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Hospitals Ask Congress to Protect 340B Program

The leaders of more than 700 hospitals and health systems have written to congressional leaders to ask them to protect the section 340B prescription drug discount program.

The letter states that

 We are concerned about recent regulatory actions that have reduced the reach of this vital program and by legislative proposals that would undo more than two decades of bipartisan work to preserve the health care safety net.

The letter explains that

 In 2015, 340B hospitals provided $26 billion in uncompensated and unreimbursed care to low-income and rural patients in need. That represented 60 percent of all such care delivered in the U.S. even though our hospitals comprise only 38 percent of all acute care hospitals operating in our country. Because of the savings from 340B, we are able to offer vital but often money-losing services including obstetrics, trauma care, opioid addiction treatment, and HIV/AIDS care. In many rural communities, 340B savings are the difference between hospitals staying open and closing. We do all of this without using taxpayer dollars.

And

Efforts to reduce the scope of the 340B program would not reduce the cost of prescription drugs in the U.S. and would weaken nonprofit hospitals’ ability to serve patients who often have nowhere else to turn.

NAUH has long advocated protecting the 340B program, writing to Congress to express this view on many occasions, and most recently, earlier this year.

Go here to see the complete letter from the more than 700 hospitals and health systems.

New Approach to Readmissions Program Takes Effect

Medicare’s hospital readmissions reduction program is moving in a new direction beginning in FY 2019 after Congress directed the Centers of Medicare & Medicaid Services to compare hospitals’ performance on readmissions to similar hospitals instead of to all hospitals.

The policy change, driven by a belief that safety-net hospitals were harmed by the program and excessive penalties because their patients are more challenging to serve, results in all hospitals being divided into peer groups based on the proportion of low-income patients they serve.  The readmissions performance of hospitals is then compared only to other hospitals within each peer group.

As a result of this new approach, readmissions penalties against safety-net hospitals are expected to decline 25 percent in FY 2019 while the average penalty for hospitals serving the fewest low-income patients will rise.

NAUH was one of the leading proponents of this major change in how the readmissions reduction program treats hospitals.

Kaiser Health News has published a detailed story describing the policy change and its implications for hospitals, which face penalties of up to three percent of their Medicare revenue for what is considered “excessive” readmissions of Medicare patients within 30 days of their discharge from the hospital.  Included in the article is a searchable database of every hospital in the country that lists the peer group for each hospital, its FY 2018 and FY 2019 readmissions penalties by percentage of Medicare revenue, and the change in readmissions penalty expected from FY 2018 to FY 2019.  Go here to see the article “Medicare Eases Readmission Penalties Against Safety-Net Hospital.”

New Approach to Readmissions Program to Take Effect October 1

Medicare’s hospital readmissions reduction program will move in a new direction beginning in FY 2019 after Congress directed the Centers of Medicare & Medicaid Services to compare hospitals’ performance on readmissions to similar hospitals instead of to all hospitals.

The policy change, driven by a belief that safety-net hospitals were harmed by the program and excessive penalties because their patients are more challenging to serve, results in all hospitals being divided into peer groups based on the proportion of low-income patients they serve.  The readmissions performance of hospitals is then compared only to other hospitals within each peer group.

As a result of this new approach, readmissions penalties against safety-net hospitals are expected to decline 25 percent in FY 2019 while the average penalty for hospitals serving the fewest low-income patients will rise.

NAUH was among the loudest and most persistent voices calling for reform of the program to better reflect the special challenges private safety-net hospitals face in working to prevent the readmission of their low-income Medicare payments to the hospital.

Kaiser Health News has published a detailed story describing the policy change and its implications for hospitals, which face penalties of up to three percent of their Medicare revenue for what is considered “excessive” readmissions of Medicare patients within 30 days of their discharge from the hospital.  Included in the article is a searchable database of every hospital in the country that lists the peer group for each hospital, its FY 2018 and FY 2019 readmissions penalties by percentage of Medicare revenue, and the change in readmissions penalty expected from FY 2018 to FY 2019.  Go here to see the article “Medicare Eases Readmission Penalties Against Safety-Net Hospital.”

NAUH Endorses 340B Bill

In a letter to the leaders of the House Energy and Commerce Committee, NAUH has endorsed H.R. 6071, the Stretching Entity Resources for Vulnerable Communities Act (SERV), which was introduced earlier this week by Representative Doris Matsui (D-CA).

H.R. 6071 seeks to clarify the intent of the 340B prescription drug discount program and restore $1.6 billion in funding that was eliminated from the program effective January 1.

