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House to Set Sights on Medicare, Medicaid Cuts in 2018

The House of Representatives will pursue entitlement spending cuts next year, House Speaker Paul Ryan recently explained on a radio program. That means Medicare, Medicaid, and possibly even Social Security. Ryan said that We’re going to have to get back next year at entitlement reform, which is how you tackle the debt and the deficit… Frankly, it’s the health care entitlements that are the big drivers of our debt, so we spend more time on the health care entitlements — because that’s really where the problem lies, fiscally speaking. Medicare and Medicaid cuts would be very harmful to Pennsylvania safety-net hospitals. Learn more about Ryan’s remarks, the administration’s priorities, and what other members of Congress are saying about entitlement cuts in this Washington Post story.

Posted in Federal Medicaid issues, Medicare

Senators Seek 340B Reprieve

A bipartisan group of senators has written to Senate majority leader Mitch McConnell and Senate minority leader Chuck Schumer expressing concern about cuts in Medicare Medicare prescription drug payments to qualified providers as a result of new regulations governing the section 340B prescription drug discount program.  Those cuts have been adopted by regulation by the Centers for Medicare & Medicaid Services and will take effect beginning on January 1, 2018. Under the regulation adopted by CMS, Medicare payments for prescription drugs dispensed on an outpatient basis to low-income patients will be reduced to qualified providers by $1.6 billion in the coming year.  While acknowledging problems with how the 340B program has evolved over the years, the senators ask their leaders … Read More

Posted in Medicare, Pennsylvania safety-net hospitals

The Value-Based Payment Modifier: Program Outcomes and Implications for Disparities

Physicians who serve large numbers of low-income patients are more likely to incur penalties under Medicare value-based purchasing programs. So concludes a new study in Annals of Internal Medicine. According to the report, Performance differences between practices serving higher- and those serving lower-risk patients were affected considerably by additional adjustments, suggesting a potential for Medicare’s pay-for-performance programs to exacerbate health care disparities.  This result is based on a study of the Medicare Value-Based Payment Modifier program, which no longer operates, but could have implications for other programs that seek to reward or penalize practitioners based on the outcomes they produce. Such findings could lead practitioners to avoid serving such patients so they can avoid penalties, which in turn could jeopardize … Read More

Posted in Medicare, Pennsylvania safety-net hospitals, Uncategorized

The Battle Over 340B

Hospitals and other health care providers say it is an essential tool in ensuring access to care, and to prescription drugs, for their low-income patients. Pharmaceutical companies say it has expanded beyond its original purpose and is being used by hospitals to pad their profits. Members of Congress are divided:  some are supportive and some are skeptical. The section 340B program that requires drug companies to provide discounts to selected hospitals and other providers that serve large numbers of low-income patients has been the subject of controversy in recent years.  During that time, the administration has generally sided with hospitals and maintained the program. That support was tempered recently when the Centers for Medicare & Medicaid Services proposed a 28 … Read More

Posted in Medicare, Pennsylvania safety-net hospitals

340B Changes Would Hurt Hospital Margins

Proposed changes in the federal section 340B prescription drug discount program would hurt hospital margins. So says Moody’s Investors Service, the credit rating agency. According to Moody’s, the margins of non-profit hospitals are already under pressure because revenue increases are not keeping pace with prescription drug costs.  Reductions of payments under the 340B program recently proposed by the Centers for Medicare & Medicaid Services would make a challenging situation worse, Moody’s speculates. Under the 340B program, eligible hospitals purchase prescription drugs at a discount, supply them to eligible outpatients, and use the savings they gain to provide additional services and outreach to the low-income residents of their communities. Skeptics maintain that hospitals simply pocket the savings. Under the regulation proposed … Read More

Posted in Medicare, Pennsylvania safety-net hospitals

Leave 340B Alone, CMS Advisory Group Says

The Centers for Medicare & Medicaid Services should not significantly reduce Medicare payments for some prescription drugs. Or so says one of CMS’s own advisory panels. The agency’s Advisory Panel on Outpatient Prospective Payment reached this conclusion after listening to testimony from hospital industry stakeholders who told of the savings the federal government’s 340B prescription drug discount program produces and how those savings enable hospitals in low-income areas to help low-income patients who would not otherwise be able to afford their drugs and help improve access to care for low-income patients with very limited health care options. The panel’s recommendation came just a month after CMS proposed reducing Medicare reimbursement for 340B drugs from its current level, average sales price … Read More

Posted in Medicare, Pennsylvania safety-net hospitals, Uncategorized

Serving High-Risk Patients Leads to VPB Penalties

Practices that served more socially high-risk patients had lower quality and lower costs, and practices that served more medically high-risk patients had lower quality and higher costs. These patterns were associated with fewer bonuses and more penalties for high-risk practices. So concludes a new study that looked at the results of the first year of the Medicare Physician Value-Based Payment Modifier Program. The study looked at 899 physician practices serving more than five million Medicare beneficiaries, and it points to the continuing challenge of how best to serve patients who pose greater socio-economic risks than the average patient. Pennsylvania safety-net hospitals serve far more high-risk patients than the typical hospital. Learn more these findings and how they were reached in … Read More

Posted in Medicare, Pennsylvania safety-net hospitals

Ways and Means Seeks to Cut Medicare Red Tape

The House Ways and Means Committee’s Health Subcommittee has launched a new initiative to attempt to improve the delivery of Medicare services and eliminate statutory and regulatory obstacles to more effective care delivery. The subcommittee describes its “Medicare Red Tape Relief Project” as …a new initiative to deliver relief from the regulations and mandates that impede innovation, drive up costs, and ultimately stand in the way of delivering better care for Medicare beneficiaries. In support of this initiative, the committee has announced a three-part approach in which it will seek feedback from stakeholders, host roundtables with stakeholders across the country, and pursue congressional action to address the problems identified through this process. As part of the first step, the Health … Read More

Posted in Medicare

Congress Looks at 340B Program

Last week the House Energy and Commerce Committee took a look at the 340B prescription drug discount program, which requires pharmaceutical companies to sell discounted drugs for outpatient use to hospitals that care for especially large numbers of low-income patients. The previous week, the Centers for Medicare & Medicaid Services issued a proposed Medicare regulation calling for significant reductions in Medicare payments for such drugs. The hearing touched on the CMS proposal to reduce Medicare payments for 340B drugs, the high prices of prescription drugs, the 340B program’s growth over the years, the possibility that the program is being abused by hospitals and clinics, and more. The 340B program is an essential tool in the efforts of Pennsylvania safety-net hospitals … Read More

Posted in Medicare, Pennsylvania safety-net hospitals, Uncategorized

Temporarily Gone But Not Forgotten

While last week’s withdrawal of the American Health Care Act at least temporarily halted talk of immediate repeal and replacement of the Affordable Care Act, at least one aspect of that proposed legislation, often discussed in the past, is sure to arise in the future as well:  replacing the current manner in which the federal government matches state Medicaid funding with Medicaid per capita limits or Medicaid block grants. In a new issue brief, the Kaiser Family Foundation examines how a switch to per capita limits or block grants might affect low-income seniors served by both Medicare and Medicaid.  Among the issues the brief addresses are: why such a switch would matter to low-income seniors at all how it might … Read More

Posted in Federal Medicaid issues, Medicare, Pennsylvania safety-net hospitals
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