IBM Watson names 100 top hospitals

https://www.prnewswire.com/news-releases/ibm-watson-health-announces-100-top-hospitals-300805633.html

https://www.beckershospitalreview.com/rankings-and-ratings/ibm-watson-names-100-top-hospitals.html

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2019 Study Finds Top-Performing U.S. Hospitals Provide Better Care at Lower Cost and Higher Profit Margins than Peers Evaluated in the Study

ARMONK, N.Y.March 4, 2019 /PRNewswire/ — IBM Watson Health™ (NYSE: IBM) today published its 100 Top Hospitals® annual study identifying top–performing hospitals in the U.S. This study spotlights the best–performing hospitals in the U.S. based on a balanced scorecard using publicly available data for clinical, operational, and patient satisfaction metrics. The study is part of IBM Watson Health’s commitment to leveraging science and data to advance health and it has been conducted annually since 1993.

Overall, the Watson Health 100 Top Hospitals® study found that the top-performing hospitals in the country achieved better risk-adjusted outcomes while maintaining both a lower average cost per patient and higher profit margin than peer group hospitals that were part of the study.

“At a time when research shows that the U.S. spends nearly twice as much on healthcare as other high-income countries, yet has less effective population health outcomes1, the 100 Top Hospitals are setting a different example by delivering consistently better care at a lower cost,” said Ekta Punwani, 100 Top Hospitals® program leader at IBM Watson Health.

Kyu Rhee, M.D., M.P.P., vice president and chief health officer at IBM Watson Health, added: “From small community hospitals to major teaching hospitals, these diverse hospitals have demonstrated that quality care, higher patient satisfaction, and operational efficiency can be achieved together. In this era of big data, analytics, transparency, and patient empowerment, it is essential that we learn from these leading hospitals and work to spread their best practices to our entire health system which could translate into over 100K more lives saved, nearly 40K less complications, over 150K fewer readmissions, and over $8 billion in savings.”

Following were the key performance measurements on which 100 Top Hospitals showed the most significant average outperformance versus non-winning peer group hospitals (full study results available here):

  • Higher Survival Rates: The 100 Top Hospitals winners achieved survival rates that were 24.9 percent higher than those of peer hospitals.
  • Fewer Complications and Infections: Patients at winning hospitals experienced 18.7 percent fewer complications and 19.3 percent fewer healthcare-associated infections than peer group hospitals.
  • Shorter Length of Stay: Winning hospitals had a median severity-adjusted length of stay that was one half-day shorter (0.5) than peers.
  • Shorter Emergency Department Wait Times: Overall, winning hospitals delivered median emergency department wait times that were 17.3 minutes shorter than those of peer group hospitals.
  • Lower Inpatient Expenses: Average inpatient costs per discharge were 11.9 percent lower (a difference of $830 per discharge) at 100 Top Hospitals versus peer group hospitals.
  • Higher Profit Overall Margins: Winning hospitals maintained a median operating profit margin that was 11.9 percentage points higher than peer group hospitals.
  • Higher Patient Satisfaction: Overall hospital experience, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), was rated 3 percent higher for winning hospitals than peer group hospitals.

The IBM Watson Health 100 Top Hospitals winners outperformed peer group hospitals within all 10 clinical and operational performance benchmarks evaluated in the study: risk-adjusted inpatient mortality index, risk-adjusted complications index, mean healthcare-associated infection index, mean 30-day risk-adjusted mortality rate, mean 30-day risk-adjusted readmission rate, severity-adjusted length of stay, mean emergency department throughput, case mix- and wage-adjusted inpatient expense per discharge, adjusted operating profit margin, and HCAHPS score.

Extrapolating the results of this year’s study, if all Medicare inpatients received the same level of care as those treated in the award-winning facilities:

  • More than 103,000 additional lives could be saved;
  • More than 38,000 additional patients could be complication-free;
  • More than $8.2 billion in inpatient costs could be saved; and
  • Approximately 155,000 fewer discharged patients would be readmitted within 30 days.

In addition to the 100 Top Hospitals, the IBM Watson Health study also recognizes the 100 Top Hospitals Everest Award winners. These are hospitals that earned the 100 Top Hospitals designation and also are among the 100 top for rate of improvement during a five-year period. This year, there are 15 Everest Award winners.