See NAUH’s letter to the House Energy and Commerce Committee here.

 

NAUH Asks Congressional Leaders to Delay Medicaid DSH Cut

Delay cuts in Medicaid disproportionate share (Medicaid DSH) allotments to states, NAUH has asked congressional leaders.

Medicaid DSH payments, which help private safety-net hospitals with the cost of caring for their low-income and uninsured patients, were slated for cuts under the Affordable Care Act in anticipation of a steep decline in the number of uninsured Americans.  While the reform law has helped millions obtain insurance, safety-net hospitals continue to serve large numbers of low-income and uninsured patients.  Recognizing this, Congress has twice delayed this Medicaid DSH cut but its moratorium on the cut ended on December 31.

Now, NAUH has asked the leaders of Congress to restore the Medicaid DSH cut delay as part of their current budget deliberations.

See NAUH’s letter to congressional leaders here.

NAUH Seeks Action on Medicaid DSH, 340B

The National Association of Urban Hospitals has written to leaders of the House and Senate asking them to reverse implementation of Affordable Care Act-mandated cuts in Medicaid disproportionate share hospital (Medicaid DSH) allotments to state and to block implementation of a federal regulation that would reduce Medicare payments to qualified participants in the section 340B prescription drug discount program by 28 percent.

See NAUH’s letter here.

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 percent cut in Medicare payments to hospitals for drugs provided to low-income patients through the 340B program.  Hospital industry groups responded by suing the federal government and will have their day in court later this month.

Most private safety-net hospitals participate in the 340B program and consider it essential to their ability to serve their communities.  NAUH conveyed this view to CMS recently in response to its proposed regulation calling for reduced 340B payments to hospitals.  See that letter here.

What are the issues?  Why do hospitals and other providers consider 340B so essential to their well-being while pharmaceutical companies and now, CMS, view the program with increasing skepticism?

Kaiser Health News has taken a look at these and other 340B questions.  Read its story here.

NAUH Asks House to Renew CHIP and Delay Medicaid DSH Cuts

In a message sent to every member of the House of Representatives, NAUH conveyed its support for key provisions in HR 3922, the Championing Healthy Kids Act.

Those provisions include renewal of the Children’s Health Insurance Program (CHIP) and a two-year delay in implementation of mandatory cuts in Medicaid disproportionate share (Medicaid DSH) allotments to states.  NAUH asked House members to seek a bipartisan agreement to adopt and pay for these important measures.

See NAUH’s message to House members here.

House Members to CMS: Don’t Cut 340B Payments

More than half of the members of the House of Representatives have written to CMS administrator Seema Verma asking her to withdraw a controversial proposal that would greatly reduce Medicare reimbursement for prescription drugs for urban safety-net hospitals and other safety-net providers that serve large numbers of low-income patients..

At issue are proposed changes in the federal section 340B prescription drug discount program – changes that would drastically reduce payments to participating hospitals for the prescription drugs they provide to low-income outpatients.  Savings from the program help underwrite services and outreach for low-income patients.

The letter to CMS administrator Verma expresses concern that

…this misguided policy will directly limit the ability of hospitals to offer necessary services to vulnerable patients and their communities, especially low-income individuals and rural communities.

The letter goes on to point out that the proposed change in 340B program policy does not address the high cost of prescription drugs and “…would not benefit many Medicare beneficiaries, including dually eligible Medicare beneficiaries.”

A majority of the members of the House – 228 of them – signed the letter.  NAUH recently sent a message to all House members asking them to sign.  Most safety-net hospitals participate in the 340B program.

Go here to see the congressional letter to Administrator Verma and go here to see NAUH’s letter to House members asking them to sign the letter.

House Members Seek Delay of DSH Cuts

221 members of the House of Representatives have written to House leaders asking them to delay cuts in Medicaid disproportionate share payments (Medicaid DSH) that are scheduled to begin on October 1.

The cuts, mandated by the Affordable Care Act, have already twice been delayed by Congress, both times for two years, and now, a majority of House members have written to House speaker Paul Ryan and minority leader Nancy Pelosi asking them to advance legislation to delay Medicaid DSH cuts once again.

The purpose of Medicaid DSH payments is to help hospitals that serve especially large numbers of low-income patients to absorb some of the losses they incur serving uninsured and underinsured people.  All private safety-net hospitals receive Medicaid DSH payments and NAUH recently wrote to House members asking them to sign this letter asking Mr. Ryan and Ms. Pelosi.

See the letter to House leaders here and see NAUH’s letter to House members here.