Hundreds of Hospitals Penalized for Medical Mistakes

786 hospitals will see their Medicare payments slashed one percent for a year because of their performance under Medicare’s hospital-acquired conditions reduction program.

That program penalizes the 25 percent of hospitals with the highest rate of patient safety problems, such as infections and injuries.

Among the more interesting aspects of this year’s program results:

  • Among those being penalized are seven of the 21 hospitals on the S. News “best hospitals” list.
  • Three hospitals also on that list have never been penalized.
  • 145 hospitals will be penalized for the first time.
  • 16 hospitals that have been penalized every year since the program’s launch six years ago will not be penalized for the first time.

Since the program’s launch, 1865 of the 5276 hospitals that participate in the program have been penalized.

NASH has long been concerned about the manner in which the hospital-acquired conditions reduction program works, including its failure to reflect improved performance by individual hospitals and its approach of comparing the performance of hospitals that serve very different patients under very different circumstances.

Learn more about Medicare’s hospital-acquired conditions reduction program and this year’s penalties in the Kaiser Health News article “Preeminent Hospitals Penalized Over Rates Of Patients’ Injuries.”


NASH Unveils 2020 Advocacy Agenda

The National Alliance of Safety-Net Hospitals has published its 2020 advocacy agenda.

To advance the interests of private safety-net hospitals, in the coming year NASH will:

  • Continue to address the major policy challenges of 2019 that had not been resolved as that year ended:  an extended delay of Medicaid disproportionate share (Medicaid DSH) cuts, surprise medical bills, and prescription drug prices.
  • Respond to administration-driven policies such as the calculation of Medicare disproportionate share (Medicare DSH) payments, reduced payments for prescription drugs under the 340B prescription drug discount program, and efforts to reduce Medicaid eligibility and benefits and to limit the means through which states may finance their share of Medicaid payments.
  • Respond to expected judicial decisions addressing the extension of site-neutral Medicare outpatient payments to additional outpatient settings and the implementation of a new public charge regulation.

For a more detailed look at NASH’s advocacy plans for the coming year, see its complete 2020 advocacy agenda.

NASH Urges CMS to Withdraw Medicaid Fiscal Accountability Regulation

CMS should withdraw its proposed Medicaid fiscal accountability regulation, NASH wrote in formal comments in response to the proposed regulation.

In its comment letter, the National Alliance of Safety-Net Hospitals wrote that

While NASH supports greater transparency in Medicaid, that support is outweighed by too many troubling aspects of the proposed regulation.

Specifically, NASH told CMS that the proposed regulation would:

  • deprive states of important, established policy-making prerogatives;
  • create major new administrative burdens for hospitals, state governments, and federal regulators;
  • inappropriately regulate how states finance their share of their Medicaid spending;
  • introduce new, unspecified standards for state Medicaid programs; and
  • violate the federal Administrative Procedures Act.

Learn more by reading NASH’s complete formal comment letter to CMS in response to the agency’s proposed Medicaid fiscal accountability regulation.


CMS Introduces New Approach to Medicaid Block Grants

States would be able to convert part of their Medicaid programs into block grants under a new program introduced by the federal government.

The program, which the Centers for Medicare & Medicaid Services calls “Healthy Adult Opportunity,” would encompass services only for adults under the age of 65 who are not eligible for Medicaid because of disability or the need for long-term care, services, and supports and who are not otherwise eligible for the pre-Affordable Care Act Medicaid program.

Under the program, states can develop either a total expenses model or per enrollee model for their block grants and would have expanded opportunities to introduce co-pays and deductibles, impose work requirements, expand eligibility criteria, and waive retroactive coverage and hospital presumptive eligibility requirements.  To save on the cost of prescription drugs, they would be empowered to implement limited drug formularies.

The new program appears to be targeting states that did not expand their Medicaid programs under the Affordable Care Act.  It also appears to be CMS’s attempt to introduce the block grant concept in a limited way in the hope that it will be successful and lead to demand to expand block grants to the entire Medicaid program and not just the Medicaid expansion population.

In the past NASH has viewed Medicaid block grants with a degree of skepticism, maintaining that its possible support or opposition to them would be based on how a block grant program is structured and how new block grants might affect the ability of private safety-net hospitals to serve their communities.

