Hospitals lose legal challenge to 340B drug payment cut

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340B Program: Important, but Weaknesses Cited - Pharmacy Practice News

Dive Brief:

  • A significant rate cut for some medications for 340B hospitals was based on a “reasonable interpretation of the Medicare statute” and can stand, the U.S. Court of Appeals for the District of Columbia ruled Friday.
  • The 2-1 ruling overturns a district court decision that HHS overstepped its bounds when it cut the reimbursement rate for a certain category of outpatient drugs by 28.5% for hospitals enrolled in the 340B drug discount program.
  • The American Hospital Association, which challenged the rate cut along with three individual hospitals, did not immediately respond to a request for comment. An advocacy group for 340B hospitals said in a statement it was disappointed in the ruling and that the rate change has “caused real and lasting pain to safety-net hospitals and the patients they serve.”

Dive Insight:

The decision is another major blow for hospitals, coming two weeks after the same court ruled HHS also acted within its authority when it reduced payments to off-campus hospital outpatient departments.

AHA said this week it is seeking to have that ruling overturned.

HHS made the cut to 340B hospital outpatient drug reimbursement in the 2018 Outpatient Prospective Payment System rule, arguing that those hospitals, which primarily serve low-income populations, get the drugs at a deep discount and thus could be incentivized to overuse them.

The cut was from 106% of the average sales price to 22.5% less than ASP. Hospitals immediately sued, but HHS retained the reduction in the 2019 OPPS. The department has said the change would save Medicare $1.6 billion in 2018.

Writing for the court, Chief Judge Sri Srinivasan said the department did indeed have the authority to make the reduction, “so as to avoid reimbursing those hospitals at much higher levels than their actual costs to acquire the drugs.”

He also called the cut “a fair, or even conservative, measure of the reduction needed to bring payments to those hospitals into parity with their costs to obtain the drugs.”

In a partially dissenting opinion, Circuit Judge Cornelia Pillard wrote that she believes the statute only allows HHS to make the change for a specific group of hospitals under a clause that requires the agency to use a certain data set it did not use.

 

 

 

 

30 million unemployed lose extra jobless benefits, as talks between Congress and the White House are at an impasse

Posted on by • Posted in 2020 Election Issues, Coronavirus, Crisis, Crisis Management, Deferred Healthcare, Economic Crisis, Economic Recovery, Employee Furlough, Employee Hiring Freeze, Employee Layoffs, Employee Pay Cuts, Employer-Based Health Insurance, Health Insurance Coverage Adequacy, Infection Control, Infection Control Plan, Infectious Virus, Job, Job Loss, Job Market, Job Search, Job Security, Out of Pocket Expenses, Pandemic, Preexisting Conditions, Public Good, Public Health, Public Safety, Public Welfare, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment

https://www.washingtonpost.com/us-policy/2020/07/31/congress-bailout-unemployment-insurance/?utm_campaign=wp_main&utm_medium=social&utm_source=facebook&fbclid=IwAR209BwfddkZBp9kx4ot4BY41ncIlgSEDRHn7Ykg4RwGrys6O1dIUeCBjQY

30 million unemployed to lose extra jobless benefits, as talks ...

White House Chief of Staff Mark Meadows says Democrats rejected reasonable offers to extend unemployment insurance; Pelosi disputes pointing out House passed a bill to extend benefits back in May.

Nearly 30 million workers have lost $600 in enhanced weekly unemployment benefits that have kept much of the economy afloat these past four months during the coronavirus pandemic, as top lawmakers in Congress and the White House remain at an impasse over how and whether to extend the benefits.

Most of the last checks went out this week, but the program officially ended Friday, a day that Democrats and Republicans spent trading barbs over who was to blame for the failed negotiations.

White House Chief of Staff Mark Meadows said Democrats had rejected reasonable offers, while House Speaker Nancy Pelosi (D-Calif.) derided Republicans for trying to advance a short-term fix that would have extended the benefits for just a week.

