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Administration Delays Major 340B Program Regulation

The U.S. Department of Health and Human Services has decided against releasing a long-awaited regulation that was expected to bring sweeping changes to the federal government’s 340B Drug Pricing Program.
The 340B program requires drug manufacturers to sell drugs at a discount to hospitals and other providers that serve especially large proportions of low-income patients.  While providers believe the program enables them to serve more vulnerable patients at a reasonable cost, drug companies have argued that the federal government has expanded the program to include more providers and more drugs than the program originally envisioned.
A spokesman for the federal Health Resources and Services administration told Bloomberg BNA that the release has been delayed until next year and that the agency

…plans to issue a proposed guidance for notice and comment that will address key policy issues raised by various stakeholders committed to the integrity of the 340B program. HRSA is also planning to issue proposed regulations where the statute provides explicit rulemaking authority, pertaining to civil monetary penalties for manufacturers, calculation of the 340B ceiling price, and administrative dispute resolution.

Because they serve so many low-income patients and typically participate in the 340B program, Pennsylvania’s private safety-net hospitals have a great deal of interest in any attempt by the federal government to alter the scope or regulation of the program.

To learn more about the delay in the anticipated 340B regulation, see this Bloomberg BNA article.

2014-11-24T06:00:26+00:00November 24th, 2014|Uncategorized|Comments Off on Administration Delays Major 340B Program Regulation

States Face Medicaid Challenges

Fifty American states have 50 different Medicaid programs.  While no two state Medicaid programs are alike, the people who run those programs often share common concerns, problems, and priorities.
The National Association of Medicaid Directors has surveyed its members on the challenges they face, their priorities, and the matters they see occupying most of their time in the coming years.  Among the areas the survey explored are:

  • budgets
  • Affordable Care Act implementation
  • relationships with others in their state government, federal agencies, and regulators
  • program integrity
  • innovations like bundled payments, accountable care organizations, demonstration projects, delivery system reform and improvements, and challenges in the area of long-term services and supports

Find out how the country’s 50 Medicaid directors view the challenges they face in the coming year in State Medicaid Operations Survey:  Third Annual Survey of Medicaid Directors, which you can find here.

2014-11-19T06:00:27+00:00November 19th, 2014|Uncategorized|Comments Off on States Face Medicaid Challenges

PA Congressional Delegation Seeks Medicare “Doc Fix”

Seventeen of the 18 members of Pennsylvania’s U.S. House delegation have sent a joint, bipartisan letter to House Speaker John Boehner and minority leader Nancy Pelosi asking them make a priority of repealing – before the current session of Congress ends – the sustainable growth rate formula (SGR) used to determine how doctors are paid to serve Medicare patients.
See their letter here.

2014-11-18T06:00:21+00:00November 18th, 2014|Uncategorized|Comments Off on PA Congressional Delegation Seeks Medicare “Doc Fix”

MedPAC Meets, Addresses Hospital Issues

The independent federal agency that advises Congress on Medicare payment issues met last week in Washington and addressed a number of issues of importance to hospitals.
Among the issues discussed by the Medicare Payment Advisory Commission (MedPAC) were:

  • beneficiary access to hospital care and how service volume affects hospital costs
  • hospital short stay policy issues
  • per beneficiary payment for primary care
  • the 340B drug pricing program
  • site-neutral payments for selected conditions treated in inpatient rehabilitation facilities and skilled nursing homes
  • payment policies to promote the use of services based on clinical evidence

Find links to the presentations offered by MedPAC staff on these issues here, on MedPAC’s web site.

2014-11-17T06:00:53+00:00November 17th, 2014|Uncategorized|Comments Off on MedPAC Meets, Addresses Hospital Issues

PA Mcare Assessment Goes Down

The Mcare assessments of Pennsylvania hospitals and doctors will decrease 48 percent in 2015.
Doctor listening to patientPennsylvania’s Medicare Care Available and Reduction of Error Fund, or Mcare, provides supplemental medical malpractice liability insurance for Pennsylvania health care providers.  Pennsylvania requires hospitals and doctors to have a minimum level of liability coverage and they obtain half of that minimum amount from the Mcare Fund.
Next year’s assessment is smaller because of reduced claims against the Mcare Fund and leftover money from previous years that a court ordered to be used for this purpose.
To learn more about the fund and the decrease, see this news release on the state Insurance Department’s web site.
 