To conduct the 100 Top Hospitals study, IBM Watson Health researchers evaluated 3,156 short-term, acute care, non-federal U.S. hospitals. All research was based on the following public data sets: Medicare cost reports, Medicare Provider Analysis and Review (MEDPAR) data, and core measures and patient satisfaction data from the Centers for Medicare & Medicaid Services (CMS) Hospital Compare website. Hospitals do not apply for awards, and winners do not pay to market this honor.

For more information, visit www.100tophospitals.com.

Here are the winning hospitals, by category, with asterisks indicating the Everest Award winners:

Major Teaching Hospitals

Advocate Illinois Masonic Medical Center – Chicago, IL
Ascension Providence Hospital  – Southfield, MI
Banner – University Medical Center Phoenix – Phoenix, AZ
Cedars-Sinai Medical Center – Los Angeles, CA
Garden City Hospital – Garden City, MI*
Mayo Clinic Hospital – Jacksonville, FL
Mount Sinai Medical Center – Miami Beach, FL
NorthShore University HealthSystem – Evanston, IL
Saint Francis Hospital and Medical Center – Hartford, CT
Spectrum Health Hospitals – Grand Rapids, MI
St. Joseph Mercy Hospital – Ann Arbor, MI*
St. Luke’s University Hospital – Bethlehem – Bethlehem, PA
The Miriam Hospital – Providence, RI
UCHealth University of Colorado Hospital – Aurora, CO*
University of Utah Hospital – Salt Lake City, UT

Teaching Hospitals

Abbott Northwestern Hospital – Minneapolis, MN
Aspirus Wausau Hospital – Wausau, WI
Brandon Regional Hospital – Brandon, FL
BSA Health System – Amarillo, TX
CHRISTUS St. Michael Health System – Texarkana, TX*
Good Samaritan Hospital – Cincinnati, OH
Lakeland Medical Center – St. Joseph, MI
Mercy Hospital St. Louis – St. Louis, MO
Monmouth Medical Center – Long Branch, NJ
Morton Plant Hospital – Clearwater, FL
Mount Carmel St. Ann’s – Westerville, OH
Park Nicollet Methodist Hospital – St. Louis Park, MN
Parkview Regional Medical Center – Fort Wayne, IN*
PIH Health Hospital – Whittier – Whittier, CA
Riverside Medical Center – Kankakee, IL
Rose Medical Center – Denver, CO*
Sentara Leigh Hospital – Norfolk, VA*
Sky Ridge Medical Center – Lone Tree, CO
SSM Health St. Mary’s Hospital – Madison – Madison, WI
St. Luke’s Hospital – Cedar Rapids, IA
St. Mark’s Hospital – Salt Lake City, UT*
Sycamore Medical Center – Miamisburg, OH
UCHealth Poudre Valley Hospital – Fort Collins, CO
Utah Valley Hospital – Provo, UT*
West Penn Hospital – Pittsburgh, PA

Large Community Hospitals

Advocate Sherman Hospital – Elgin, IL*
Banner Del E. Webb Medical Center – Sun City West, AZ
Baylor Scott & White Medical Center – Grapevine – Grapevine, TX
Hoag Hospital Newport Beach – Newport Beach, CA
IU Health Bloomington Hospital – Bloomington, IN*
Mease Countryside Hospital – Safety Harbor, FL
Memorial Hermann Memorial City Medical Center – Houston, TX
Mercy Health – Anderson Hospital – Cincinnati, OH
Mercy Health – St. Rita’s Medical Center – Lima, OH
Mercy Hospital  – Coon Rapids, MN
Mercy Hospital Oklahoma City – Oklahoma City, OK
Northwestern Medicine Central DuPage Hospital – Winfield, IL
Sarasota Memorial Hospital – Sarasota, FL
Scripps Memorial Hospital La Jolla – La Jolla, CA
St. Clair Hospital – Pittsburgh, PA
St. David’s Medical Center – Austin, TX
St. Joseph’s Hospital – Tampa, FL*
Texas Health Harris Methodist Hospital Southwest Fort Worth – Fort Worth, TX
University of Maryland St. Joseph Medical Center – Towson, MD
WellStar West Georgia Medical Center – LaGrange, GA