“The president has been very clear for us to be aggressive and forward-leaning to make sure that they get protected, and yet what we’re seeing is politics as usual from Democrats on Capitol Hill,” Meadows said, addressing reporters in the White House briefing room.

As he was speaking, Pelosi held a news conference on Capitol Hill, where she criticized Republicans for proposing the short-term extension with their backs against the wall.

“What are we going to do in a week?” Pelosi asked as she explained why Democrats rejected the proposal to continue enhanced unemployment benefits at the current $600 weekly level for an additional week.

As many as 30 million workers, including gig workers and the self-employed, are currently receiving some form of unemployment insurance, which has been supplemented by $600 in extra benefits each week — on top of whatever state unemployment benefits a worker gets — since the crisis deepened in March.

Many economists and workers credit the additional money with helping them keep up with basic bills during the crisis: rent, mortgage, car and credit card payments, as well as everyday expenses like food. Most states cap weekly unemployment benefits well below $600; some pay as little as $275 a week as their maximum.

Candida Kevorkian, 53, her son and her daughter-in-law have all been laid off and live together with her two grandchildren in a two-bedroom apartment in South San Francisco, Calif. She worked at the Westin St. Francis hotel; her son worked at the Moscone Center, a convention center downtown; and her daughter-in-law worked at a Marriott.

The extra $600 Kevorkian gets brings her overall jobless benefits to about $1,050 a week before taxes. But she has about $1,700 in other fixed expenses on top of rent, which is $2,350 — after she negotiated with her landlord to lower it from $2,850. The family has already cut back on clothing, shoes and food, including cooking with meat once a week. She says she has little hope that her job will return given how poorly the public health side of the crisis is going, and she said she feels powerless.

“People are taking decisions for you and your life,” she said. “In the middle of this pandemic they’re playing with us.”

Back in March, when the economy was beginning to fail, because of the forced shutdowns to stop the spread of the virus, lawmakers rallied around the idea that they were rushing to shore up the economy through a short-lived public health crisis, agreeing to pass more than $2 trillion in stimulus that they thought would see the nation through the summer, when they hoped the pandemic would ease.

But surging coronavirus cases have spurred many states to reverse course and close down restaurants and bars again, weighing on the economic recovery. The novel coronavirus has killed more than 150,000 people in the United States, according to data gathered by The Washington Post.

Indeed, the pandemic outlasted the original relief efforts Congress passed.

Jim Quebman, 61, an engineer in Thousand Oaks, Calif., was initially told he’d be back at work in two weeks when he was furloughed in March from his job at a machine shop. But the date for his return keeps getting pushed back.

He’s been relying on the $600 he gets from the federal government, in addition to $450 in state benefits, to keep up to date with his monthly payments: $2,200 in property taxes, $1,200 to keep his health insurance once his employer stops paying in August, a $300 car payment and other expenses like food and repairs.

Without the $600, he said he might have to have to raid his 401(k) retirement savings.

“I’ll be in trouble within two months, basically,” he said. “How can you retire if you don’t have a pension and health care, that’s paid by, let’s say, a government.”

Raven Holmes, 38, a single mother of two who lost her job as an secretary in New Haven, Conn., back in February, said she already instituted a series of cuts in anticipation of the benefits’ expiration. She started carpooling to the grocery store, split a BJ’s Wholesale Club card with family to buy food in bulk, and has stopped getting takeout or restaurant food.

She also said she’s begun visiting food banks to help feed her and her two sons.

“Once you have absolutely nothing, it’s not hard at all,” she said, about accepting charity.

The longer Congress stalls, the more likely it is that she will have to plead with her landlord, utility companies, and other bill-holders to let accounts go into arrears until she lands on her feet again.

“Money is not a resource that can be depleted. It’s a man made thing: if you need more make more,” she said. “There are other countries — their citizens are fine, nobody is suffering and everybody is healthy. All our government wants is money in their pockets, while the people are poor and starving and scrounging.”

The wrangling over whether and how to extend jobless benefits has occupied Washington for months.

