NASH Asks Congress to Help Prevent Attempt to Undermine 340B

Pharmaceutical companies are attempting to prevent safety-net hospitals and others from receiving the full benefits of the section 340B prescription drug discount program and the National Alliance of Safety-Net Hospitals is asking members of the House of Representatives to sign a congressional letter to Health and Human Services Secretary Alex Azar asking to him intervene and stop the pharmaceutical companies.

In asking members of Congress to sign onto the bipartisan letter, NASH notes that

The 340B program is essential for private safety-net hospitals and others like them throughout the country, enabling them to obtain discounts on prescription drugs they dispense on an outpatient basis to qualified, low-income patients.  The program greatly enhances the ability of hospitals to serve their low-income patients and does not cost taxpayers a single dime, but in recent weeks several pharmaceutical companies have taken steps to prevent hospitals from receiving the prescription drug discounts that Congress clearly intended when it created the 340B program nearly 30 years ago.

Learn more about the 340B problem and what NASH and others are asking Secretary Azar to do to help in this NASH message to members of Congress.

 

Comfort, Not Quality, Woos Patients

People are more likely to recommend a hospital based on the comfort they felt when hospitalized rather than the quality of the care they received, a new study has found.

Good food, rooms with a view, friendly nurses, peace and quiet, more television channels, and other amenities impress patients more than higher survival rates and lower hospital-acquired conditions rates.

These are among the findings from an analysis of patient satisfaction data from 3000 hospitals between 2007 and 2010.

This has long been a concern of NASH, and in the past, NASH wrote to federal regulators in response to proposals to use patient survey results in Medicare quality purchasing programs, explaining that

… we believe some of the [federal government’s] survey’s questions are biased against large urban hospitals.  We think it is inappropriate, for example, to compare the degree of quietness of a seventy-five-year-old hospital with semi-private rooms located in a congested urban area with that of a new facility with private rooms located on a sylvan, multi-acre campus set well off any major thoroughfares. 

Learn more about how inpatients view their hospital experiences and how those experiences shape how they rate hospitals in Oxford Academic’s Social Forces article “Patients as Consumers in the Market for Medicine: The Halo Effect of Hospitality” and find a summary of that analysis in the HealthLeaders Media article “Hospitality Trumps Clinical Outcomes When It Comes To Patient Satisfaction.”

Safety-Net Hospitals, Others Benefit From Changes in Medicare Readmissions Program

Safety-net hospitals are among the leading beneficiaries of changes implemented this year in Medicare’s  hospital readmissions reduction program.

According to a new study, safety-net, academic, and rural hospitals have enjoyed improved performance under the program since Medicare began organizing hospitals into peer groups based on the proportion of low-income patients they serve rather than simply comparing individual hospital performance to that of all other hospitals.

While the current fiscal year is still under way, it appears that safety-net hospitals will enjoy a collective decline of $22 million in Medicare readmissions penalties while 44.1 percent of teaching hospitals and 43.7 percent of rural hospitals will face smaller penalties than last year.

NASH was one of the leading and most outspoken proponents of leveling the playing field in the readmissions reduction program, encouraging policy-makers to reform the program so it would compare hospital readmission rates among similar hospitals instead of to those of all hospitals.  NASH’s multi-year effort proved successful and private safety-net hospitals are now benefiting from that success.

Learn more about the readmissions reduction program and how changes in that program have significantly altered its outcomes in the JAMA Internal Medicine study “Association of Stratification by Dual Enrollment Status With Financial Penalties in the Hospital Readmissions Reduction Program.”

Safety-Net Hospitals Struggle in Medicare Joint Replacement Model

Non-safety-net hospitals are outperforming safety-net hospitals in the Comprehensive Care for Joint Replacement model introduced in 2016.

According to a new study published in Health Affairs,

…in comparison to non-safety-net hospitals, 42 percent fewer safety-net hospitals qualified for rewards based on their quality and spending performance (33 percent of safety-net hospitals qualified, compared to 57 percent of non-safety-net hospitals), and safety-net hospitals’ rewards per episode were 39 percent smaller ($456 compared to $743). Continuation of this performance trend could place safety-net hospitals at increased risk of penalties in future years.

What might be done to address this disparity?  The study suggests that

Medicare and hospital strategies such as those that reward high-quality care for vulnerable patients could enable safety-net hospitals to compete effectively in CJR.

Learn more in the Health Affairs article Performance of Safety-Net Hospitals in Year 1 of the Comprehensive Care for Joint Replacement Model.

 

Proposed Public Charge Regulation Causes Confusion in Clinics, Elsewhere

A Trump administration proposal to redefine what constitutes a “public charge” is making life challenging for low-income immigrants and the clinics and other providers to which they turn for Medicaid-covered health care.

The proposed regulation from the Department of Homeland Security would establish new criteria for determining whether a person is a “public charge,” based on their participation in certain public programs, and therefore in jeopardy of losing their legal immigration status.

Some Medicaid patients who come to clinics ask if receiving Medicaid-covered services might jeopardize their legal immigration status; others fail to keep appointments or forego seeking care out of fear of the future implications.  Clinic operators walk a fine line between trying to provide the care their patients need and deciding how to answer patients’ questions honestly but without causing undue alarm.  Some choose not to address the issue at all; others seek to answer patient questions but only when asked; while still others provide information about the situation without being asked – doing so, they realize, at the risk of scaring off some of those patients.

Meanwhile, some legal experts believe that a new standard, if adopted, would not be retroactive and consider Medicaid enrollment prior to the regulation’s adoption.

The result is confusion and concern among providers, legal immigrants enrolled in Medicaid, and advocates.

Last month NASH wrote to the Department of Homeland Security to convey its objections to the proposed legislation, expressing concern about its potential impact on private safety-net hospitals and the patients and communities they serve.

Learn more about the proposed regulation and the challenges providers face as they await a decision on whether it will be implemented in the Kaiser Health News report “Providers Walk ‘Fine Line’ Between Informing And Scaring Immigrant Patients.”