, and almost every part of the system is pushing its costs up, not down.

 

Hospitals collect the biggest piece of the health care pie, at about $1 trillion per year.

  • Their incentive is to fill beds — to send as many bills as possible, for as much as possible.
  • Big hospital systems are buying up smaller ones, as well as physician practices, to reduce competition and charge higher prices.
  • And hospitals have resisted efforts to shift toward a system that pays for quality, rather than volume.

 

Drug companies, meanwhile, are the most profitable part of the health care industry.

  • Small biotech companies usually shoulder the risk of developing new drugs.
  • Big Pharma companies then buy those products, market them aggressively and develop a fortress of patents to keep competition at bay as long as possible.

 

The money bonanza is enticing some nontraditional players into the health care world.

 

Insurers do want to keep costs down — but many of their methods are deeply unpopular.

  • Making us pay more out of pocket and putting tighter restrictions on which doctors we can see create real and immediate headaches for patients.
  • That makes insurers the most convenient punching bag for politicians.

 

The frustrating reality: Democrats’ plans are engaging in the debate about possible solutions more than the candidates themselves.

  • It’s a tacit acknowledgment of two realities: That controlling the cost of care is imperative, and that talking about taking money away from doctors and hospitals is a big political risk.

 

What they’re saying: The top 2020 Democrats have actually released “insanely aggressive” cost control ideas, says Larry Levitt, executive vice president at the Kaiser Family Foundation. “But they don’t talk about that a lot.”

  • Medicare for All, the plan endorsed by Sens. Bernie Sanders and Elizabeth Warren, would sharply reduce spending on doctors and hospitals by eliminating private insurance and paying rates closer to Medicare’s. Estimates range from about $380 billion to nearly $600 billion in savings each year.
  • Joe Biden and Pete Buttigieg have proposed an optional Medicare-like insurance plan, which anyone could buy into. It would pay providers less than private insurance, with the hopes of putting competitive pressure on private plans’ rates.
  • The savings there would be smaller than Medicare for All’s, but those plans are still significantly more ambitious than the Affordable Care Act or most of the proposals that came before it.

 

Yes, but: The health care industry has blanketed Iowa with ads, and is prepared to spend millions more, to defend the very profitable status quo.

  • The argument is simple: Reframe the big-picture debate about costs as a threat to your doctor or your hospital. It’s an easy playbook that both parties, and the industry, know well. And it usually works.

 

The bottom line: “Voters want their health care costs reduced, but that doesn’t mean they would necessarily support what it would take to make that happen,” Levitt said.