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Flu, saline-bag shortage create crisis for U.S. medical supply chain

This year’s bad flu season has shown that the U.S. has bad problems with its medical supply chain, according to an essay in The Washington Post. One is that Hurricane Maria slashed production of IV saline bags.

The writers noted: “There are two ways the ‘just in time’ system can be disrupted: an unexpected surge in demand or a delay in delivery. In this case, both occurred simultaneously. The United States is dealing with an unusually potent strain of the flu, while Hurricane Maria brought production in Puerto Rico  {of the saline bags} to a grinding halt. If only one of the two had occurred, it’s unlikely the United States would have experienced a shortage.”

To read their essay, please hit this link.

 


Some home healthcare firms refuse to help patients with Medicare

By SUSAN JAFFE

For Kaiser Health News

Colin Campbell needs help dressing, bathing and moving between his bed and his wheelchair. He has a feeding tube because his partially paralyzed tongue makes swallowing “almost impossible,” he said.

Campbell, 58, spends $4,000 a month on home healthcare services so he can continue to live in his home just outside Los Angeles. Eight years ago, he was diagnosed with amyotrophic lateral sclerosis, or “Lou Gehrig’s disease,” which relentlessly attacks the nerve cells in his brain and spinal cord and has no cure.

The former computer systems manager has Medicare coverage because of his disability, but no fewer than 14 home healthcare providers have told him he can’t use it to pay for their services.

That’s an incorrect but common belief. Medicare does cover home care services for patients who qualify, but incentives intended to combat fraud and reward high quality care are driving some home health agencies to avoid taking on long-term patients such as Campbell, who have debilitating conditions that won’t get better, according to advocates for seniors and the home care industry. Rule changes that took effect this month could make the problem worse.

“We feel Medicare coverage laws are not being enforced and people are not getting the care that they need in order to stay in their homes,” said Kathleen Holt, an attorney and associate director of the Center for Medicare Advocacy, a nonprofit, nonpartisan law firm. The group is considering legal action against the government.

Federal law requires Medicare to pay indefinitely for home care — with no co-payments or deductibles — if a doctor ordered it and patients can leave home only with great difficulty. They must need intermittent nursing, physical therapy or other skilled care that only a trained professional can provide. They do not need to show improvement. Those who qualify can also receive an aide’s help with dressing, bathing and other daily activities. The combined services are limited to 35 hours a week.

Medicare affirmed this policy in 2013 when it settled a key lawsuit brought by the Center for Medicare Advocacy and Vermont Legal Aid. In that case, the government agreed that Medicare covers skilled nursing and therapy services — including those delivered at home —to maintain a patient’s abilities or to prevent or slow decline. It also agreed to inform providers, bill auditors and others that a patient’s improvement is not a condition for coverage.

Campbell said some home healthcare agencies told him Medicare would pay only for rehabilitation, “with the idea of getting you better and then leaving,” he said. They told him that Medicare would not pay them if he didn’t improve, he said. Other agencies told him Medicare simply did not cover home health care.

Medicaid, the federal-state program for low-income adults and families, also covers home health care and other home services, but Campbell doesn’t qualify for it.

Securing Medicare coverage for home health services requires persistence, said John Gillespie, whose mother has gone through five home care agencies since she was diagnosed with ALS in 2014. He successfully appealed Medicare’s decision denying coverage, and afterward Medicare paid for his mother’s visiting nurse as well as speech and physical therapy.

“You have to have a good doctor and people who will help fight for you to get the right company,” said Gillespie, of Orlando, Fla. “Do not take no for an answer.”

Yet a Medicare official did not acknowledge any access problems. “A patient can continue to receive Medicare home health services as long as he/she remains eligible for the benefit,” said spokesman Johnathan Monroe.

But a leading industry group contends that Medicare’s home health care policies are often misconstrued. “One of the myths in Medicare is that chronically ill individuals are not qualified for coverage,” said William Dombi, president of the National Association for Home Care and Hospice, which represents nearly half of the nation’s 12,000 home care providers.