Eager to avoid blame for Friday’s expiration of the enhanced unemployment aid, Republicans have increasingly coalesced around the idea of a short-term fix. But Democrats have repeatedly rejected that approach and continue pushing for a wide-ranging $3 trillion bill the House passed in May. That bill would extend unemployment benefits through January.

Senate Majority Leader Mitch McConnell (R-Ky.) unveiled a $1 trillion counterproposal Monday, but it was quickly rejected by many members of his own conference and has increasingly seemed irrelevant as Republicans look to a short-term fix.

Senate Republicans have proposed cutting the $600 weekly federal benefit to $200 per week for two months while giving states time to transition to a more complicated system that would aim to replace 70 percent of a worker’s prior wages. A second proposal emerged this week that would give states the choice to implement the $200 bonus or move to a system that would replace up to 66 percent of wages.

Pelosi and Meadows have held meetings for four days straight, along with Treasury Secretary Steven Mnuchin and Senate Minority Leader Charles E. Schumer (D-N.Y.).

Pelosi said such a short-term extension might make sense if a deal were in sight on a larger bill and more time was needed to complete it. But, she said, that is not the state of play as the parties remain far apart.

“We anticipate that we will have a bill, but we’re not there yet,” Pelosi said.

Those who are relying the benefits have been watching the debate unfold wearily.

“Just a few men have to make this decision for how many million people? Ten guys to make a decision over these millions of people’s lives?” said Willie Woods, 60, who has been furloughed from his job as a hotel banquet server in New Orleans since April and is also losing the extra $600 a week in jobless benefits. “This country not taking care of American citizens like they’re supposed to. We didn’t bring this pandemic home. We were at work, and you hit us with a pandemic.”

 

 

 

 

Coronavirus update: July marked the worst month on record for new infections. In excess of 1,000 died per day which represents greater than 50% of those who died during the entire Vietnam War (this in just 1 month).

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Economy Reopening, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, Expert, Expert Opinion, False Hope, False Narrative, Health Policy, Infection Control, Infection Control Plan, Infectious Virus, Judgement, Leadership Decentralized, Misinformation, Misinterpret, Mislead, Misleading, Mistake, Mistrust, Mixed Message, Mortality, National Strategy, Out of Control, Pandemic, Public Good, Public Health, Public Safety, Public Trust, Quarantine, School Reopening, Scientists, Social Distancing, Underinsured, Unemployment, Unemployment Insurance, Uninsured, Wishful Thinking • Leave a comment

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U.S. Hits Another Record for New Coronavirus Cases - The New York ...

The United States saw a devastating surge in coronavirus infections during July, with more than 1.9 million new cases in total reported — by far the most tallied in a single month and a grim sign that the country had lost its grip on the pandemic.

The month’s infection total reported by states was more than double that of June and represents about 42 percent of the 4.5 million cases the country has logged since the outbreak started, according to tracking by The Washington Post. Nationwide, testing has steadily increased — in July, it rose from about 600,000 to 820,000 tests per day — but soaring positivity rates and hospitalizations made clear that virus transmission was accelerating.

Coronavirus-related deaths also rose after declining during April and May: The country saw 25,259 fatalities in July, up more than 3,700 from the previous month, according to The Post’s data. Health experts predicted daily deaths would continue to trend upward in August, trailing spikes in infections by a few weeks. To date, more than 150,000 people in the United States have died of covid-19, the disease the novel coronavirus causes.

Here are some significant developments:

  • Over the past week, 24 states surpassed a case increase of more than 100 cases per 100,000 people — a metric the White House and Deborah Birx, the coronavirus response coordinator, have defined as “red zone” states, where the spread of the virus is serious enough to warrant stricter public health precautions.
  • The United States tallied 1,315 coronavirus deaths Friday, the fifth day in a row the country has reached a four-digit death toll, according to data analysis by The Post.
  • Anthony S. Fauci, the country’s leading expert on infectious diseases, told Congress on Friday that a “diversity of response” from states had hampered efforts to bring down the number of new infections. In contrast, he said, many European nations went into near-total lockdowns.
  • Students can return to college safely if they are tested for the coronavirus every two days, according to a JAMA study by researchers from the Yale School of Public Health, Harvard Medical School and Massachusetts General Hospital.

