Posts

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.

 

MACPAC Issues Annual Report, Recommendations to Congress

The Medicaid and CHIP Payment and Access Commission has published its annual report and recommendations to Congress.

MACPAC’s report addresses three primary areas:  Medicaid managed care, telehealth, and Medicaid disproportionate share payments (Medicaid DSH).

With 80 percent of Medicaid beneficiaries now enrolled in managed care plans, MACPAC offers three major recommendations for improving Medicaid managed care efforts:

  • permit states to require all of their Medicaid beneficiaries to enroll in a managed care plan
  • extend Medicaid managed care section 1915(b) waivers from two to five years
  • permit states to obtain waivers to waive freedom of choice and selective contracting restrictions

MACPAC notes the growing use of telehealth by state Medicaid programs and encourages states to continue this expansion while learning more from the efforts of one another to use telehealth effectively.

Finally, MACPAC notes that it

…continues to find little meaningful relationship across the country between DSH allotments and number of uninsured individuals, hospitals’ uncompensated care costs, and the number of hospitals providing essential community services that have high levels of uncompensated care. Total hospital charity care and bad debt continue to fall, especially in states that expanded Medicaid coverage, but Medicaid shortfall showed an uptick as a result of increased Medicaid enrollment. Now that Congress has delayed DSH allotment reductions for two years, the Commission will explore opportunities to improve the targeting of DSH payments in future reports.

MACPAC is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide array of issues affecting Medicaid and the CHIP program.

Medicaid DSH is very important to the nation’s private safety-net hospitals so NAUH will carefully monitor the response to MACPAC’s Medicaid DSH recommendations.

Learn more about MACPAC’s recommendations to Congress in its Report to Congress on Medicaid and CHIP, which can be found 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.

A Different Perspective on Telehealth

Residents of urban areas often have the same access-to-care problems as rural residents, although the latter receive far more attention.

So concludes a new report published on the Health Affairs Blog.

According to the analysis, urban and rural residents have similar access problems – and among urban residents, the problems in some instances are even greater.  One distinction:

…while rural America has access problems because there are not enough doctors, urban America has access problems because there are not enough appointments.

One potential solution to this problem, the report suggests, is focusing on access instead of geography and making telehealth services more available to rural and urban residents alike.  To date, most telehealth efforts have focused on serving residents of rural areas only.

NAUH made this very point in a letter last month to the Centers for Medicare & Medicaid Services about CMS’s proposed Medicare physician fee schedule for 2018, writing that

Geography… is not the only factor that limits access to medical services, and for this reason, NAUH urges CMS to take steps to facilitate greater use of telehealth services in non-rural areas. Specifically, there are many urban areas across the country that have been designated medically underserved areas or health professional shortage areas by the Health Services and Resources Administration. NAUH believes Medicare beneficiaries who live in such communities are no less deserving of federal policies that seek to enhance their access to care than residents of rural areas and therefore urges CMS to take steps to expand the use of telehealth services. The result, we believe, would be better, more appropriate care and very possibly even reduced overall health care costs as Medicare beneficiaries receive assistance with their medical problems in a more timely manner. For this same reason, NAUH also urges CMS to consider even greater use of telehealth, beyond both its current parameters and its expansion to medically underserved and health professional shortage areas, as we have recommended.

Learn more about the issue and this new perspective in the article “Giving Urban Health Care Access Issues The Attention They Deserve in Telemedicine Reimbursement Policies,” which can be found here, on the Health Affairs Blog.