Learn more about CMS’s new Healthy Adult Opportunity program in this CMS news release, this fact sheet, and a letter the agency sent to the nation’s state Medicaid directors.


Medicaid DSH Cut Delayed

Scheduled cuts in Medicaid DSH payments to hospitals will be delayed until at least late May under new federal spending legislation.

The cuts in Medicaid disproportionate share allotments to the states, mandated by the Affordable Care Act and delayed several times by Congress – including twice in FY 2020 alone under continuing resolutions to fund the federal government – are among a number of so-called “extenders” included in spending bills passed by Congress this week and sent to the president for his signature.

Authorization for delaying the cut in allotments to the states, which would have resulted in reduced Medicaid DSH payments for many hospitals – including private safety-net hospitals – would expire on May 22.  Congress is expected to address Medicaid DSH, along with surprise medical bills, the price of prescription drugs, and other health care matters, before that time.

NASH has argued against Medicaid DSH cuts for a number of years, doing so most recently in this September 2019 position statement in which it observed that

The conditions that led Congress to believe Medicaid DSH payments could be reduced significantly without harming the health care safety net have not unfolded entirely as anticipated. While many Americans have taken advantage of the Affordable Care Act to obtain health insurance, millions remain uninsured…

NASH also noted that

…any decline now in Medicaid DSH payments could lead to an increase in the provision of charity care, possibly forcing hospitals to reduce services, limit community outreach, and even reduce staff. Such measures could jeopardize access to care not only for hospitals’ uninsured and low-income patients but also for their privately insured, Medicare, and Medicaid patients as well.

Learn more about the delay in Medicaid DSH cuts and other aspects of this recent health care spending legislation in the Becker’s Hospital Review article “Congress unveils $1.3T spending deal: 5 healthcare takeaways.”


A Look at Surprise Medical Bill Legislation

While Congress’s decision this week to put off addressing the surprise medical bill challenge until next year has disappointed many, that decision did not reflect any lack of ideas for what to do.

At last count, various parts of Congress were considering four major surprise medical bill proposals:  one from the Senate Health, Education, Labor and Pensions Committee, one from the House Energy and Commerce Committee, one from the House Ways and Means Committee, and a compromise proposal from the Senate HELP and House Energy and Commerce committees.  Some have been around for some time while one emerged only in the past week.

The Commonwealth Fund has prepared a summary of the four proposals that includes a chart that compares where they stand on six major aspects of surprise billing legislation:

  • The medical settings to which the legislation would apply.
  • Whether they hold consumers harmless for surprise bills.
  • Whether they ban balance-billing.
  • How – or if – they establish standard rates.
  • How they resolve disputes between insurers and providers.
  • How they interact with existing state surprise medical bill laws.

NASH conveyed its perspective on surprise medical bills in a message to Congress last week.

Learn more from the Commonwealth Fund report “Update on Federal Surprise Billing Legislation: Understanding a Flurry of New Proposals.”

NASH Conveys End-of-Year Priorities to Congress

Preventing Medicaid DSH cuts, a fair approach to protecting patients from surprise medical bills, and reducing prescription drug costs are among the policy positions that the National Alliance of Safety-Net Hospitals recently shared with Congress.

In its message to Congress, NASH also asked lawmakers to protect 340B prescription drug discounts for private safety-net hospitals and to preserve dedicated funding for community health centers, the National Health Service Corps, and the Teaching Health Center Graduate Medical Education.

Learn more about NASH’s end-of-year policy priorities from the message “Protect Safety-Net Hospitals and the Communities They Serve in Upcoming Budget and Legislative Deliberations” that NASH delivered yesterday to all 535 members of Congress.

Hospital Groups Critical of CMS 340B Proposal

The federal government should not survey providers to determine their costs for drugs covered by the section 340B prescription drug discount program, hospitals and hospital groups have told the Centers for Medicare & Medicaid Services.

Their comments came in response to a regulation CMS proposed in September that would require hospitals to report their acquisition costs for 340B-covered drugs.  CMS proposed such data collection after federal courts ruled against its attempt to reduce 340B reimbursement to hospitals that participate in the program.  Among the court’s objections were CMS’s lack of data about those drug acquisition costs.