Medium Community Hospitals

AdventHealth Wesley Chapel – Wesley Chapel, FL
Dupont Hospital – Fort Wayne, IN
East Cooper Medical Center – Mt. Pleasant, SC
East Liverpool City Hospital – East Liverpool, OH*
Garden Grove Hospital Medical Center  – Garden Grove, CA
IU Health North Hospital – Carmel, IN
IU Health West Hospital – Avon, IN
Logan Regional Hospital – Logan, UT
Memorial Hermann Katy Hospital – Katy, TX
Mercy Health – Clermont Hospital – Batavia, OH
Mercy Hospital Northwest Arkansas – Rogers, AR
Mercy Medical Center – Cedar Rapids, IA
Montclair Hospital Medical Center – Montclair, CA
Mountain View Hospital – Payson, UT
Northwest Medicine Delnor Hospital – Geneva, IL
St. Luke’s Anderson Campus – Easton, PA
St. Vincent’s Medical Center Clay County – Middleburg, FL
UCHealth Medical Center of the Rockies – Loveland, CO
West Valley Medical Center – Caldwell, ID
Wooster Community Hospital – Wooster, OH

Small Community Hospitals

Alta View Hospital – Sandy, UT
Aurora Medical Center – Two Rivers, WI
Brigham City Community Hospital – Brigham City, UT
Buffalo Hospital – Buffalo, MN
Cedar City Hospital – Cedar City, UT
Hill Country Memorial Hospital – Fredericksburg, TX
Lakeview Hospital – Bountiful, UT
Lone Peak Hospital – Draper, UT
Marshfield Medical Center – Rice Lake, WI
Nanticoke Memorial Hospital – Seaford, DE
Parkview Noble Hospital – Kendallville, IN
Parkview Whitley Hospital – Columbia City, IN*
Piedmont Mountainside Hospital – Jasper, GA
San Dimas Community Hospital – San Dimas, CA
Seton Medical Center Harker Heights – Harker Heights, TX
Southern Tennessee Regional Health System – Lawrenceburg, TN
Spectrum Health Zeeland Community Hospital – Zeeland, MI
St. John Owasso Hospital – Owasso, OK
St. Luke’s Hospital – Quakertown – Quakertown, PA
Stillwater Medical Center – Stillwater, OK*

 

 

ANA CRITICIZES ‘CRIMINALIZATION OF MEDICAL ERRORS’ AS VANDERBILT NURSE ARRAIGNED

https://www.healthleadersmedia.com/nursing/ana-criticizes-criminalization-medical-errors-vanderbilt-nurse-arraigned?utm_source=silverpop&utm_medium=email&utm_campaign=ENL_190220_LDR_BRIEFING_resend%20(1)&spMailingID=15165362&spUserID=MTY3ODg4NjY1MzYzS0&spJobID=1581568052&spReportId=MTU4MTU2ODA1MgS2

The statement expresses support for handling medical errors with ‘a full and confidential peer review process.’


KEY TAKEAWAYS

The fatal error was made in December 2017, but it didn’t become public until November 2018, with a CMS report.

Vanderbilt was threatened with a loss of its Medicare status over the incident.

The nurse was indicted this month and scheduled for an arraignment Wednesday.

As a former nurse for Vanderbilt University Medical Center in Nashville, Tennessee, was scheduled to appear in court Wednesday morning for an arraignment on felony charges of reckless homicide and impaired adult abuse, the American Nurses Association raised concerns about the precedent the case could set.

Radonda Vaught administered a fatal dose of the wrong medication to a 75-year-old woman in late 2017, after overriding system safeguards, as The Tennessean’s Brett Kelman reported, citing an investigation report by the Centers for Medicare & Medicaid Services. That incident, which VUMC reportedly failed to convey to the medical examiner, prompted CMS to threaten VUMC’s Medicare status last November.

Vaught was indicted earlier this month, prompting the ANA to voice some concerns.

“Health care is highly complex and ever-changing resulting in a high risk and error-prone system,” the ANA said in a statement Tuesday. “However, the criminalization of medical errors could have a chilling effect on reporting and process improvement.”

Related: How DeKalb Medical Fixed Drug Safety Problems After Fatal Error

The statement, which specifically mentions Vaught’s case, expresses support for handling medical errors with “a full and confidential peer review process.”