Part of the problem is that some agencies fear they won’t be paid if they take on patients who need their services for a long time, Dombi said. Such cases can attract the attention of Medicare auditors who can deny payments if they believe the patient is not eligible or they suspect billing fraud. Rather than risk not getting paid, some home health agencies “stay under the radar” by taking on fewer Medicare patients who need long-term care, Dombi said.

And they may have a good reason to be concerned. Medicare officials have found that about a third of the agency’s payments to home health companies in the fiscal year ending last September were improper. 

Another factor that may have a negative effect on chronically ill patients is Medicare’s Home Health Compare ratings Web site. It includes grades on patient improvement, such as whether a client got better at walking with an agency’s help. That effectively tells agencies who want top ratings “to go to patients who are susceptible to improvement,” Dombi said.

 

This year, some home care agencies will earn more than just ratings. Under a Medicare pilot program, home health firms in nine states will start receiving payment bonuses for providing good care and those who don’t will pay penalties. Some criteria used to measure performance depend on patient improvement, Holt said.

Another new rule, which recently took effect,  prohibits agencies from discontinuing services for Medicare and Medicaid patients without a doctor’s order. But that, too, could backfire. 

“This is good,” Holt said. “But our concern is that some agencies might hesitate to take patients if they don’t think they can easily discharge them.”


Physicians, payers vow to partner to reduce prior-authorization hassles

FierceHealthcare looks at five ways in which physicians and payers are pledging to cooperate to help reduce the difficulties of obtaining  prior authorizations.

They are:

 

1. “Reduce the number of healthcare professionals subject to prior authorization requirements based on their performance, adherence to evidence-based medical practices or participation in a value-based agreement with the health insurance provider.

2. “Review the services and medications that require prior authorization on a regular basis and eliminate requirements for therapies that no longer warrant them.

3. “Improve communication between health insurance providers, healthcare professionals and patients to minimize delays in care and ensure clear prior authorization requirements, rationale and changes.

4. “Protect the continuity of care for patients on an ongoing active treatment or a stable treatment regimen when there are changes in coverage, insurance providers or prior authorization requirements.

5. “Accelerate industry adoption of national electronic standards for prior authorization and improve transparency of formulary information and coverage restrictions at the point-of-care.”

To read the Fierce article, please hit this link.


Hospital leaders for 2018

 

Med Page Today and STAT News look at four hospital executives that may have a big impact in the healthcare sector this year.

They are:

Dr. Tomislav Mihaljevic, incoming CEO of Cleveland Clinic.

 

 

Tim Putnam, CEO of Margaret Mary Community Hospital.

 

 

And Kevin Lofton and Lloyd Dean, co-CEOs of the new Dignity-Catholic Health Initiatives health system.

To read about them, please hit this link.

 

 

 

 

 


Fed-up hospitals plan to enter drug business themselves

 

 

Fed up with astronomical drug prices, some of America’s largest hospital systems plan to enter the drug business themselves. Many patients would cheer them on.

“This is a shot across the bow of the bad guys,”  Marc Harrison,  M.D., the chief executive of Intermountain Healthcare, the nonprofit Salt Lake City hospital group that is spearheading the effort, told The New York Times. “We are not going to lay down. We are going to go ahead and try and fix it.”

The newspaper reported that “while Intermountain executives would not name the drugs they intend to make, hospitals have long experienced shortages of drugs like morphine or encountered sudden price increases for old, off-patent products like the heart medicine Nitropress. Hospitals have also come under criticism for overcharging for their services, including for some drugs.

“Several major hospital systems, including Ascension, a Catholic system that is the nation’s largest nonprofit hospital group, plan to form a new nonprofit company, that will provide a number of generic drugs to the hospitals. The Department of Veterans Affairs is also expressing interest in participating.

“In all, about 300 hospitals are now included in the group. Other hospitals are expected to join.”

To read more, please hit this link.

 

 


As patients worry, well-heeled attendees confer at luxury healthcare confab

The luxurious Westin St. Francis Hotel, in San Francisco.