Among the reasons hospitals conveyed in expressing their opposition were the cost of reporting the data in question; the design of the survey; the flawed premise underlying the survey; and the proposed rule’s requirement that all hospitals complete the survey and not just those that participate in the 340B program.

Among the groups criticizing the proposed regulation were the Association of American Medical Colleges, which wrote in its comment letter that

Congress did not design the 340B program to pay hospitals at acquisition costs…Congress designed the program so that eligible hospitals could purchase covered drugs at a discounted rate below the Medicare reimbursement rate and use the difference to reach more eligible patients and provide more comprehensive services.

The National Alliance of Safety-Net Hospitals was among the groups commenting on the proposed regulation.  Writing on behalf of private safety-net hospitals, NASH observed in its November 27, 2019 formal comment letter that

The 340B program was created by Congress to enable hospitals (and other providers) that serve low-income communities to maximize their resources when working to serve those communities.  The program helps improve access to high-cost prescription drugs for low-income patients and helps put additional resources into the hands of qualified providers so those providers can do more for their low-income patients:  provide more care that their patients might otherwise not be able to afford, offer more services that might otherwise be unavailable to such patients, and do more outreach into communities consisting primarily of low-income residents.  This was the purpose of the 340B program when Congress created it in 1992 and Congress has done nothing to modify that purpose since that time:  it has not directed that special assistance to qualified providers be reduced; it has not insisted that participating providers document the expenditure of their savings in service to their communities; and it most certainly has not dictated that 340B payments to eligible providers be reduced so that payments to non-340B providers could be increased.  NASH believes that through this proposed data collection CMS is seeking to exert authority it does not have to demand of providers information to which the agency is not entitled.

Learn more about hospital industry opposition to the proposed 340B regulation in the Fierce Healthcare article “Hospitals blast CMS’ proposed 340B survey.”

Hospitals Sue Over Hospital Price Transparency Requirement

The federal government should be prohibited from implementing its new price transparency requirement for hospitals, a group of hospital trade groups and health systems has declared in a lawsuit against the U.S. Department of Health and Human Services.

The requirement exceeds the federal government’s authority, the suit maintains, and its implementation would create an undue burden on hospitals, cost a great deal of money, require hospitals to divulge proprietary information, inhibit competition, and overwhelm their information systems.  Even after all of that, the suit claims, consumers would still not have useful information because insurers, not hospitals, are the key in determining what consumers pay for the care they receive.

In response to the suit, an HHS spokesman, according to the online publication Healthcare Dive, said that

Hospitals should be ashamed that they aren’t willing to provide American patients the cost of a service before they purchase it.

NASH conveyed its opposition to the price transparency requirement in a September 26, 2019 letter to the Centers for Medicare & Medicaid Services in response to that agency’s proposed outpatient prospective payment system regulation, which included the transparency requirement.

The requirement will take effect on January 1, 2021.  The hospital groups and systems that filed the suit have asked the court for a prompt ruling.

Learn more in the Healthcare Dive article “Hospitals sue HHS, warning price transparency rule would chill competition, crash computers.”


Back Off 340B Data Collection, NASH Tells CMS

The federal government should not impose a new, major data reporting requirement on 340B-eligible hospitals to support the implementation of a new policy that federal courts twice have rejected, NASH told the Centers for Medicare & Medicaid Services last week.

In formal comments in response to a CMS proposal to require hospitals that participate in the section 340B prescription drug discount program to provide CMS with extensive data on their acquisition costs for 340B drugs, NASH wrote that such data collection would be burdensome; that CMS should not be reducing 340B payments to providers because such a policy decision falls solely within the purview of Congress, which created the program; and that instead of focusing on just this one aspect of the court’s rejection of its attempts to reduce 340B payments, CMS should instead focus on the court’s order that the agency develop a means of reimbursing hospitals for the lost 340B payments Medicare has withheld from providers for the past two years.

Most private safety-net hospitals participate in the 340B program and count on the resources the program generates to help them provide additional services to the low-income residents of the communities in which they are located.

Learn more about why NASH objects to CMS’s planned data reporting requirement in NASH’s formal comment letter to CMS.