Amid the rise in infections and deaths, the country’s virus response remains fractured and halting. Officials at all levels of government spent July sparring over whether to roll back reopening plans and institute mask mandates and other public health requirements recommended by leading health experts.

The pandemic has also had a harsh impact on the economy, with the nation’s gross domestic product shrinking at an annual rate of 32.9 percent in the second quarter. At midnight Friday, tens of millions of American workers lost $600 weekly unemployment payments after congressional leaders failed to reach an agreement on how to extend the benefit, which has helped keep many households afloat the past four months.

 

 

 

 

Cartoon – Importance of Transparency

Posted on by • Posted in 2020 Election Issues, Cartoon, Election, Ethics, Evasive, Evidence, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, False Narrative, False Reassurance, Governance, Honesty, Importance, Integrity, Leadership, Leadership Integrity, Leadership Trust, Misinformation, Misinterpret, Mislead, Misleading, Mistake, Mistrust, Mixed Message, Spin, Transparency, Trust, Truth, Vote, Voting • Leave a comment

Government Transparency Cartoons and Comics - funny pictures from ...

Three Predictable Covid Nightmares — and How Congress Can Help Prevent Them

Posted on by • Posted in 2020 Election Issues, Budget, Clinical Research, Coronavirus, Crisis, Crisis Management, Denial, Economic Crisis, Economic Recovery, Economic Stimulus, Election, False Hope, False Narrative, Infection Control, Infection Control Plan, Infectious Virus, Leadership, Mortality, National Institute of Health (NIH), National Strategy, Pandemic, Partisanship, Public Good, Public Health, Public Perception, Public Safety, Public Trust, Quarantine, Social Distancing, Transparency, Vaccine, Vote, Voting, Voting by Mail • Leave a comment

https://www.politico.com/news/agenda/2020/07/29/states-congress-covid-nightmare-vaccine-385217?mkt_tok=eyJpIjoiTVRNNU0yWXpNMlk1TVRsaiIsInQiOiJ1Vlg3dlBCYytaWTdtcGtMd3ZaUVh6TTBZRlMxXC9MaW9UMk9MRHhpdkFpSFFJMHFVWWpocUhWR1ZEZTM2NFBXb0xOVUZTSXNJMzYxWk90Yld

Opinion | Three Predictable Covid Nightmares — and How Congress ...

The good news is that they aren’t partisan, and they’re fixable.

In our response to the Covid-19 pandemic, the United States has all too often been caught flat-footed. Our public officials have tried to avoid or deny problems until they have been right on top of us, and legislative measures have tended to react to major challenges rather than avert them.

That has left policymakers with a lot to react to. And the relief and assistance bill now being worked out in the Senate will need to do that on several fronts. But to do better in the future, that bill should also take on several predictable problems that will face our country over the remainder of the year and which could benefit enormously from some advance attention and action.

Three sets of such predictable problems stand out above all, and in all three cases there are measures that can be taken now that should be able to attract bipartisan support.

First, states are going to face a monumental fiscal crisis.

The pandemic and the ensuing shutdowns of economic activity have left state governments with immense revenue shortages. Balanced-budget amendments in all but one state severely restrict their capacity to run deficits, in many cases even in major emergencies. That means states will have to either find other ways to raise revenue quickly or make major cuts to basic services. Such cuts in spending, jobs and public assistance would exacerbate the deep recession we are in and leave millions who need help in the lurch.

Most state fiscal years begin in July, so in many cases budgets designed or enacted before the severity of the crisis was clear are now starting to take effect, leaving states facing gaps they can easily predict but haven’t formally accounted for. In fact, 16 states are now starting the second year of biennial budgets enacted in 2019, before anyone could have imagined the sort of crisis we now face. Over the coming months, there will be no avoiding the fiscal crunch.

