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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?”

 


Minn. reforms could presage ACA repeal and replacement

By MARK ZDECHIK

Via Kaiser Health News

What’s going to happen to the federal health law? The quick answer is no one knows. But in the midst of the uncertainty about the Affordable Care Act, states still must govern their insurance markets. Most have been muddling through with the 2017 status quo, but Minnesota is a special case, taking three unusual actions that are worth a closer look.

Last month, Minnesota:

  • Passed a one-time bailout for some consumers in the individual insurance market dealing with skyrocketing premiums.
  • Rejected an attempt to let insurers offer cheaper, bare-bones coverage.
  • Laid the groundwork for a sort of homegrown “public option” insurance plan.

Here’s more on each item.

The Bailout

Faced with some of the country’s highest hikes on premiums in the individual market — 50 to 67 percent, on average — Minnesota lawmakers passed a bailout for people who earn too much to qualify for the Affordable Care Act’s federal tax credit. The $300 million law will cut monthly 2017 premiums by 25 percent for about 125,000 Minnesotans.

Democratic Gov. Mark Dayton backed the measure since October when he called the ACA “no longer affordable to increasing numbers of people.” But passage wasn’t assured as both houses of Minnesota’s legislature are controlled by Republicans.

It is thought to be the second time a state has offered up state tax dollars to stabilize an insurance marketplace created by the ACA. (Alaska came up with a $55 million bailout for insurers in 2016.)

Bare-Bones Coverage

A failed amendment to the Minnesota legislation sought to strip dozens of so-called “essential benefits” from health plans with the expectation that slimmed-down coverage would cost less.

Republican State Rep. Steve Drazkowski, who offered the amendment, said he was trying to eliminate the current, “government-controlled, one-size-fits-all, dictating set of mandates.

“What we’re doing is trying to create an environment that, if and when the ACA goes away, that Minnesotans will have the freedoms they need in order to start to bring some free-market competition, some free-market ingenuity and innovation into the health insurance market,” he said.

The laundry list of benefits that consumers could choose to have covered or not under Drazkowski’s amendment included maternity care, diabetes treatment and mental health care among many others. Some items on the list are very specific: Lyme disease, prostate cancer screenings, outpatient surgery.

Dayton and other Democrats opposed the amendment and it dropped out of the final legislation.

Still, it caught the eye of Minnesota native Andy Slavitt, who is the former administrator of the Centers for Medicare & Medicaid Services, which oversee the health law marketplaces. Slavitt, who tweeted about the amendment, said it is a cautionary tale about high-deductible catastrophic

 

Still, it caught the eye of Minnesota native Andy Slavitt, who is the former administrator of the Centers for Medicare & Medicaid Services, which oversee the health law marketplaces. Slavitt, who tweeted about the amendment, said it is a cautionary tale about high-deductible catastrophic plans that cover little or no basic care.

Democratic Gov. Mark Dayton backed the measure since October when he called the ACA “no longer affordable to increasing numbers of people.” But passage wasn’t assured as both houses of Minnesota’s legislature are controlled by Republicans.

It is thought to be the second time a state has offered up state tax dollars to stabilize an insurance marketplace created by the ACA. (Alaska came up with a $55 million bailout for insurers in 2016.)

Bare-Bones Coverage

A failed amendment to the Minnesota legislation sought to strip dozens of so-called “essential benefits” from health plans with the expectation that slimmed-down coverage would cost less.

Republican State Rep. Steve Drazkowski, who offered the amendment, said he was trying to eliminate the current, “government-controlled, one-size-fits-all, dictating set of mandates.

“What we’re doing is trying to create an environment that, if and when the ACA goes away, that Minnesotans will have the freedoms they need in order to start to bring some free-market competition, some free-market ingenuity and innovation into the health insurance market,” he said.

The laundry list of benefits that consumers could choose to have covered or not under Drazkowski’s amendment included maternity care, diabetes treatment and mental health care among many others. Some items on the list are very specific: Lyme disease, prostate cancer screenings, outpatient surgery.

Dayton and other Democrats opposed the amendment and it dropped out of the final legislation.

Still, it caught the eye of Minnesota native Andy Slavitt, who is the former administrator of the Centers for Medicare & Medicaid Services, which oversee the health law marketplaces. Slavitt, who tweeted about the amendment, said it is a cautionary tale about high-deductible catastrophic plans that cover little or no basic care.


For-profits’ entry into program for the elderly worries some

nursinghome

By SARAH VARNEY

For Kaiser Health News

DENVER

Inside a senior center here, nestled along a bustling commercial strip, Vivian Malveaux scans her bingo card for a winning number. Her 81-year-old eyes are warm, lively and occasionally set adrift by the dementia plundering her mind.

Dozens of elderly men and women — some in wheelchairs, others whose hands tremble involuntarily — gather excitedly around the game tables. After bingo, there is more entertainment and activities: Yahtzee, tile-painting, beading.

But this is no linoleum-floored community center reeking of bleach. Instead, it’s one of eight vanguard centers owned by InnovAge, a company based in Denver with ambitious plans. With the support of private-equity money, InnovAge aims to aggressively expand a little-known Medicare program that will pay to keep older and disabled Americans out of nursing homes.

