What health care is getting out of the stimulus package

https://www.axios.com/health-care-hospitals-coronavirus-stimulus-package-c49bd0cc-05a0-479a-a83d-d4455bd0e7bd.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

Senate passes $2 Trillion coronavirus economic stimulus plan, it ...

Congress’ big stimulus package will provide more than $100 billion and several favorable payment policies to hospitals, doctors and others in the health care system as they grapple with the coronavirus outbreak.

The big picture: Hospitals, including those that treat a lot of rural and low-income patients, are getting the bailout they asked for — and then some.

The cornerstone provision is a no-strings-attached $100 billion fund for hospitals and other providers so they “continue to receive the support they need for COVID-19 related expenses and lost revenue,” according to a summary of the legislation.

  • It’s unclear how that money would be divvied up. One lobbyist speculated the funds would go to the “hardest-hit areas first and those areas that are next expected to get hit,” but that has not been clarified.

The bill provides many other incentives for the industry.

  • Hospitals that treat Medicare patients for COVID-19 will get a 20% payment increase for all services provided. That means Medicare’s payment for these types of hospital stays could go from $10,000 to $12,000, depending on the severity of the illness.
  • Employers and health insurers will be required to pay hospitals and labs whatever their charges are for COVID-19 tests if a contract is not in place. By comparison, Medicare pays $51.33 for a commercial coronavirus test.
  • Medicare’s “sequestration,” which cuts payments to providers by 2%, will be lifted until the end of this year.
  • Labs won’t face any scheduled Medicare cuts in 2021, and won delays in future payment cuts as well.

What’s missing: Patients who are hospitalized with COVID-19 could still be saddled with large, surprise bills for out-of-network care.

  • There also are no subsidies for COBRA coverage, which employers wanted for people who lost their jobs. However, people who are laid off are able to sign up for a health plan on the Affordable Care Act’s marketplaces or could qualify for Medicaid.

 

 

 

 

Everybody wants a piece of the stimulus

https://www.axios.com/newsletters/axios-vitals-a411a6cb-fd41-45d9-9dcb-da9136c68ea6.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

Image result for axios vitals Everybody wants a piece of the stimulus

Lobbyists are racing to grab a piece of the stimulus package lawmakers are still trying to hammer out on Capitol Hill, Bob writes.

Driving the news: Hospitals and physicians want at least $100 billion and significant Medicare payment hikes, partially because they’ve had to cancel lucrative elective procedures.

  • Hotels, airlines, restaurants, casinos, manufacturers and other service industries that have been battered by the coronavirus spread are angling to get hundreds of billions in loans and other funding.
  • A coalition of major employers is lobbying Congress for payroll tax credits and coverage subsidies for people who lose their jobs.

The intrigue: The chance for federal bailouts has motivated small players to make bigger investments, and some nontraditional parties are spending their first lobbying dollars.

 

 

 

 

Op-Ed: As a doctor, I use telemedicine. With the coronavirus threat, it could revolutionize healthcare

https://www.latimes.com/opinion/story/2020-03-17/op-ed-as-a-doctor-i-use-telemedicine-with-the-coronavirus-threat-it-could-revolutionize-healthcare?fbclid=IwAR1D6sHWYhvei0Hda4dRuqRaydyxO7AVRjWQj-2UTFqwf3gdKaWuVfxa2Hs

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As a physician, waiting for the worst of coronavirus to hit, I see a lot to fear. It seems increasingly likely that this will be one of the most significant pandemics in modern human history, and that it will change our approach to healthcare going forward. But not all of its legacy will be negative. Here’s one thing I hope will come out of the crisis: an increased reliance on telemedicine, something that should have happened long ago.

A few months ago, when I was between jobs, I took a part-time job in a rural hospital serving a county of more than 150,000 people. On the verge of bankruptcy, the hospital was unable to attract many specialists to join its ranks, and in desperation, had turned to telemedicine to cover many services. So, for example, if a patient was rushed to the emergency room after a stroke, there was unlikely to be a neurologist in the room. Instead, a neurologist would assess the patient on a mobile screen from far away, with local nursing staff and doctors aiding him or her.

I had been skeptical of telemedicine going in. Physical exams are the bedrock of how doctors and nurses assess patients. We look patients and their loved ones in the eye, palpate sore spots with our fingers and offer comfort with a hand on a shoulder. Physical contact, I’d always thought, was at the heart of how doctors and patients communicate.

It was with this skepticism that I found myself next to a young man who been brought to the emergency room after attempting to take his own life. Again. This time, instead of seeing a psychiatrist in person, he saw one on a screen with wheels. The psychiatrist was in some distant location, but she had been in touch with the local doctors and had access to his medical records. Despite her physical remoteness, she connected with him, and he opened up. She knew of all the local resources to refer him to, and at the end of her conversation, she had developed a real rapport with him. After the visit ended and the nurse wheeled the monitor out of the room, I asked the young man what he thought, and to my surprise, he told me he was more comfortable with this than an in-person visit. He wasn’t the only one — many patients say they prefer a virtual doc to one sitting across from them.

