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Proposed Federal Reorganization Could Affect Health Care

Aspects of a proposed reorganization of the federal government could affect the agencies that administer key health care programs. In its 132-page Delivering Government Solutions in the 21st Century:  Reform Plan and Reorganization Recommendations proposal, the White House calls for consolidating many social safety-net programs in a new Department of Health and Public Welfare.  This department would retain responsibility for Medicare and Medicaid but also would assume responsibility for some food aid programs, including food stamps (now the Supplemental Food Assistance Program, or SNAP). In addition, the proposal would: consolidate all health research programs in the National Institutes of Health, including the Agency for Healthcare Research and Quality, the National Institute for Occupational Safety and Health, and the National Institute … Read More

Posted in Federal Medicaid issues, Medicare

MedPAC Issues 2018 Report to Congress

The non-partisan legislative branch agency that advises Congress and the administration on Medicare payment policies has submitted its mandatory annual report to Congress. Among the findings included in the report by the Medicare Payment Advisory Commission are: Medicare’s hospital readmissions reduction program has not resulted in increases in emergency room visits or hospital observation stays. Many Medicare accountable care organizations, while maintaining or improving quality, are producing more modest savings than predicted. MedPAC approves of Medicare’s proposals to redesign the case-mix classification system for skilled nursing facilities. MedPAC supports changes Medicare has proposed for patient assessment and therapy requirements for skilled nursing facilities. MedPAC’s recommendations include: Authorizing outpatient-only hospitals in isolated rural communities to ensure access to emergency care. Reducing … Read More

Posted in Medicare

S&P: 340B Cuts Will Hurt

Payment cuts in the 340B prescription drug program will most likely hurt hospital financial performance, and among those most likely to be hurt are DSH hospitals, small hospitals, and rural hospitals. These are among the conclusions in a report recently issued by S&P Global Ratings. The report concludes that …the impact of the cuts to the 340B Drug Pricing Program on not-for-profit hospitals that rely on 340B drug savings will likely weaken their operating performance at a time of already tightening margins. Effective the beginning of 2018, the Centers for Medicare & Medicaid Services cut the 340B program 16 percent, or $1.6 billion, reducing the reimbursement 340B-eligible hospitals receive for dispensing prescription drugs on an outpatient basis to eligible patients. … Read More

Posted in 340b, DSH hospitals, Medicare, Pennsylvania safety-net hospitals

The 340B Issue Explained

The section 340B prescription drug discount program has grown increasingly controversial in recent years. The program, established in the 1990s to help hospitals with the cost of the prescription drugs they provide to low-income patients on an outpatient basis, has grown considerably since its inception.  Pharmaceutical companies argue that it is too large, that it contributes to the growing cost of prescription drugs, and that hospitals are not using the savings they reap from the program to serve more low-income patients, as was envisioned when Congress created the program. Eligible providers, on the other hand, note that much of the program’s growth was mandated by Congress and that 340B continues to serve its original purpose of helping hospitals serve low-income … Read More

Posted in Medicare

Helping Safety-Net Hospitals Help Their Patients

A new report published on the Health Affairs Blog describes the continuing challenges safety-net hospitals face and offers suggestions for helping them meet those challenges. The challenges, according to the report, are the virtual elimination of the Affordable Care Act’s individual health insurance mandate; the continued decline in the amount of Medicare disproportionate share hospital money (Medicare DSH) provided to safety-net hospitals; and hospital closures that shift more of the burden for caring for uninsured patients onto a smaller pool of safety-net hospitals.  The result is under-served patients and new financial risks for the hospitals that remain after some safety-net hospitals close because of the large amounts of uncompensated care those hospitals continue to provide. To address these challenges, the … Read More

Posted in Affordable Care Act, Medicare

New 340B Bill Proposed

A new bill introduced in the House seeks to bring greater transparency to the controversial 340B prescription drug discount program. Under H.R.5598, proposed by Rep. Earl “Buddy” Carter (R-GA), hospitals would be required to report the outpatient care they provide to low-income patients in both their main hospital and at pediatric care sites.  Hospitals already separately report the inpatient care they provide to such patients. According to Representative Carter, I introduced this legislation today because I believe the 340B program is very important, but it needs to be improved.  340B is an outpatient program and currently hospitals do not have to report low-income utilization in outpatient settings. This legislation adds an additional layer of transparency to allow us to better … Read More

Posted in Medicare

Safety-Net Hospitals Improve More on Readmissions But Still More Likely to be Penalized

Hospitals that serve large numbers of minority patients are reducing their Medicare readmissions rates more than other hospitals but are still more likely to be penalized under Medicare readmissions reduction program. This is one of the findings in a new study published in the journal Health Affairs. According to the study, hospitals that serve larger numbers of minority patients – typically, safety-net hospitals – are more likely to be penalized for readmissions than other hospitals because even though they are reducing their readmissions rates faster than other hospitals, their performance is compared, unfavorably, to hospitals that had fewer Medicare readmissions prior to the launch of the readmissions reduction program. This situation may change beginning in FY 2019 when a new … Read More

Posted in Medicare

340B Program Getting the Job Done

The oft-scrutinized section 340B prescription drug discount program is doing what the program is supposed to do, according to a new analysis published on the Health Affairs Blog. According to the report, 340B DSHs treat significantly more low-income patients than non-340B hospitals, provide a disproportionate amount of the nation’s uncompensated and unreimbursed care, and are more likely to provide specialized services that are critical to low-income patients but which are often underpaid. In addition, 340B …has saved billions in drug costs while providing free or discounted care to millions of patients who might otherwise be unable to get needed care. This is accomplished at no cost to taxpayers. In addition, the report concludes that 340B-eligible hospitals: care for significantly more … Read More

Posted in Medicare, Uncategorized

Senate Committee Looks at 340B Program

The Senate Health, Education, Labor, and Pensions Committee (HELP) held a hearing last week on the 340B prescription drug discount program. The hearing was prompted by complaints from pharmaceutical companies about the discounts they are required to provide to eligible providers and by concern that hospitals are insufficiently accountable for how they use the savings they derive from those discounts to serve their low-income patients.  In addition, the Centers for Medicare & Medicaid Services recently reduced its Medicare payments to participating hospitals. During the hearing, Senate Republicans expressed support for the program but spoke of the need for greater transparency in the use of the savings the 340B program generates for hospitals and a clearer sense of how those savings … Read More

Posted in Medicare

MedPAC Issues 2018 Report to Congress

The Medicare Payment Advisory Commission has issued its 2018 report and recommendations to Congress. The report includes MedPAC’s recommendations for next year’s Medicare fee-for-service payments; a review of the Medicare Advantage and Medicare Part D programs, with recommendations; and a report telehealth required by the 21st Century Cures Act. For Medicare fee-for-service rates, MedPAC proposes: the inpatient and outpatient rate increases, physician and other health professional rate increases, and outpatient dialysis increase included under current law no increase for ambulatory surgical centers, long-term-care hospitals, and hospice providers no rate increase for skilled nursing facilities a five percent reduction of payments for home health providers and the introduction of a two-year rebasing of home health rates beginning in 2020 a five … Read More

Posted in Medicare
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