The states have already begun pleading with Congress for help, and sooner or later Congress will need to provide it. Taking steps sooner rather than later would make an enormous difference. The federal government has often been called on to serve as a fiscal backstop for states in extreme emergencies, since its borrowing power vastly exceeds that of the states. And that role is particularly appropriate in a truly national—indeed global—crisis of this magnitude.

But to provide such help responsibly, Congress will need to clearly delineate what kinds of assistance it can offer and on what terms. Congressional Republicans are not wrong to be wary of state efforts to use the emergency to fill fiscal holes dug over decades of irresponsible state policies. Yet that can’t mean that they deny state governments the help they need to contend with this crisis. Rather, it means they must draw some distinctions.

As I’ve argued elsewhere, Congress would do well to divide state needs into three tranches: direct pandemic spending (which should be covered by federal dollars), lost state revenue (which states should be given the opportunity to make up with federally guaranteed loans on favorable terms), and longstanding obligations like pension and retiree health costs made untenable by the recession (for which affected states should be given options only for strictly conditional support, like a new state bankruptcy code or federal support conditioned on major pension reforms).

To be effective, that sort of response would need to take shape now, before states have truly hit the wall. It should be part of the bill the parties are now beginning to negotiate.

Second, this fall’s election is going to be seriously complicated by the pandemic.

There is pretty much no way around that. We’ll be voting while the virus is still spreading, which means that far more people than usual will vote by mail. Only a few states have real experience with voting by mail in large numbers, and the logistics involved are not simple. Primary elections in many states have already made the challenge clear.

To take just one example among many, mailed ballots require signature verification. In states that haven’t spent years building the required infrastructure, such verification will probably need to be done by hand, creating huge risks of confusion and error. States will need to develop new processes to handle this, to train election workers to use unfamiliar equipment, and to take on problems in real time. Signature verification also requires a process for notifying voters whose handwriting is challenged and giving them time to respond. All that, and similar challenges on other election administration fronts, makes it easy to imagine that many races will be impossible to call on election night, and perhaps for quite some time afterward.

Particularly in an era already overflowing with cynical mistrust and conspiracy mongering, such problems raise the prospect of a legitimacy crisis around the election. And policymakers need to take steps now to reduce the risk of such a crisis.

The first step must be to prepare the public. Elected officials, candidates, journalists and others must start speaking plainly about the likelihood of logistical challenges around the election so that voters are not shocked if things don’t go smoothly. People must know in advance that we should not expect every race to be called straight away and that results which take days or even weeks to determine are not therefore illegitimate.

But beyond setting voter expectations, policymakers should also be looking for ways to reduce the strain on the system and to deal with predictable problems. One simple step Congress could take now is to push back the deadlines involved in the work of the Electoral College, to give the states more time to count votes in the presidential race if they need it. A simple change in the federal law governing these dates, which wouldn’t give either party an advantage, could give every state about three more weeks to count. Such a change would be essentially impossible after the election—when partisans looking at partial results would argue over which side it would advantage. But it could easily be done today, it would just take a few sentences of legislative language, and it too should be part of the relief bill now being worked out.

Opinion | Three Predictable Covid Nightmares — and How Congress ...

Finally, if we’re lucky, we’re going to need to figure out how to distribute a Covid-19 vaccine early next year. That would be a good problem to have, of course, but a huge problem nonetheless. And getting it wrong could catastrophically undermine the effort to defeat the virus.

Vaccine development itself is one area where our country has not been behind the curve: The federal government has invested heavily in the effort, the National Institutes of Health has played a key coordinating role, and the administration is prepared to pay for “at risk” manufacturing of millions of doses of any vaccine that makes it into Phase III trials, so that if a vaccine is found to be safe and effective there will immediately be doses to provide to high-risk individuals. But who will be first in line to get these early doses? And who will decide?