The ANA also offered its condolences to the those who have suffered as a result of this error.

“This tragic incident should serve as reminder to all nurses, other health care professionals, and administrators that we must be constantly vigilant at the patient and system level,” the ANA added.

 

 

 

Testing a new role for ambulance services

https://www.cms.gov/newsroom/fact-sheets/emergency-triage-treat-and-transport-et3-model?utm_source=The+Weekly+Gist&utm_campaign=41103e2ef1-EMAIL_CAMPAIGN_2019_02_14_09_16&utm_medium=email&utm_term=0_edba0bcee7-41103e2ef1-41271793

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On Thursday, the Center for Medicare & Medicaid Innovation (CMMI) announced the launch of a new payment pilot that would pay ambulance providers to deliver an expanded range of care services, and to transport patients to alternative care settings. Expected to launch next year, the Emergency Triage, Treat and Transport Model (ET3) is a five-year, voluntary payment model that would reimburse care such as onsite and telemedicine-enabled assessment, transport to an alternative care site, or treatment in place in response to a 911 call. The model will require ambulance providers and local governments responsible for 911 dispatch to cooperate on triage and care delivery and will provide funds to assist in integrating services. The agency also plans to invite state Medicaid programs and private insurers to collaborate in model adoption.
We’ve long been impressed by programs that use “community paramedics” to provide in-home assessment of homebound patients with complex care needs. As one participant told us, paramedics are ideally suited to assess a home situation; they have “seen everything” so nothing fazes them, and patients who frequently call 911 are comfortable with letting a paramedic in their home and are often willing to engage with them on broader care issues. Yet few of these programs have enjoyed sufficient funding to scale services. At first blush, the ET3 program could be one of the most innovative payment models CMMI has yet proposed, with the potential not only to eliminate thousands of unnecessary ED visits and provide more appropriate care in a lower-cost setting, but also to link at-risk patients with ongoing care management and social resources.

 

 

Loosening Up Stark and Anti-Kickback Laws: What Would It Look Like?

https://mailchi.mp/burroughshealthcare/pc9ctbv4ft-1611881?e=7d3f834d2f

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The Department of Health and Human Services under the Trump administration has taken a deregulatory approach toward healthcare delivery. Its efforts on the payer side includes expanding the availability of individual health insurance policies that don’t conform to the rules of the Affordable Care Act, and more recently liberalizing the use of tax credits to purchase them.

However, the HHS has made one of its boldest proposals on the provider side. Over the summer, the Centers for Medicare & Medicaid Services issued a request for information (RFI) regarding potentially loosening up the Stark and anti-kickback laws.

Originally signed into law in 1972, the Anti-Kickback Statute barred any sort of renumeration to a provider to induce the referral of a patient. The Stark Law, enacted in 1990, bars doctors from referring Medicare or Medicaid patients to any ‘designated facility’ in which they have any form of a financial relationship. Both laws have been updated – and strengthened – numerous times in the intervening years. The HHS’ proposed changes would signal a shift away from how those laws are interpreted.

According to Mark Hardiman, partner with the Nelson Hardiman healthcare law firm in Los Angeles, the move represents a desire by HHS “to move all payments away from fee-for-service and make the providers at risk on both the upside and downside.”

Although the proportion of fee-for-service payments made to Medicare providers has shrunk in recent years, it still comprises the majority. A total of $392 billion in Medicare fee-for-service payments were made in 2017, according to the Kaiser Family Foundation, 56 percent of all payments made from the program. Although that’s down from 70 percent of all Medicare payments made a decade prior, the continuing aging of the Baby Boomer population and healthcare cost inflation is putting pressure on CMS and HHS to find ways to continue to pare back costs. Coordinated care initiatives such as accountable care organizations comprise just a small fraction of all Medicare payments, and many providers are balking about taking on too much downside financial risk when forming accountable care organizations.

 According to HHS, the intent is to make it easier for providers to implement value-based care initiatives. “Removing unnecessary government obstacles to care coordination is a key priority for this administration,” said HHS Deputy Secretary Eric Hargan of the rationale behind the regulatory review. “We need to change the healthcare system so that it puts value and results at the forefront of care, and coordinated care plays a vital role in this transformation.”