Over the past few decades, medical care has been transformed by technology. Whenever a new drug becomes available, or a medical procedure is approved by the FDA, the medical community is quick to deploy it. Yet, when it comes to how we see patients, our current practices haven’t changed much since the time of Hippocrates. If a patient is sick they either have to come see us in clinic, urgent care, the emergency room or the hospital. Despite the internet transforming every aspect of our lives, from how we find love to how we order groceries, the way we deliver medical care has stagnated.

In the United States, not only are doctors often inaccessible for those living in rural areas, hospitals everywhere have huge economic challenges. One healthcare executive jokingly told me his hospital made more money from its parking lots than its clinics.

The response to COVID-19 might help change that.

One of the main reasons China has been able to slow coronavirus transmission has been because of a dramatic increase in virtual visits. In fact, China has moved half of all medical care online, allowing patients to consult with their doctors and get prescriptions from the comfort of their homes. Hospitals have been notorious petri dishes for deadly bugs since long before COVID-19, and this pandemic has brought that risk into crystal-clear focus. On Tuesday, Medicare announced that it will greatly expand coverage for telemedicine visits, previously sharply restricted. And at a White House briefing, the government announced it was urging states to similarly expand Medicaid coverage to include telemedicine visits by Skype, Facetime or other platforms. Some insurers have also said they will cover telehealth visits at parity with in-person visits.

These measures are commendable, but policies need to be put in place to ensure that the expansion of telemedicine is not temporary. Of course, in-person visits will still be necessary in many cases. But supporting telemedicine on a par with such visits has the potential to protect patients and healthcare personnel and allow for much more efficiency in the system. That said, physicians and nurses will need high-quality training to provide compassionate and thorough care to a patient from across a computer screen. Technology that allows patients to be “examined” remotely needs to be better studied and made more accessible. And since the backbone of telemedicine is reliable high-speed internet, Congress should consider Elizabeth Warren’s plan to bring broadband internet to the remotest parts of this country, to ensure broad access to these services.

This week my team converted most of our clinic visits from face to face to virtual visits. Some were over the phone, others were over video, often with a family member present as well. While there were some patients that still needed to be seen in person, we were able to minimize the risk of viral transmission not only for patients, but also for valuable members of our clinical team. Even before this crisis, as part of my job at the Veterans Affairs Health System in Boston, I often consulted with patients I had never seen as part of an “E Consult” system. While I was initially nervous when I first started doing this, it allowed me to expand my footprint far beyond what I could manage if I were seeing every patient in person.

At some point, I fervently hope the coronavirus will be a thing of the past. But I hope it leaves behind a legacy. I hope it changes how well we wash our hands, how well we fund public health and how well we protect the healthcare workers caring for our sickest patients. And, most of all, I hope it pushes us to embrace telemedicine.

 

 

 

 

MedPAC’s report to Congress: 7 takeaways

https://www.beckershospitalreview.com/finance/medpac-s-report-to-congress-7-takeaways.html?utm_medium=email

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The Medicare Payment Advisory Commission released its March 2020 report on Medicare payment policy to Congress, which includes a chapter analyzing the effects of hospital and physician consolidation in the healthcare sector.

Here are seven takeaways:

1. Medicare’s Insurance Trust Fund is likely to run out without changes. Trustees from Medicare estimate that the program’s Hospital Insurance Trust Fund, mostly funded through a payroll tax, will be depleted by 2026. To keep the fund solvent for the next 25 years, Medicare trustees advise that the payroll tax immediately be raised from 2.9 percent to 3.7 percent, or Part A spending to be reduced by 18 percent.

2. MedPAC recommends boosting payment rate for three sectors:

  • Hospitals. MedPAC recommended 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. Currently, CMS has scheduled a 2.8 percent increase in 2021 Medicare payments.
  • Outpatient dialysis services. MedPAC recommended that the End Stage Renal Disease Prospective Payment System base payment rate is raised by the amount determined under current law. This is projected to be a boost of 2 percent
  • Long-term care hospitals. The commission recommended a 2 percent increase in the payment rates for long-term care hospitals in 2021.