 

By BARBARA FEDER OSTROV

For Kaiser Health News

SAN FRANCISCO

There’s so much money floating around here this week, you can almost see it wafting through the air.

About 10,000 attendees, mostly confident men in well-cut suits and even nicer watches, are packing the elegant Westin St. Francis Hotel for the invite-only J.P. Morgan Healthcare Conference, which ends Thursday.

For many of these investors, health providers, insurers and entrepreneurs at the nation’s largest and most prestigious health investment conference, it’s all about the deal — and the after-hours parties.

In the first few days of what’s become known as J.P. Morgan Week, New Jersey-based Celgene announced it would spend up to $7 billion to acquire Impact Biomedicines. And Novo Nordisk, the world’s biggest insulin maker, bid $3.1 billion for a Belgian biotech firm.

For those who didn’t land a coveted invite, satellite conferences on digital health and biotechnology dot the city, offering lesser mortals an opportunity to network and make their own deals. Former Vice President Joe Biden even popped into town to keynote the StartUp Health Festival satellite conference, speaking about cancer-treatment costs and electronic health records.

The J.P. Morgan gathering comes at a jarring time when you consider that the other world of healthcare is flooded with uncertainty for the millions of ordinary Americans who inhabit it. They face a precarious political landscape in which the future of the Affordable Care Act remains uncertain and Republican leaders in Congress mull dramatic cuts to Medicaid and Medicare.

John Baackes, CEO of the nation’s largest public health plan, L.A. Care, which insures 2.1 million low-income patients, said if his enrollees wandered into the conference, “they’d think they were in a foreign land and that this has nothing to do with them.”

Much of U.S. healthcare is underwritten by public dollars, but people here didn’t come to talk about that or rising costs, particularly for prescription drugs. Only a few presentations at this year’s conference have touched on prices, including a J.P. Morgan study released Monday that found many Americans put off medical care until they get their tax refund — a clear sign that that they don’t have enough saved up to pay for care when they need it.

“It’s just so striking how much maneuvering and desire there is at this meeting for a piece of the 18 percent of GDP spent on health care,” mused Dr. Vivian Lee, the former leader of the University of Utah Health Care system, who made a point of tracking costs with pinpoint precision. “Is anyone here trying to decrease their share?”

Baackes, who comes to the conference to network and monitor the latest developments in health care, said he’s always skeptical of the well-heeled company officials who attend promising better health outcomes and cost savings. “In a way, there’s too much money walking around here,” he said. “Investors are thinking, ‘Health care is a $3 trillion sector of the economy; surely it will benefit from my genius.’”

Many attendees view the conference with a less critical eye.

“It’s a useful place for us to be,” said Amanda Cowley, strategy director of the quasi-governmental organization that produces the U.S. Pharmacopeia, a compendium of information and standards for producing medicines and food ingredients. Cowley said she and her colleagues need to learn about emerging health technologies so they can anticipate their future work products.

Cowley stood in a line of hundreds of attendees waiting to dine on tri-tip, vegetables and macarons while listening to Microsoft founder Bill Gates talk about how his foundation is helping improve the health of subsistence farmers and children in the developing world.

But there was little talk of America’s subsistence patients, who often cannot afford the expensive drugs and medical devices that are bought and sold in deals brokered at conferences like these, in private rooms guarded by phalanxes of staffers at tony hotels.

Those patients, however, were the focus of a Medicaid panel held Tuesday at Glide Memorial Church, in San Francisco’s troubled Tenderloin district, a few blocks and a world away from the Westin St. Francis. That event, which drew about 70 people, was sponsored by ConsejoSano, a Southern California-based startup that has raised $7.2 million to help Spanish speakers better navigate the health system.

Rallying the troops at Glide was former Medicare and Medicaid chief Andy Slavitt, a fierce critic of Republican efforts to repeal and replace the ACA. Slavitt recently invested in Cityblock Health, a public health startup focusing on Medicaid and other low-income patients.

The good thing about J.P. Morgan Week, Slavitt told Kaiser Health News, is that it draws innovative people who want to invest. “The question is, should health care capital be focused on solving big problems and getting rewarded for them, or just focused on the status quo?”