Nonetheless, the hospital sector has been generally supportive of regulatory changes. In testimony to a U.S. House Ways and Means subcommittee over the summer, Michael Lappin, chief integration officer at Advocate Aurora Health, observed that strict liability rules discourage value-based arrangements.

So, what would the healthcare delivery environment resemble with looser regulations governing both laws?

   According to Hardiman, the changes HHS is seeking to the regulations are far from sweeping.
“They are really on the margins, and they are not signaling a fundamental shift in the enforcement of the Stark and  Anti-Kickback Law,” he said. 

Why would there not be a major regulatory unraveling? Hardiman notes that doing so would create chaos in healthcare delivery. Moreover, qui tam(whistleblower) lawsuits in healthcare have become a major source of income for attorneys, and they would object to too much of an unwinding. Data from the non-profit watchdog organization Taxpayers Against Fraud bears that out: Of the more than $3.7 billion in False Claims Act settlements reached in 2017, $2.4 billion involved litigation involving healthcare enterprises. It was the eighth consecutive year that healthcare case settlements topped $2 billion. Hardiman also noted that more and more litigation is being settled for large sums even when the U.S. Justice Department declines to intervene in a case.

Hardiman believes that if the regs are loosened, they would likeliest be in the form of a “series of fraud and abuse waivers.” They would cover initiatives such as managed care ventures or ACOs, making it easier for hospitals and physicians to collaborate on care coordination, as well create models to more equitably share expenses and profits and encourage cross-referrals.

“You are going to see a much more comprehensive definition as to what types of risk-sharing arrangements will not be reviewed as renumeration under the kickback statute,” Hardiman said. “I wouldn’t be surprised to see safe harbors around Medicare Advantages, ACOs, and participants in other innovative risk-sharing arrangements.”

Individual physicians and medical groups may also have the opportunity to pay inducements to patients to lose weight or engage in another health-enhancing activity – something they are currently barred from doing under most circumstances.

“Everybody knows we’re heading toward a value-based coordinated care model,” Hardiman said. “And promoting and incentivizing it is still a risky business. You want at least some practical guideposts.” 

 

Trump wants to bypass Congress on Medicaid plan

https://www.politico.com/story/2019/01/11/trump-bypass-congress-medicaid-plan-1078885?utm_source=Sailthru&utm_medium=email&utm_campaign=Newsletter%20Weekly%20Roundup:%20Healthcare%20Dive%2001-19-2019&utm_term=Healthcare%20Dive%20Weekender

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Block grants for states would achieve conservative dream on health program for poor.

The Trump administration is quietly devising a plan bypassing Congress to give block grants to states for Medicaid, achieving a longstanding conservative dream of reining in spending on the health care safety net for the poor.

Three administration sources say the Trump administration is drawing up guidelines on what could be a major overhaul of Medicaid in some states. Instead of the traditional open-ended entitlement, states would get spending limits, along with more flexibility to run the low-income health program that serves nearly 75 million Americans, from poor children, to disabled people, to impoverished seniors in nursing homes.

Capping spending could mean fewer low-income people getting covered, or state-designated cutbacks in health benefits — although proponents of block grants argue that states would be able to spend the money smarter with fewer federal strings attached.

Aware of the political sensitivity, the administration has been deliberating and refining the plan for weeks, hoping to advance an idea that Republicans since the Reagan era have unsuccessfully championed in Congress against stiff opposition from Democrats and patient advocates. During the Obamacare repeal debate in 2017, Republican proposals to cap and shrink federal Medicaid spending helped galvanize public opposition, with projections showing millions would be forced off coverage.

In addition to potential legal obstacles presented by moving forward without Congress, the administration effort could face strong opposition from newly empowered House Democrats who’ve vowed to investigate the administration’s health care moves.

“Hell no,” Sen. Bob Casey (D-Pa.) wrote on Twitter on Friday evening, vowing to oppose the administration’s block grant plan “through legislation, in the courts, holding up Administration nominees, literally every means that a U.S. Senator has.”

The administration’s plan remains a work in progress, and sources said the scope is still unclear. It’s not yet known whether CMS would encourage states to seek strict block grants or softer spending caps, or if new limits could apply to all Medicaid populations — including nursing home patients — or just a smaller subset like working-age adults.