Here, too, there is an enormous danger of a legitimacy crisis. Both public fear about the safety of a vaccine (building on decades of anti-vaccine conspiracy theories on the right and left alike) and the danger of corruption, or at least perceived corruption, in the distribution of doses could undermine the potential of effective vaccination to end the nightmare of this pandemic.

Widespread uptake is essential to the effectiveness of any vaccine. It is not so much by protecting each vaccinated individual as by vaccinating enough Americans to achieve broad-based communal (or “herd”) immunity that a vaccine could truly change the game. That means public trust in the process and wholesale vaccination across our society will be crucial.

To achieve that, it is essential that both the safety of the vaccine-development process and the basic fairness of the ultimate distribution formula be established in advance, and in a very public way. Congress has a crucial role to play here, too. Hearings should begin very soon to put before the public all available information about the efforts taken by the Food and Drug Administration to ensure the safety of the vaccine-development process, even as that process proceeds with unprecedented speed. And Congress should establish, ideally in this next relief bill, a public commission to develop a formula for equitable distribution of early vaccine doses: setting out tiers of priority (for front-line health workers, vulnerable populations, the elderly, and those with particular preexisting conditions), and seeking out ways to make sure that economic and other disadvantages do not translate into lesser or later access to vaccination.

The work of such a group should be reasonably transparent and would need to begin very soon if it is to bear fruit in time to be useful. Policymakers must not underestimate the danger of a loss of public confidence in a Covid-19 vaccine, and must take steps now to avoid such a foreseeable disaster.

The same is true on all three of these fronts. These may not be the greatest problems we confront in the remainder of this dark and difficult year, but they share some features that ought to make them high priorities: All three are predictable and serious, each would amount to a disaster if left unchecked, but each could be made much easier to handle with some straightforward preparation. The relief bill being negotiated this summer could easily, without sparking a partisan war, take concrete steps on all three fronts.

Leadership in a crisis demands a combination of planning for foreseeable difficulties and responding to the unexpected. Getting the former right can make the latter far more doable. To make the rest of this year less disastrous, our leaders need to look ahead.

 

8 hospitals closing departments, ending services

Posted on by • Posted in Cost Management, Cost Reduction, Health System, Hospital, Hospital Department Closure, Hospital Industry • Leave a comment

https://www.beckershospitalreview.com/patient-flow/8-hospitals-closing-departments-ending-services.html?utm_medium=email

Several healthcare organizations recently closed medical units or terminated services to shore up finances, focus on more in-demand services or prevent patient care lapses. Here are eight that have announced or completed closures in the last three weeks:

1. As part of a systemwide strategy, Cleveland-based University Hospitals plans to consolidate its birthing services and its cardiac surgery program. University Hospitals Elyria (Ohio) Medical Center will end labor and delivery services in the next few months. University Hospitals St. John Medical Center in Westlake, Ohio, will end its heart surgery program.

2. St. Albans, Vt.-based Northwestern Medical Center will stop providing addiction treatment services by the end of the month in a cost-saving move. The hospital said that it will close the department because it was spending more on addiction treatment than it was making.

3. Kansas City, Mo.-based Saint Luke’s Health System ended inpatient care at Saint Luke’s Cushing Hospital in Leavenworth, Kan., on July 17.

4. In an effort to consolidate services and cut costs, Jersey City, N.J.-based Christ Hospital said it will close its OB-GYN department by July 31.

5. WellSpan Waynesboro (Pa.) Hospital plans to close its birthing unit and end inpatient pediatric services on Sept. 18, the organization announced in July.

6. New York City-based Montefiore Health System is scaling back services at Mount Vernon (N.Y.) Hospital. In early July, Montefiore shut down the intensive care unit at the hospital and laid off 18 nurses. The ICU closure comes after the 121-bed hospital ended obstetrics, pediatrics, cardiology and oncology services.

7. In a cost-cutting move, Seattle Children’s said it will shut down its day care center that employees use for their kids.

8. Ashtabula (Ohio) County Medical Center plans to close its birthing unit by Aug. 1, according to the Star Beacon. The Ohio Nurses Association has filed a lawsuit to prevent the shutdown.