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NASH Unveils 2021 Advocacy Agenda

NASH has introduced its 2021 agenda.

In the coming year, NASH will:

  • Work to ensure that private safety-net hospitals receive the federal resources and regulatory assistance they need to help their low-income, medically underserved communities through the COVID-19 crisis.
  • Advocate the development and implementation of laws, regulations, and programs that enhance the ability of private safety-net hospitals to serve their communities more effectively.
  • Pursue enhanced access to Medicaid and to affordable, high-quality health insurance.
  • Urge Congress and the administration to work with safety-net hospitals and do more to address the social determinants of health to bring about health equity and better health outcomes in diverse and underserved communities.

To see NASH’s complete 2021 advocacy agenda, go here.

Coronavirus Update for Friday, February 5

The following is the latest COVID-19 information from the federal government as of 2:30 p.m. on Friday, February 5.

NASH Advocacy

  • This week NASH wrote to congressional leaders on behalf of private safety-net hospitals asking them to include in the administration’s COVID-19 relief bill:
    • more resources for the Provider Relief Fund
    • additional targeted funding for safety-net hospitals
    • help with staffing
    • an extension of the current moratorium on the Medicare sequestration
    • forgiveness for safety-net hospitals for loans they received under the Medicare Accelerated and Advance Payment Program

See NASH’s letter to congressional leaders here.

NASH will engage in additional advocacy in the coming days.

The White House

Provider Relief Fund

A new proposal has been adopted by the Senate to include $35 billion for the Provider Relief Fund in the administration’s proposed $1.9 trillion COVID-19 relief bill.

Centers for Medicare & Medicaid Services

HHS and CMS COVID-19 Stakeholder Calls

HHS Clinical Rounds Peer-to-Peer Virtual Communities of Practice

HHS’s Office of the Assistant Secretary for Preparedness and Response sponsors COVID-19 Clinical Rounds Peer-to-Peer Virtual Communities of Practice that are interactive virtual learning sessions that seek to create a peer-to-peer learning network in which clinicians from the U.S. and abroad who have experience treating patients with COVID-19 share their challenges and successes.  These webinar topics are covered every week:

  • EMS:  Patient Care and Operations (Mondays, 12:00-1:00 PM eastern)
  • Critical Care:  Lifesaving Treatment and Clinical Operations (Tuesdays, 12:00-1:00 PM eastern)
  • Emergency Department:  Patient Care and Clinical Operations (Thursdays, 12:00-1:00 PM eastern)

Go here for information about signing up to participate in the sessions and go here for access to materials and video recordings of past sessions.

CMS Stakeholder Calls

CMS hosts recurring stakeholder engagement sessions to share information about the agency’s response to COVID-19.  These sessions are open to members of the health care community and are intended to provide updates, share best practices among peers, and offer participants an opportunity to ask questions of CMS and other subject matter experts.

CMS COVID-19 Office Hours Calls

Tuesday, February 23 at 5:00 – 6:00 PM (eastern)

Toll Free Attendee Dial In:  833-614-0820; Access Passcode:  2528725

Audio Webcast link:  go here

Tuesday, March 16 at 5:00 – 6:00 PM (eastern)

Toll Free Attendee Dial In:  833-614-0820; Access Passcode:  4177586

Audio Webcast link:  go here

Tuesday, April 6 at 5:00 – 6:00 PM (eastern)

Toll Free Attendee Dial In:  833-614-0820; Access Passcode:  2769397

Audio Webcast link:  go here

Food and Drug Administration

Centers for Disease Control and Prevention

The National Academies of Sciences, Engineering, and Medicine

NASH Presents COVID-19 Relief Needs to Congress

The next COVID-19 relief bill should include more resources for the Provider Relief Fund, additional targeted funding for safety-net hospitals, help with staffing, an extension of the current moratorium on the Medicare sequestration, and forgiveness for safety-net hospitals for loans they received under the Medicare Accelerated and Advance Payment Program.

This was the message the National Alliance of Safety-Net Hospitals conveyed this week in a letter to congressional leaders.  See that letter here.

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.

 

Safety-Net Hospitals Gird for Loss of Medicaid DSH Money

Safety-net hospitals and others will lose a significant portion of their Medicaid disproportionate share (Medicaid DSH) payments on November 22 unless Congress delays implementation of the cut in those payments that was mandated by the Affordable Care Act.