A spokesperson for CMS did not comment on the administration’s plans but indicated support for the concept of block grants.

“We believe strongly in the important role that states play in fostering innovation in program design and financing,” the spokesperson said. “We also believe that only when states are held accountable to a defined budget — can the federal government finally end our practice of micromanaging every administrative process.”

Republicans have sought to rein in Medicaid spending, especially as enrollment swelled under Obamacare’s expansion of the program to millions of low-income adults in recent years. CMS Administrator Seema Verma has warned increased spending on the Medicaid expansion population could force cutbacks on sicker, lower-income patients who rely on the program.

The administration wants to let states use waivers to reshape their Medicaid programs, but the effort could face legal challenges in the courts. Waivers approved by the Trump administration to allow the first-ever Medicaid work requirements for some enrollees, for example, are already being challenged in two states.

Also complicating the administration’s push: the newfound popularity of Medicaid, which has grown to cover about one in five Americans. Voters in three GOP-led states in November approved ballot measures to expand Medicaid, which has been adopted by about two-thirds of states. Newly elected Democratic governors in Kansas and Wisconsin are pushing their Republican-led legislatures to expand Medicaid this year.

Verma has been trying to insert block grant language into federal guidance for months but has encountered heave scrutiny from agency lawyers, two CMS staffers said. She mentioned interest in using her agency’s authority to pursue block grants during a meeting with state Medicaid directors in the fall but did not provide details, said two individuals who attended.

There is some precedent for the federal government capping its spending on the entitlement program. Former President George W. Bush’s health department approved Medicaid spending caps in Rhode Island and Vermont that would have made the states responsible for all costs over defined limits. However, those spending caps were set so high there was never really any risk of the states blowing through them.

In recent years, governors have complained about the rising costs of Medicaid, which is eating up a bigger share of their budgets. States jointly finance the program with the federal government, which on average covers 60 percent of the cost – though the federal government typically shoulders more of the burden in poorer states. The federal government covers a much higher share of the cost for Medicaid enrollees covered by the Obamacare expansion.

An official from a conservative state, speaking on background to discuss an effort not yet public, said states would consider a block grant as long as the federal government’s guidance isn’t overly prescriptive.

CMS is hoping to make an announcement early this year, but it could be further delayed by legal review, which has already been slowed by the prolonged government shutdown.

Some conservative experts said the administration’s plans ultimately may be limited by Medicaid statute, which requires the federal government to match state costs. However, they say the federal government can still try to stem costs by approving program caps.

“There’s no direct provision of authority to waive the way that the federal government pays the states,” said Joe Antos of the American Enterprise Institute, a right-leaning think tank. “However, that doesn’t mean that you can’t try to have some of the effects that people that like block grants would like to see, in terms of encouraging states to be more prudent with the ways they spend the money.”

 

 

 

CMS cuts ACA exchange fees, floats proposal to end silver-loading

https://www.healthcaredive.com/news/cms-cuts-aca-exchange-fees-floats-proposal-to-end-silver-loading/546399/

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Dive Brief:

  • CMS proposed in its 2020 Payment Notice on Thursday a reduction to exchange user fees and is asking for feedback on a proposals to potentially eliminate auto-reenrollment and “silver-loading,” a strategy used by payers where they pack the ACA’s subsidy-rich silver tier plans in order to make up for losses incurred by the elimination of cost-sharing reduction (CSR) payments.
  • The agency is proposing to drop the exchange fee to 3% from 3.5% of premiums for plans sold on the federal exchange and to 2.5% from 3% for plans sold on state exchanges. If finalized as-is, the rule would also increase the annual cost-sharing limit for self-only coverage to $8,200 from $7,900 and to $16,400 from $15,800 for family coverage.
  • While rule’s intentions are to lower premiums, critics have argued it would trigger the opposite. Former CMS Administrator Andy Slavitt warned through a series of tweets that the rule is an “act of sabotage” that would cut coverage for 2 million Americans, “significantly increase premiums, and raise out of pocket costs.”

Dive Insight:

CMS has presented the rule as another step toward deregulating healthcare and lowering costs for consumers. Consumers, the agency argues, will ultimately save money on premiums, savings that will theoretically trickle down from insurers, who will pay less in exchange user fees once the proposal is finalized.