3. MedPAC recommends unchanged payment rates for four sectors:

  • Physicians: Under current law, there is no update to the 2021 Medicare fee schedule base payment rate for physicians who treat Medicare patients. MedPAC is recommending that CMS keeps the physician rate the same as it is this year.
  • Surgery centers. MedPAC recommended eliminating an expected 2.8 percent payment rate bump for surgery centers next year. It said its decision was due to not having enough cost data from surgery centers.
  • Skilled nursing. MedPAC is recommending skilled nursing facilities receive no change to their base rate next year to better align payments with costs while exerting pressure on providers to keep their cost growth low.
  • Hospice. MedPAC recommends that the hospice payment rates in 2021 be held at their 2020 levels

4. MedPAC recommends payment rate reductions for two sectors: 

  • Home health. The commission recommended a 7 percent reduction in home health payment rates for 2021.
  • Inpatient rehabilitation hospitals. MedPAC is recommending that CMS reduce the payment rate to inpatient rehabilitation facilities by 5 percent for fiscal year 2021.

5. MedPAC builds on its recommendation to revamp quality programs. MedPAC is furthering its recommendation to replace Medicare’s four current hospital quality programs with a single hospital value incentive program. MedPAC said it believes that this recommendation would provide hospitals  higher aggregate payments than they would get under current law.

6. MedPAC’s findings on hospital and physician consolidation. MedPAC said that consolidation gives providers greater market power, which has a statistically significant association with higher profit margins for treating non-Medicare patients. Higher non-Medicare margins also are associated with higher standardized costs per discharge. But the direct association between market power and standardized costs per discharge is statistically insignificant, the commission found.

“The effect of consolidation on hospitals’ costs is not clear in theory or from our current analysis. From a theoretical standpoint, the merger of two hospitals could initially create some efficiencies and bargaining power with suppliers. But over time, higher prices from commercial payers could loosen hospitals’ budget constraints and lead to higher cost growth, thus offsetting any efficiency gains,” MedPAC’s report states.

7. MedPAC’s findings on the 340B Drug Discount Program. MedPAC was asked to analyze whether the availability of 340B drug discounts creates incentives for hospitals to choose more expensive products than they would without the program. MedPAC studied the effect of 340B market share on higher drug spending on cancer treatments between 2009 and 2017. The commission found that for two of the five cancer types studied, 340B participation boosted prices by about $300 per patient per month. However, the boost in spending attributed to 340B was much smaller than the general increase in oncology spending, which includes rising prices and the launch of new products with high drug prices. For example, cancer drug spending grew by more than $2,000 per patient month for patients with breast cancer, lung cancer, and leukemia/lymphoma.

“The MedPAC report released today uses rigorous analysis and finds little evidence 340B participation influences cancer drug spending. Modest differences may be attributable to the types of patients treated in 340B facilities. The safety-net hospitals that participate in the 340B drug-pricing program are essential providers of cancer care in this nation, especially to patients who are living with low incomes, those living with disabilities, and patients requiring more complex oncology care,” said Maureen Testoni, president and CEO of 340B Health, an association that represents more than 1,400 hospitals participating in the 340B program.

Access MedPAC’s full report here. 

 

 

 

 

Taking a look at the Biden healthcare plan

https://mailchi.mp/325cd862d7a7/the-weekly-gist-march-13-2020?e=d1e747d2d8

 

Now that the Democratic primary campaign has produced a clear front runner, it’s worth examining Joe Biden’s healthcare plan, which aims to expand the Affordable Care Act (ACA) by increasing access and affordability. As the graphic above highlights, former Vice President Biden has a broad—if at this point, still fairly high-level—proposal that includes a Medicare-like public option along with a variety of other ACA tweaks that aim to offer consumers more options and lower their healthcare costs.

These include allowing individuals in states without Medicaid expansion to join the pubic option premium-free, providing unlimited subsidy eligibility, and limiting drug price increases to the level of consumer inflation.

An independent analysis projects Biden’s plan would cost $2.25T and add an additional $800B to the deficit over 10 years. While large at first blush, these costs pale in comparison to Sen. Bernie Sanders’ Medicare for All plan, which would add a projected $12.95T to the deficit over the same period.

Of course, there are still many unanswered questions in Biden’s proposal, including how much consumers would pay under the public option, how much the public option plan would reimburse providers as a percentage of Medicare, and how the public option would impact competition among private insurers.

A public option offered at a significant discount has the potential to drive private plans out of business, which some project could eventually result in Medicare for All as an ultimate consequence. The devil will, as always, be in the details.

 

Winners and losers of the HHS interoperability final rule

https://www.beckershospitalreview.com/ehrs/winners-and-losers-of-the-hhs-interoperability-final-rule.html?utm_medium=email

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HHS released its much-anticipated final rules on EHR interoperability, ruling against “information blocking” tactics by EHR vendors and giving patients more control over their medical records.

The new rule will be applied over the next two years and will make patient records downloadable to smartphones using consumer apps. Overall, members of the healthcare industry applaud these efforts to make patient information more accessible to improve healthcare delivery. However, there are privacy concerns around how patient data can be used once downloaded to third-party consumer apps that weren’t addressed in the final rule.

