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Five questions on healthcare following Price’s resignation

Five questions on healthcare following Price’s resignation

Five questions on healthcare following Price's resignation

Tom Price’s resignation as Health and Human Services (HHS) secretary creates a big leadership void at the top of the department tasked with administering a health law Republicans hate.

President Trump accepted the embattled secretary’s resignation Friday on the heels of Politico reports detailing how Price’s travel on military and charter jet flights had cost taxpayers more than $1 million since May.

“I have spent forty years both as a doctor and public servant putting people first,” Price said in his resignation letter. “I regret that the recent events have created a distraction from these important objectives.”

Price’s resignation also follows the GOP’s latest failure to repeal and replace ObamaCare, which Trump had wanted accomplished quickly earlier in the year.

Here are five questions about what comes next:

Who is taking over?

Dr. Don Wright, a career official at HHS,  will serve as acting HHS secretary effective Saturday. Wright has served as the acting assistant secretary for health at HHS since February after joining the agency in 2007, according to HHS’s website.

He’s held a number of positions during his tenure at HHS, including deputy assistant secretary for health and director of the Office of Disease Prevention and Health Promotion.

During his time at HHS, Wright oversaw the national dietary guidelines and the department’s health literacy agenda.

He also represented the U.S. at the World Health Organization executive board.

Prior to joining HHS, Wright worked for the Occupational Safety and Health Administration (OSHA).

Before he started working for the government, he worked for 15 years in the private sector at a clinic and consulting practice in Texas.

What comes next on ObamaCare?

Congressional Republicans won’t be voting to repeal ObamaCare anytime soon. That’s because the vehicle they were using to repeal President Obama’s signature health law without requiring a single Democratic vote expires Saturday.

The focus will now be on how HHS implements the health law.

ObamaCare supporters and local groups tasked with enrolling consumers in the exchanges, known as navigators, are openly frustrated with the administration.

Democrats are arguing that the White House is blatantly sabotaging the law. They point to the administration’s decision to shorten the open enrollment window by half. In late August, HHS announced it was slashing advertising funding by 90 percent and cutting funding for navigator groups by 41 percent.

Open enrollment begins Nov. 1.

Who could replace Price permanently?

Several names have been reported as possibilities for taking over Price’s job.

One is Seema Verma, who heads the Centers for Medicare and Medicaid Services. She was an architect of several state-tailored Medicaid waivers, notably Indiana’s Medicaid expansion program when Vice President Pence was governor. Several Democrats joined Republicans to confirm Verma in a 55 to 43 Senate vote.

Verma was also dispatched to the Hill during the Senate’s ObamaCare repeal bill effort in attempts to smooth over intra-party divisions over how to tackle Medicaid.

Another name being floated is Scott Gottlieb, the Food and Drug Administration commissioner. A handful of Democrats also supported Gottlieb’s nomination.

Politico also noted that Department of Veterans Affairs Secretary David Shulkin was rumored to be a possible replacement, but Shullkin has had questionable travel expense of his own.

Before Trump nominated Price, a short-list of candidates for the HHS job included Housing and Urban Development Secretary Ben Carson, former Speaker Newt Gingrich (R-Ga.), Florida Gov. Rick Scott (R) and former New Jersey state Sen. Rich Bagger, according to a list obtained by Buzzfeed.

What will the confirmation process be like?

It’s unclear when Trump plans to nominate Price’s replacement. But Price’s resignation is setting up a potentially nasty confirmation process in the Senate.

Democrats have accused the Trump administration of trying to sabotage ObamaCare and whomever is nominated will likely be asked about how they would handle the law.

“Throughout his brief time leading the Department of Health and Human Services, Tom Price has repeatedly abused the public trust and betrayed the agency’s mission to improve Americans’ health care,” Sen. Ron Wyden, ranking Democrat on the Senate Finance Committee, said in a statement Friday.

“I hope that his resignation will mark the beginning of a new chapter for the Trump administration’s health care agenda. Tom Price’s replacement needs to be focused on implementing the law as written by Congress and keeping the president’s promise to bring down the high cost of prescription drugs.”