CMS Administrator Seema Verma said in a statement that the rule is aligned with the Trump administration’s healthcare goals, which include lowered premiums, reduced regulations, market stability, consumerism and protection for taxpayers.

While no regulations limiting or banning auto-enrollment and silver-loading are contained in the rule, CMS has requested public comment on the two issues for consideration in future rules before 2021.

The Administration supports a legislative solution that would appropriate CSR payments and end silver loading,” the proposed rule states. “There is a concern that automatic re-enrollment eliminates an opportunity for consumers to update their coverage and premium tax credit eligibility as their personal circumstances change, potentially leading to eligibility errors, tax credit miscalculations, unrecoverable federal spending on the credits, and general consumer confusion.”

Critics called it the latest act of “sabotage” on the ACA.

Ending auto-enrollment, a key feature of the ACA, would result in lost coverage for a number of Americans.

The end of silver-loading, a tactic many health plans resorted to in 2018 after the elimination of the law’s cost sharing reductions, could wreak havoc for insurers in the exchanges.

Opponents of the rule believe cracking down on silver-loading would do little more than boost premiums for consumers, as insurers would have no other mechanism to mitigate subsidy losses. 

President Trump, Senator Patty Murray, D-Wash., said in a statement. is “hurting families left and right.” Murray is the top Democrat on the Senate Health, Education, Labor, and Pensions Committee.

“Even 27 days into the shutdown he caused, President Trump has somehow found time to further sabotage health care for patients, families, and women —this time by proposing what would amount to a health care tax on patients and families across the country,” Murray said.

America’s Health Insurance Plans praised the reduced user fee, adding the proposed rule focuses on “stability in the individual market.” But it is unclear where the insurance lobby stands on the proposals to potentially end auto-reenrollment and the practice of silver-loading.

Public comments on the rule are due February 19. 

 

 

3+ clicks needed to find online price lists of largest hospitals, Quartz says

https://www.beckershospitalreview.com/finance/3-clicks-needed-to-find-online-price-lists-of-largest-hospitals-quartz-says.html?origin=cfoe&utm_source=cfoe

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The websites of 75 percent of the nation’s 115 biggest hospitals required three or more clicks to find their chargemaster, according to an analysis by Quartz.

Five things to know:

1. As of Jan. 1, hospitals are required to post their standard charges online under a CMS price transparency rule. They must present the information in a machine-readable format that can be easily imported into a computer system and update the information at least annually. On Jan. 10, CMS Administrator Seema Verma acknowledged that the information hospitals are posting “isn’t patient-specific,” but she said the federal government still believes the requirement “is an important first step.”

2. For its analysis, Quartz surveyed the websites of 115 of the largest U.S. hospitals, which receive 20 percent of all Medicare and Medicaid hospital funding. The reporters said “after spending an inordinate amount of time clicking through pages,” they found 105 hospitals’ lists online.

3. “Even among those hospitals that are technically compliant with the new rule, the vast majority don’t make it especially easy for the average person to find their pricing information. We found that most price lists are buried under many sub-menus or at the very bottom of a long page scroll,” the reporters said.

4. For six hospitals the reporters had trouble finding price lists for, they were able to track them down through a Google search pairing the name of each hospital with phrases like “price list” or “chargemaster.” Another four hospitals whose lists remained elusive to the reporters were contacted via email or phone, with three — Hackensack (N.J.) University Medical Center, Allentown, Pa.-based Lehigh Valley Hospital and Washington Hospital Center in the District of Columbia — not replying to Quartz at the time of writing.

5. Even for hospitals whose online lists were more accessible, some required hundreds of clicks to find a particular item, according to the publication. For example, Louisville, Ky.-based Norton Hospital’s 1,560-page price list had three separate pages for “treatment rooms.” At least five hospitals also requested a user’s email and name to access the data.

“In many instances, the price list is published on illogical pages. Most hospital sites have a ‘billing’ section, but, for example, the Methodist Hospital in San Antonio decided to put its standard rates on the legal page while [Indianapolis-based] Indiana University Health has placed it under the Frequently Asked Questions section of its website. Baptist Hospital in Miami published their chargemaster as fine print,” according to Quartz.

For the full Quartz report, click here.