2014-11-12T06:00:03+00:00November 12th, 2014|Uncategorized|Comments Off on PA Mcare Assessment Goes Down

Suit Against Medicare Rate Cut Continues

Hospital groups are suing the Centers for Medicare & Medicaid Services (CMS) over the 0.2 percent rate cut in Medicare inpatient payments during the 2014 fiscal year.
According to the hospital groups, CMS failed to provide a rationale for the rate cut and denied interested parties access to the data and analysis underlying its rate cut decision.
At the heart of the cut was CMS’s expectation that implementation of Medicare’s controversial “two-midnight rule” would result in an increase in admissions.  The rule was never fully implemented.
CMS has asked the court to dismiss the suit.
Learn more about the suit and find links to the hospitals’ and CMS’s legal briefs in this Fierce Healthcare article.

2014-11-07T06:00:29+00:00November 7th, 2014|Uncategorized|Comments Off on Suit Against Medicare Rate Cut Continues

The Candidates Talk Health Care

One of the issues in almost any major election is health care, and this year’s gubernatorial race in Pennsylvania is no exception.
With this in mind, the Central Penn Business Journal has published excerpts of Pennsylvania Physician magazine interviews with the candidates in next month’s election, Republican Governor Tom Corbett and his Democratic challenger, Tom Wolf.  In the article, the candidates share their views on some of this year’s more important health care issues, including Medicaid expansion, emergency care, the challenge of attracting more doctors to Pennsylvania, and more.
Find the article here.

2014-10-28T06:00:19+00:00October 28th, 2014|Uncategorized|Comments Off on The Candidates Talk Health Care

Corbett Signs Observation Status Notification Bill

Pennsylvania Governor Tom Corbett has signed into law a bill that requires hospitals to inform patients when their stay in a hospital has been classified as observation status and not an inpatient admission.
House Chamber of the State HouseThe new law calls for hospitals to provide such notification when patients are under a hospital’s care for more than 23 consecutive hours; when they are in a bed and receiving meals outside of the emergency room; and when they have not formally been admitted.
Observation status poses considerable financial challenges to patients, leaving them vulnerable for charges for tests, medicine, and post-discharge nursing and rehabilitation care that would be covered by their insurance if they were inpatients but are not covered to the same degree if their stay has been classified as observation status (because insurers pay lower outpatient rates only for observation services).  Most people have been unaware of this distinction and have neither been told of their observation status nor apprised of the difference between that status and inpatient hospitalization.  This has especially been a problem for Medicare beneficiaries.
The bill was sponsored by Pennsylvania state representative Stan Saylor (R-York County).  See Rep. Saylor’s memo to his House colleagues outlining the rationale for his bill here and find the bill itself here.

2014-10-23T06:00:13+00:00October 23rd, 2014|Uncategorized|Comments Off on Corbett Signs Observation Status Notification Bill

Congressman Calls for Helping Safety-Net Hospitals by Improving Medicare Readmissions Program

Congressman James Renacci (R-OH) is again asking his House colleagues to support his proposal to adjust Medicare’s hospital readmissions reduction program – a program he maintains is especially harmful to safety-net hospitals.
Noting that in its current form the program penalizes hospitals that care for larger numbers of poorer, sicker patients and that this “jeopardizes the viability of hospitals that service this vulnerable population,” the congressman urges his colleagues to support his bill, H.R. 4188, the Establishing Beneficiary Equity in the Hospital Readmissions Program Act.
This bill calls for adjusting the program’s approach “to account for certain disparities in patient population…”
See Representative Renacci’s letter to House colleagues here.

2014-10-22T11:44:02+00:00October 22nd, 2014|Uncategorized|Comments Off on Congressman Calls for Helping Safety-Net Hospitals by Improving Medicare Readmissions Program

Teaching Hospitals Pitch More Residencies

With the country facing a physician shortage and the number of medical residencies capped by the 1997 Balanced Budget Act (because Medicare and Medicaid provide the primary funding for the residencies), teaching hospitals need an additional 4000 residency slots a year.
This was the message conveyed recently to a gathering of congressional aides co-sponsored by the Association of American Medical Colleges.
This issue is of interest to Pennsylvania’s safety-net hospitals, some of which are teaching hospitals.
Such an increase would cost $10 billion over the next ten years.
Learn more about the case for more residency slots in this Kaiser Health News article.

2014-10-09T06:00:10+00:00October 9th, 2014|Uncategorized|Comments Off on Teaching Hospitals Pitch More Residencies
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