Democrats were opposed to Price’s confirmation, mostly because of questions about his stock trades and investments, which they said were a conflict of interest.

In protest, Democrats didn’t show up to the Finance Committee’s confirmation hearing, and Chairman Orrin Hatch (R-Utah) used a procedural maneuver to push through the nomination. He could likely do that again if Democrats don’t show up.

The whole process took a little less than three months, and it’s unlikely this one will move any faster.

That means HHS is unlikely to have a permanent health secretary in time for ObamaCare’s fifth open enrollment season.

Will Price still pay for his charter seats?

Price said he would pay $52,000 to the U.S. Treasury for the cost of his seats on the private charter planes. That’s a small amount compared to the more than $1 million he reportedly racked up.

But there are also questions about whether he still plans to pay that money back.

“Wait… did we get our money back first?” asked Rep. Linda Sanchez (D-Calif.)

Price, who was worth more than $8 million in January according to his nomination disclosure forms, didn’t mention the money in his resignation letter.

 

 

Obamacare Repeal Bills, Like ‘Game of Thrones’ White Walkers, Are Very Difficult to Kill

https://www.americanprogress.org/issues/healthcare/news/2017/09/21/439380/obamacare-repeal-bills-like-game-thrones-white-walkers-difficult-kill/

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Michele and Igor speak with Andy Slavitt, former acting administrator at the Centers for Medicare and Medicaid Services under former President Barack Obama—and Twitter hero—about the latest efforts in Congress to repeal the Affordable Care Act in the form of the Graham-Cassidy bill. He reminds listeners why health care is far more personal and significant than partisan politics and how to work toward universal coverage.

 

3 Ways the Senate Budget Reopens the Door for ACA Repeal

https://www.americanprogress.org/issues/economy/news/2017/09/29/440039/3-ways-senate-budget-reopens-door-aca-repeal/

After the latest failed attempt to repeal the Affordable Care Act (ACA) in the Senate, Sens. Lindsay Graham (R-SC) and Ron Johnson (R-WI) declared that they would only support a new budget resolution that enabled them to keep trying to force through their own health care bill. The Senate has not had to meet the 60-vote standard to pass ACA repeal because of the budget reconciliation process, which lets the Senate pass legislation with a simple majority vote. This process began with reconciliation instructions included in the fiscal year 2017 budget that Congress passed in January 2017, but those instructions expire on September 30.

While the new FY 2018 budget resolution from the Senate Budget Committee retreats from ACA repeal to some extent—after massive public opposition—it would still enable Congress to revive major elements of ACA repeal using reconciliation. Here are three ways the proposed Senate budget supports ACA repeal.

1. An overly broad reconciliation instruction to the Senate Finance Committee

The Senate Finance Committee has jurisdiction over both tax policy and several federal health care programs, including Medicare and Medicaid. If the Senate wanted to limit the scope of a reconciliation bill to tax policy, the budget resolution could give instructions to the Senate Finance Committee that only cover revenues. Instead, the budget instructs the Finance Committee to produce legislation that increases deficits by up to $1.5 trillion over 10 years.

Since deficit changes can be accomplished via changes to both spending and revenues, the Finance Committee could use this reconciliation instruction to repeal ACA-related taxes as well as much of the spending that helps people purchase health insurance under current law. Politico reports that “95 percent of health care policy” goes through the Senate Finance Committee, according to a Republican Congressional staffer discussing ACA repeal. As a result, the staffer said, “it’s not like we couldn’t slip it in anyway.”

Every dollar the Finance Committee cuts from health care could be used to pay for tax cuts for the rich that would be on top of the $1.5 trillion tax cut financed by deficits. This reconciliation instruction could let Congress pass a huge deficit-financed tax cut for the wealthy and corporations, combined with major elements of ACA repeal, in a single omnibus reconciliation bill. If the Finance Committee’s overall bill does not increase deficits by more than $1.5 trillion over 10 years, the Senate could pass it on a party-line vote under reconciliation.

