AHA, AAMC sue Trump administration over site-neutral payment rule


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Two of the nation’s largest healthcare groups are suing the Trump administration over a final rule to institute site-neutral payments for clinic visits, saying the policy would hurt patients.

Last month, the Centers for Medicare & Medicaid Services (CMS) finalized the 2019 Outpatient Prospective Payment System (OPPS) rule (PDF), which will gradually institute site-neutral payments in the Medicare program over the next two years. Agency officials said site-neutral payments for clinic visits will lower out-of-pocket costs for beneficiaries and save the program as much as $380 million in 2019.

In a complaint filed in the U.S. District Court for the District of Columbia, the American Hospital Association (AHA) and the Association of American Medical Colleges (AAMC) said the rule would lead to access problems as hospitals cut services, hurting vulnerable patients. The associations claimed the administration is overstepping its legal bounds  and were joined in the legal action by Olympic Medical Center in Port Angeles, Washington; Mercy Health in Muskegon, Michigan; and York Hospital in York, Maine.

“These cuts directly undercut the clear intent of Congress to protect hospital outpatient departments because of the real and crucial differences between them and other sites of care,” said Rick Pollack, president and CEO of the AHA, in a statement.

AHA said it was planning legal action shortly after the rule was finalized.

Physician groups, including the American Association of Family Physicians (AAFP) and the American College of Physicians (ACP) as well as groups like the Cancer Oncology Alliance, have supported site-neutral payments for some time. AAFP has said site-neutral payments can also help community clinics stay open at a time many have had to close due to vertical integration, consequently advancing patient choice and reducing costs.

But hospital groups oppose the rule, which also expands a CMS policy limiting how much drug companies can charge hospitals for their products in the 340B program.

“Patients who receive care in a hospital outpatient department are more likely to be poorer and have more severe chronic conditions than patients treated in an independent physician office,” Pollack said. “In addition, only hospitals provide 24/7 access to care for patients, regardless of their ability to pay, hospitals are held to far higher regulatory requirements, and hospital outpatient departments in inner cities and rural areas are often the only sites of care that provide the services they do.”

Most recently, AHA had sued CMS over the 340B program changes before HHS bumped up the implementation date last month for changes that would set price ceilings and add civil monetary penalties for manufacturers—two changes the AHA supported.


4 dead, including gunman, in shooting at Chicago’s Mercy hospital


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A gunman opened fire at the Mercy Hospital & Medical Center campus in Chicago the afternoon of Nov. 19, killing a Chicago police officer, a physician and a first-year pharmacy resident, according to CBS Chicago.

The reported gunman, 32-year-old Juan Lopez, was killed by a police bullet to the abdomen, but the Cook Count Medical Examiner’s Office noted on Nov. 20 he also sustained a self-inflicted gunshot wound to the head, according to ABC 7

The shooting stemmed from a domestic violence incident involving Mr. Lopez’s former fiancee, Tamara O’Neal, MD, an emergency room physician, according to WGN 9. The shooting began as an argument in the hospital parking lot between Mr. Lopez and Dr. O’Neal, Mr. Lopez’s first victim.

Dayna Less, 25, a pharmacy resident who recently graduated from Purdue University, was shot as she left an elevator, according to WGN 9. Chicago police officer Samuel Jimenez, 28, was in a shootout with Mr. Lopez and later died after being taken to University of Chicago Medicine —  a level 1 trauma center. He joined the force in February 2017, the Chicago Tribune reports.

At the time of the attack, Chicago Police Department spokesperson Anthony Guglielmi tweeted that there were “reports of multiple victims.”

CBS Chicago cited dispatch reports that a woman had been shot, as well as an officer.

About 200 patients were being treated at Mercy, but authorities only evacuated the hospital’s emergency room.

Mercy Hospital posted a tweet at 2:41 p.m. Nov. 19 stating, “A shooting took place at Mercy Hospital & Medical Center this afternoon. The shooting at Mercy Hospital is over. Chicago Police Department have secured the hospital and patients are safe.”

Mercy conducted an active shooter drill just last month, Mercy CMO Michael Davenport told the Chicago Tribune.

Illinois Health and Hospital Association President and CEO A.J. Wilhelmi issued the following statement about the incident:

“On behalf of our 212 hospital members and their 250,000 healthcare employees, the Illinois Health and Hospital Association expresses our condolences to the family and friends of the victims of the senseless act of violence that occurred at Mercy Hospital in Chicago. We are incredibly saddened by the tragic loss these victims and their families have suffered.  This was an unexplainable act that took the lives of three people who went to work every day to protect and save lives in their community. We owe it to them to find ways to stop the violence, and the hospital community remains dedicated to helping in that important endeavor.”

The shooting comes in the wake of a nationwide discussion among healthcare professionals about gun violence after a controversial tweet by the National Rifle Association. Physicians have been responding to the tweet —  which told “self-important anti-gun doctors to stay in their lane” — by sharing photos and stories about their experiences treating victims of gun violence.



Yes, Doctors ‘Stay In Their Lane’ on Gun Policy


Yes, Doctors 'Stay In Their Lane' on Gun Policy

What kind of ignorant troglodyte would tell a doctor to mind his own business?

This was, in essence, the question an incredulous media was asking after the National Rifle Association disparaged the American College of Physicians (ACP) for promoting an array of gun-control regulations last week. “Someone should tell self-important anti-gun doctors to stay in their lane,” the NRA tweeted. “Half of the articles in Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves.”

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Physician group: High cost-sharing undermines insurance protections


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Increased cost-sharing, particularly high deductibles, lead patients to neglect necessary healthcare, according to a position paper from the American College of Physicians (ACP).

“The effects are particularly pronounced among those with low incomes and the very sick,” said Nitin S. Damle, M.D., president of the ACP in an announcement that accompanied the paper.

By exposing individuals to the full cost of certain expenses, cost-sharing undermines the primary function of insurance, says the ACP, noting that underinsurance may be a more challenging problem than lack of insurance.

More than 40 percent of marketplace plan enrollees and more than 20 percent of those insured through employers who report being in fair or poor health or having a chronic condition express confidence that they can afford necessary care, the paper says. But those with high-deductible plans have less confidence in their ability to afford a serious illness than those with low-deductible plans.

The ACP notes that rising premiums have led many employers to shift costs to employees in the form of higher average deductibles, which more than doubled between 2005 and 2015, even as wages remained largely flat.