Here is a brief list of a few potential winners and losers of the new rule.

 

WINNERS

Patients. Patients now have more control over their medical records and will be able to access them through third-party apps for free, which will make it easier for them to take their medical records to new providers outside of their previous provider’s system. As a result, they will have more choice in where they go for healthcare.

Hospitals and physicians. The lengthy process of trying to convert a patient’s medical records will be unnecessary. Patients will no longer need to have their medical records faxed between healthcare facilities in different networks and the rule will streamline workflow around gathering patient data to provide the best possible care. Hospitals participating in Medicare and Medicaid will also be able to send electronic notifications to other facilities or providers when a patient is admitted, transferred or discharged under its new “Coordination of Participation” rule.

App developers and health IT startups. App developers that allow patients to store their health data and medical information will have access to that data, a virtual gold mine. The federal privacy protections limiting how providers and insurers share medical records do not apply when patients transfer data to consumer apps, according to the New York Times.

Apple and Microsoft. Healthcare providers will be required to send medical data in a format that is compatible on third-party apps including Apple Health Records. Microsoft is also working to sell technology in the health sector, and the new rule will make it easier, according to CNBC.

 

LOSERS

Patients. While the rule has many benefits to patients, there is also potential for disaster. Patients who download their medical information on consumer apps may find their information shared or sold. There could also be additional security issues if those apps are hacked. Finally, some patients may become confused by their medical records and notes if the information isn’t stated clearly, causing further anxiety around their care.

Hospitals and clinics. Patient leakage may become more common if it’s easier for patients to take their medical records with them. Healthcare organizations will also need to prepare for an influx of patient data and have strong governance procedures in place as they partner with payers and other organizations to incorporate clinical data with patient-gathered data and potentially social determinants of health data.

EHR vendors. EHR companies must now adopt application programming interfaces so their systems can communicate with third-party apps. EHR companies have two years to comply and face up to $1 million per violation for engaging in “information blocking.” The new focus on interoperability may also pave the way for competitors to gain market share over the two most dominant players, Epic and Cerner.

Epic. Epic was a notable opponent to the HHS interoperability rules, citing patient privacy concerns. If forced to collaborate with other companies, Epic could potentially lose its edge over competitors, according to an op-ed written by former HHS Secretary Tommy Thompson in the Wisconsin State Journal. He contended Epic would have to “give its trade secrets away to venture capitalists, Big Tech, Silicon Valley interests and overseas competitors for little or no compensation.” Epic is also the most dominant EHR, holding 28 percent of the acute care hospital market, which could be threatened by greater interoperability. However, in response to the final rule’s release, Epic issued a statement saying that it would focus on “standards-based scope for meaningful interoperability.”

 

Two candidates remain: Mr. Medicare for All and Mr. Public Option

https://mailchi.mp/9e118141a707/the-weekly-gist-march-6-2020?e=d1e747d2d8

Image result for Medicare for All and Public Option

The past week in Presidential politics has been momentous—but not clarifying—for determining both the eventual Democratic nominee and the healthcare platform of the party. Between the first ballots cast in South Carolina and the last votes counted in California, the field of viable candidates for the nomination has been winnowed to two: Vermont Sen. Bernie Sanders and former Vice President Joe Biden. The coming weeks will feature a knock-down, drag-out fight for delegates in the run-up to what is likely to be a contested convention in Milwaukee in mid-July, pitting Biden’s “establishment” wing of the party against Sanders’ “progressive” wing.

On the healthcare front, that means a continued debate between defenders of the Affordable Care Act (ACA), who want to extend coverage, as Biden does, using a government-run “public option” plan, and supporters of single-payer, “Medicare for All” (M4A) coveragewhich Sanders advocates. That’s the same argument Democrats have been having since the campaign started, and while healthcare remains the top issue of concern for primary voters, polls indicate that both plans are popular with the electorate.

We continue to believe that the public option plan is a far more likely outcome than M4A, but only if the Democrats win control of the Senate—a prospect which appears more possible given billionaire Mike Bloomberg’s post-Super Tuesday endorsement of Biden, and plans to devote his substantial campaign resources to support Democratic candidates across the ballot. Some of that money will surely be spent in Montana, where Gov. Steve Bullock is poised to announce plans to run against incumbent Sen. Steve Daines (R-MT), in a critical race that could be the most expensive Senate contest in history.

And for an indication of how the politics of a public option would play out, look no further than Colorado, where the Democratic legislature moved forward with its version of the plan this week, over the objections of the hospital and insurance lobbies.

Finally, looming over the general election campaign will be the pivotal Texas vs. California case, which the Supreme Court agreed to take up in this fall’s term. That case will ensure that healthcare will remain the centerpiece of American political debates regardless of who leads the Democratic ticket. Buckle up.