And hospitals that receive these payments are now preparing for the worst.

The Medicaid DSH cut was included in the 2010 health care reform law in anticipation of a great reduction in the number of uninsured people leaving hospitals providing much less uncompensated care and therefore not in need of as much DSH money.  The law’s reach has not proven to be as great as anticipated, however, and two developments since the law’s passage have put a damper on the expected rise in the number of insured Americans:  a court decision that made it optional for states to expand their Medicaid program and the repeal of the requirement that everyone purchase health insurance.

Four times Congress has voted to delay the Medicaid DSH cut because so many people remained uninsured.  Now, however, the most recent delay in implementation of the cut, via a provision in the continuing resolution currently funding the federal government, expires on November 21, and hospitals – many of them already with razor-thin margins – are preparing for the worst:  a major reduction of their federal Medicaid DSH money.

NASH has asked Congress to delay the implementation of Medicaid DSH cuts on numerous occasions, citing their potential impact on the ability of private-safety-net hospitals to serve their communities.  NASH most recently made this request in September, urging members of Congress to support the continuing bipartisan effort to delay the cut.

Learn more about the prospect of a major Medicaid DSH cut later this month, how it might affect safety-net hospitals – including the kinds of private safety-net hospitals represented by NASH – and what some hospitals are doing to prepare for the possibility in the Stateline article “Rural and Safety Net Hospitals Prepare for Cut in Federal Support.”

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.

 

Ambulances Respond Slower to Low-Income Communities

People living in low-income communities wait about four minutes longer for ambulances to respond to their call for help when they are having a heart attack, a new study has found.

In communities with annual median incomes between $57,000 and $113,000, the study found that ambulances arrive in an average of 37.5 minutes – faster than in communities where the annual median income is between $20,250 and $42,642, where the typical wait time is 43 minutes.

Neither result is anywhere near industry benchmarks of 4, 8, and 15 minutes for delivering specific services in response to heart attack symptoms.

Among the possible reasons for the difference in response times, the study’s authors suggest, are hospital closures in and around low-income areas, EMS protocols that call for emergency response from facilities that specialize in cardiac care that may be farther from low-income communities, and a reduced number of private ambulance services serving lower-income areas.

Such findings have important implications for the communities served by private safety-net hospitals.

Learn more about the study, its methodology, and its findings in the report “A US National Study of the Association Between Income and Ambulance Response Time in Cardiac Arrest,” which can be found here, on the JAMA Open Network web site.

MACPAC: Let’s “hit the pause button” on Medicaid Work Requirements

The non-partisan legislative branch agency that advises Congress and the administration on Medicaid issues will ask the administration to delay approving any more state Medicaid work requirements.

That was the decision reached by the Medicaid and CHIP Payment and Access Commission when it met last week.

MACPAC warned that the work requirement currently being implemented in Arkansas, the first state to introduce such a requirement, is flawed and needs further work before moving forward.  The agency also believes the federal government should increase its oversight of new Medicaid work requirements before additional states begin implementing similar, already-approved Medicaid work requirements.

MACPAC plans to convey its concerns in a letter to Department of Health and Human Services Secretary Alex Azar.

Medicaid work requirements pose a potential challenge for private safety-net hospitals because they could leave meaningful numbers of low-income residents of the communities those hospitals serve without health insurance.

Learn more about MACPAC’s objections to the manner in which Medicaid work requirements are being introduced in this Bloomberg Law article.

 

New Report Looks at Medicaid Buy-In

While there has been a great deal of public discussion of late about “Medicare for all,” less attention has been paid to the concept of permitting people to buy into their state’s Medicaid program.

Now, the Rockefeller Institute of Government has published a new report that presents the different approaches to the concept of Medicaid buy-in.

It also seeks to address six major questions of potential Medicaid buy-in efforts:

  • How large is the intended population of new enrollees?
  • What kind of coverage would be offered?
  • How would enrollment be financed?
  • How would rates be set?
  • Would the program use standard Medicaid rate and would there be enough participating providers to meet enrollee demand?
  • How would such a program fit into individual states’ regulatory structure?

Medicaid buy-in would be of great interest to private safety-net hospitals because they serve communities in which many residents remain uninsured.

Learn more about how the concept of Medicaid buy-in and how it might work by reading the Rockefeller Institute of Government report “Medicaid Buy-In: Questions of Design and Purpose,” which can be found here.