Aside from the Finance Committee, the only other committee involved in ACA repeal in the Senate is the Health, Education, Labor, and Pensions (HELP) Committee. The Senate budget resolution does not give a reconciliation instruction to the HELP Committee, which signals a meaningful retreat from full ACA repeal. Nevertheless, the Finance Committee instruction would still enable the Senate to change major parts of the law, which could include nullifying the ACA mandate for individuals to purchase health insurance, repealing the ACA-related taxes that finance the coverage expansion, and making all of the Medicaid cuts in earlier ACA repeal legislation, such as repealing the Medicaid expansion and making further cuts by turning the program into a block grant.

2. A deficit-neutral reserve fund for ACA repeal

The Senate budget resolution further smooths the path for ACA repeal with a deficit-neutral reserve fund for “repealing or replacing” the ACA. This allows Senate Budget Committee Chairman Mike Enzi (R-WY) to adjust the aggregates that are included in the budget resolution, such as overall spending and revenue levels, to accommodate ACA repeal. This reserve fund helps the Senate majority avoid points of order that could otherwise create hurdles for passing a future health care bill. A similar reserve fund was also included in the FY 2017 budget resolution.

Budget resolutions often include many reserve funds that are mostly designed to signal rhetorical support for an issue. Not only does the reserve fund for health legislation smooth the way for ACA repeal, it also shows that supporters of the Senate budget continue to endorse ACA repeal even after the FY 2017 reconciliation instructions expire on September 30.

3. Deficit-financed tax cuts

Even if Congress does not go after the ACA using reconciliation instructions in the FY 2018 budget, the deficits from the tax cuts the Senate budget enables will be used by the ACA’s opponents to attack the law in the future. Whipping up hysteria about budget deficits is a common tactic to advocate cuts to programs such as Medicare and Medicaid, and it is already being used to justify ACA repeal. When asked a question on CNN from a person who had recovered from substance abuse addiction and who worried about loss of Medicaid coverage for treatment for others suffering from addiction, Sen. Graham responded, “Let’s talk about $20 trillion of debt.”

If lawmakers increase the debt with the very tax cuts that Treasury Secretary Steven Mnuchin says will be “done by the end of the year,” it will add further fuel to their drive to slash programs for low- and middle-income Americans using reconciliation instructions in their next budget resolution for FY 2019. This will not be a long delay—the FY 2019 budget would be passed by April 15, 2018, if Congress follows the schedule for the regular budget process.

Lawmakers can cut taxes, increase deficits, and use those higher deficits to justify a renewed push to repeal the ACA, all before the 2018 midterm elections.

Conclusion

The window is closing for Congress to pass ACA repeal using the FY 2017 reconciliation instructions, but the Senate Budget Committee is reopening it with the FY 2018 budget. The quest to repeal the ACA—thereby cutting taxes for the wealthy, taking health insurance from tens of millions of Americans, eliminating protections for preexisting conditions, and driving up out-of-pocket costs—will continue if Congress passes the Senate budget resolution.

4 financial, strategic and revenue cycle issues health systems are facing

https://www.beckershospitalreview.com/finance/4-financial-strategic-and-revenue-cycle-issues-health-systems-are-facing.html

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From uncertainty around the future of the ACA to dwindling reimbursement, hospitals and health systems across the nation are facing a myriad of challenges.

Four healthcare industry experts discussed some of the most pressing challenges facing healthcare organizations today at the Becker’s Hospital Review 3rd Annual Health IT + Revenue Cycle conference in Chicago.

1. Hospitals across all credit rating categories are feeling financial pressure. A few years ago, hospitals with an A+ or higher credit rating typically had strong margins and a lot of options for improvement. “The big difference today is we’re seeing more hospitals that are struggling with operating margin, regardless of rating,” said Charles Alston, market executive and senior vice president at Bank of America Merrill Lynch. To address this issue, hospitals and health systems must examine how to fix the problem and then determine how to sustain those results long term, he said.