 


Small improvements vs. care redesign

 

Three physicians write in NEJM Catalyst about whether healthcare organizations should  decide between small, incremental improvements or care redesign. Among their remarks:

“The shift from volume- to value-based payment may constrain revenue, forcing organizations to consider dramatic changes to care delivery. Doing this may require increasing their capacity for innovation relative to incremental improvement. Innovation and improvement are sometimes used interchangeably, but the distinction between them matters.

“Quality improvement methods are usually applied to refine existing care delivery processes. The way forward is relatively clear, and the returns are predictable and quick. Innovation, however, involves creating new products, services, or processes. The way forward is filled with uncertainty. Will the new approach work? When will it show results? Given the choice, most organizations are more comfortable with the predictability of quality improvement, labeling it innovation in some cases, but shunning the risk-taking that characterizes true innovation work.

“But incremental improvement in the absence of some degree of innovation is likely to produce limited gains.

They conclude:

“To thrive in a value-based care environment, organizations will have to be able to do the same things more efficiently and take advantage of the opportunities of digital health, patient empowerment, and integration across sectors to redesign much higher-value care. Organizations will need to decide how much money, time, or political capital they should expend to build structures and cultures that support both the goals of improvement and of innovation.”

To read their essay, please hit this link.


CMS soon to start new voluntary bundled-services plan

 

The Centers for Medicare & Medicaid Services (CMS) is implementing a new voluntary bundled services payment model for Medicare.

“BPCI [Bundled Payment for Care Improvement] Advanced builds on the earlier success of bundled payment models and is an important step in the move away from fee-for-service and towards paying for value,” CMS administrator Seema Verma said  Tuesday.

But the Trump administration has resisted  mandatory bundled care models. Indeed, last November CMS canceled mandatory bundled care payment models for hip fractures and cardiac care, and reduced the number of regions required to participate in a bundled-care payment system for joint replacement.

Carter Paine is chief operating officer of CBPCI Advanced, a Brentwood, Tenn.-based company that helps manage patients’ transition to post-acute care and has participated in the older model.  He told Med Page Today that the new bundled-care model, to  start in October, is different in important respects from the older one.

For one thing, he told the news service, CMS is, in Med Page’s paraphrase of his remarks, “incentivizing providers to reduce costs by 3 percent for each episode of care, rather than 2 percent as in the old model.”

In addition, “it lasts longer, up to 2023, which we think is a good thing.”

Mr. Paine added that the fact that CMS has fewer episodes of care to choose from may indicate that “of the 48 original [episode types], many of those weren’t being executed on, so probably they just bore down to episodes that actually have real volume.”

“I think BPCI 1.0 has proven to be successful for those participants that have hung in there. On the last go-round, people were sticking their toes in the water, and a lot of people were too nervous to get in — that felt more like a pilot, and this is more of a long-term commitment. Given the success we’ve had in BPCI 1.0 … I think people will participate more in this one, given there’s a game plan in hand.”

To read more, please hit this link.

 

 


Mass. taking its time on proposed Beth Israel-Lahey merger

 

Beth Israel Deaconess Medical Center and Lahey Health completed merger plans way back in  last July, but Massachusetts officials are still taking a very hard look at the deal.

Indeed, the state Department of Health organized a public forum  on the potential huge Greater Boston merger,  which includes 13 hospitals and would reshape the healthcare landscape in the area. The new system would unite under a new parent company, “NewCo.”

Research from across America suggests that the hospital sector’s seemingly relentless consolidation can boost costs for consumers and insurers, among  other potential downsides for patients. However, independent hospitals such as Anna Jaques Hospital, in Newburyport, Mass., affiliated with the Beth Israel Deaconess empire, that choose to stay on their own face financial challenges.

Massachusetts’s Health Policy Commission is also taking a look at the merger, with their complete report due this summer.

The merger “represents the most significant change in the structure of the Massachusetts healthcare market in more than 20 years and will reshape the delivery of care for millions of patients,”  said Stuart Altman, Ph.D., chairman of the commission.