2. Hospitals are faced with uncertainty around the future of health reform. “I’m really worried about the future of the ACA and how much bad debt we’re going to have,” said Charles Ayscue, senior vice president of finance and CFO of Asheville, N.C.-based Mission Health. “We’re going to see a lot more self pay and we don’t have the workforce to handle that self pay.” He said Mission Health is taking proactive steps to prepare for the influx of patients with high deductible health plans, with a focus on revenue cycle improvement. “We’ve tried our best to educate our physicians on documentation and coding,” he said.

3. Health system mergers can create new challenges. Chicago-based Presence Health was formed in 2011 through the merger of Resurrection Healthcare in Chicago and Provena Health in Mokena, Ill. Presence Health CFO Mark Rafalski said hospitals involved in the transaction operated on disparate IT systems, which led to some revenue cycle management issues. “We’ve struggled in the area of [claim] denials,” he said. In an effort to turn around its finances, Presence has made a lot of changes in its revenue cycle, including using analytics and outsourcing to key partners, said Mr. Rafalski.

4. Healthcare organizations need to simultaneously cut costs and innovate.  Hospitals and health systems across the nation are facing cost pressure. “On the flipside, you have to change your strategy and innovate. You have to invest in the patient experience and the physician experience,” said Keith Lohkamp, senior director of industry strategy at Workday, a provider of cloud-based applications for finance and human resources. These competing priorities have fueled consolidation in the industry, as hospitals look for ways to drive efficiency and improve quality of care.

 

Temple University Health’s $5.7M operating loss anchored by Epic installation

https://www.beckershospitalreview.com/finance/temple-university-health-s-5-7m-operating-loss-anchored-by-epic-installation.html

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Philadelphia-based Temple University Health System reported an operating loss in the 12 months ended June 30, largely due to costs associated with the implementation of an Epic EHR system, according to recently released bondholder documents.

Temple University Health System reported revenues of $1.75 billion in fiscal year 2017, up from $1.64 billion in the year prior. Although the system reported revenue growth, rising expenses offset those gains.

The increase in expenses was largely attributable to higher than expected staffing costs related to the Epic EHR implementation. The health system spent $15.1 million on staffing needs related to the Epic go-live.

Temple University Health System Senior Vice President, Treasurer and CFO Robert Lux told The Inquirer the higher staffing costs were necessary, as it was vital “to give all the physicians and nurses all the right kind of elbow-to-elbow support they needed for there to be a smooth clinical implementation.”

The system ended the most recent fiscal year with an operating loss of $5.76 million, compared to an operating surplus of $4.36 million in the year prior.

Geisinger’s operating income tumbles 34%

https://www.beckershospitalreview.com/finance/geisinger-s-operating-income-tumbles-34.html

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Danville, Pa.-based Geisinger recorded an operating surplus of $109.6 million in the fiscal year ended June 30, down 34.6 percent from an operating surplus of $167.5 million in the year prior, according to recently released bondholder documents.

Geisinger’s revenues climbed 14.3 percent year over year to $6.3 billion in fiscal year 2017. The growth was primarily due to a 13.9 percent increase in patient service revenue and a 15.8 percent increase in premium revenue. Geisinger’s health plan membership climbed 5.8 percent year over year.

The system’s expenses also grew in the most recent fiscal year. Geisinger’s expenses totaled $6.2 billion in the most recent fiscal year, compared to expenses of $5.5 billion in the year prior.

“We view fiscal 2017 as a successful year for Geisinger,” Kevin Brennan, executive vice president and CFO of Geisinger, said in a statement to Becker’s Hospital Review. In addition to the growth in patient and premium revenues, Mr. Brennan said the system completed a successful $587 million bond offering in May and ended fiscal year 2017 with 242 days cash on hand.

“Fiscal 2017’s operating income reduction in comparison to the previous year reflects significant investments in operational improvement planning and the implementation of revenue growth and expense efficiency initiatives,” said Mr. Brennan. “Aside from launching innovative care redesign initiatives intended to ensure Geisinger’s long term success, we also successfully integrated the Geisinger Commonwealth School of Medicine (formerly The Commonwealth Medical College).”

Geisinger ended fiscal year 2017 with a net surplus of $444.5 million, compared to a net surplus of $667.3 million in fiscal year 2016.