Lahey Health and Beth Israel, meanwhile, both asserted that the merger would  lower costs,  through, presumably, efficiencies of scale, noting that  healthcare costs in eastern Massachusetts are far higher than those in many other states.

To read more, please hit this link.


Despite ACA, tax-exempt hospitals slow to expand community benefits

By VICKIE CONNOR

For Kaiser Health News

The federal health law’s efforts to get nonprofit hospitals to provide more community-wide benefits in exchange for their lucrative tax status has gotten off to a slow start, new research suggests. And some experts predict that a recent repeal of a key provision of the law could further strain the effort.

The increased emphasis on community-wide benefits was mandated by the Affordable Care Act. The health law required hospitals that meet federal tax standards to be nonprofits to perform a community health needs assessment (CHNA) every three years, followed by implementing a strategy to deal with issues confronting the community, such as preventing violence or lowering the rates of diabetes.

study released Monday in the journal Health Affairs shows spending in these areas has remained relatively stagnant.

The research showed average spending by tax-exempt hospitals on community benefits in 2010 was 7.6 percent of total operating costs and bumped to 8.1 percent by 2014. But the bulk of that spending goes toward unreimbursed patient care, such as charity care. The ACA was trying to spur more spending on broader community initiatives, which have remained below 1 percent of operating costs at the hospitals.

“This is not easy for hospitals to do,” said Gary Young, the study’s lead author and director of the Center for Health Policy and Healthcare Research at Northeastern University in Boston. “By tradition, by the nature of their resources, hospitals have not been oriented to prevention, they’ve been oriented to treatment.”

New efforts by the Republican-led Congress may complicate the effort. The repeal last month of the ACA’s penalties for most people who don’t have health insurance has some experts questioning how some of these hospitals will be able to spend more on community benefits. The Congressional Budget Office has estimated that because of that change about 13 million people would give up their coverage by 2027, which could drive up costs for hospitals because there would be more uninsured patients.

“Anything that destabilizes the system and takes money out of the hospitals’ revenue stream is going to negatively impact them,” said Gregory Tung, assistant professor at the University of Colorado’s School of Public Health. “It’s tough for hospitals to be navigating that uncertainty.”

Jill Horwitz, a professor of law at UCLA who specializes in health issues, said hospitals have trouble planning community efforts when they are unsure of their finances.

“It’s a very difficult context in which to operate a stable system,” Horwitz said. “One day to the next, it’s hard to know what the rules are, what the reimbursement is going to be and what kind of insurance your patients will have.”

More than half of the hospitals in the United States are private, nonprofit organizations that are tax-exempt.

Lawrence Massa, president & CEO of the Minnesota Hospital Association, said the repeal of the ACA’s individual mandate penalties will change hospitals’ calculations.

“We certainly expect to see our uninsured rate go up as a result of repealing the individual mandate,” he said, “so that’s going to have an opposite type of effect of where we thought the trend was going to be because we changed the rules in the middle of the game.”

But it’s too early to tell how hospitals will respond, according to Massa. Many are still grappling with the new requirements.

The ACA was enacted in 2010, but the provision requiring community-based action did not come into effect until the end of March 2012, and enrollment in ACA marketplace plans didn’t begin until 2014. Hospitals began early investments for assembling the needs assessments in 2011 and 2012, Massa said.

“In the later years, they’ll be using that data and comparing and reporting to the IRS how they’ve changed their community benefits spending as a result of those community health needs assessments,” he said. “If everything stayed the way it was, I think we would know by 2020 whether this had the kind of impact that was anticipated.”

Young and his research colleagues acknowledged in their study that “certainly, more time is needed” to assess the full impact of the law’s requirements on spending for community benefits.

Nonetheless, Young said, many hospitals lack the means to provide greater preventive care in the community.

They don’t have the necessary infrastructure, “the personnel or the knowledge to develop those strategies,” he said. “They don’t have the resources to necessarily invest in those areas.”

Horwitz agreed. “If we’re going to require this high level of spending on community benefits and paying for patients who can’t afford care, something else has to give,” she said.


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