Until recently, only nonprofits were allowed to run programs like these. But a year ago, the government flipped the switch, opening the program to for-profit companies as well, ending one of the last remaining holdouts to commercialism in healthcare. The hope is that the profit motive will expand the services faster.

Hanging over all the promise, though, is the question of whether for-profit companies are well-suited to this line of work, long the province of nonprofit do-gooders. Critics point out that the business of caring for poor and frail people is marred with abuse. Already, new ideas for lowering the cost of the program have started circulating. In Silicon Valley, for example, some eager entrepreneurs are pushing plans that call for a higher reliance on video calls instead of in-person doctor visits.

The business appeal is simple: A Baby Boom-propelled surge in government healthcare spending is coming. Medicare enrollment is expected to grow by 30 million people in the next two decades, and many of those people are potential future clients. Adding to the allure are hefty profit margins for programs like these — as high as 15 percent, compared with an average of 2 percent among nursing homes — and geographic monopolies that are all but guaranteed by state Medicaid agencies to ensure the solvency of providers.

“PACE is still a secret in the minds of the public,” Andy Slavitt, Medicare’s acting administrator, said at the National PACE Association meeting in April. The challenge, he said, was to make PACE “a clear part of the solution.”

Several private-equity firms, venture capitalists and Silicon Valley entrepreneurs have jumped into the niche. F-Prime Capital Partners, a former Fidelity Biosciences group, provided seed funding for a PACE-related startup, as have well-regarded angel investors like Amir Dan Rubin, the former Stanford Health Care president, and Michael Zubkoff, a Dartmouth healthcare economist.

And no company has moved with more tenacity than InnovAge. Last year, the company overcame protests from watchdog groups to convert from a nonprofit organization to a for-profit business in Colorado. And in May, InnovAge received $196 million in backing — the largest investment in a PACE business since the rule change was made — from Welsh, Carson, Anderson & Stowe, a private-equity firm with $10 billion in assets under management.

“For years we were pariahs, and no one wanted anything to do with us,” said Julie Reiskin, executive director of the Colorado Cross-Disability Coalition, a nonprofit group that advocates for people with disabilities, many of whom are eligible for PACE.

“Now that there’s money involved,” Reiskin said, “everyone is all interested.”

Even the program’s supporters acknowledge that the movement needs fresh momentum. But they worry that commercial operators will tarnish their image in the same way many for-profits eroded trust in hospice care and nursing homes.

Three decades ago, after Congress authorized Medicare to pay for hospice care, commercial operators displaced the religious and community groups that had championed the movement. As recently as 2014, government inspectors found that for-profit hospice companies cherry-picked patients and stinted on care.

In addition, elderly patients with dementia and chronic ailments have frequently been targets of abuse and neglect at nursing homes, something advocates for the elderly say is correlated with the increased commercialization of that industry.

“I’m not wild about every knucklehead running around trying to do PACE,” said Thomas Scully, former Medicare administrator under President George W. Bush. “I would rather keep it below the radar.”

Not Quite Able

Early last year, Malveaux was drowning. She lived alone in a tidy red-brick home in a leafy Denver neighborhood that she had paid for by working shifts at a Samsonite luggage factory, now closed.

Laundry piled up. Bills went unpaid. Doors were left unlocked. Pans sometimes burned on the stove as her memory failed.

“I had lost my mind,” she recalled, sitting on her couch in a pink velour robe. “I couldn’t keep up my house.”

For Americans who find themselves in this situation, the next stop is often a traditional nursing home. Malveaux’s son took her instead to visit an InnovAge day center.

The $9 million building south of downtown Denver is designed to calm people with dementia. It has subdued lighting and winding hallways that encircle the first floor like a running track and discourage “exit-seeking behaviors,” where patients search for ways out of a building.

For the frightened Malveaux, it seemed like paradise: a flower garden, a beauty salon and day trips to casinos and candy factories. And, most importantly, it had a team of doctors, nurses, psychiatrists, dentists, physical therapists, nutritionists, home health aides and social workers whose purpose was to help her live safely in her beloved brick home.

After joining the center in June 2015, Malveaux began seeing a psychiatrist and went on medication for depression. A social worker coached her grandson, Jermaine Malveaux, on how to care for someone with dementia. Three days a week, an InnovAge van picks up Malveaux at home and takes her to the center to share lunch with other older adults and try her luck at bingo and ceramics.

“I make friends easily,” she said with a smile. “And the guys flirt with me.”

The InnovAge center, like other PACE facilities, is inspired by Britain’s much-lauded Day Hospitals, outpatient health care facilities that arose in the 1950s that became a hub of daily life for many older people. In the United States, the earliest incarnation of PACE was started in San Francisco in 1971 by a group of Asian and Italian immigrant families seeking alternatives to the American nursing home.

Federal health officials allowed the group, called On Lok — Cantonese for “peaceful, happy abode” — to test what was then a novel and prophetic approach to health care financing. Instead of physicians billing Medicare each time they treated a patient, the government would pay a fixed amount to the center for each member. On Lok would assume the financial risk, similar to an insurance company. In 1990, Medicare officially sanctioned the model.

In exchange for a capped monthly payment from Medicare and Medicaid, PACE staff members arrange and pay for all of a patient’s doctors’ visits, medications, rehabilitation and hospitalizations. At the same time, they are supposed to pay attention to the patient’s daily needs — meals, bathing, housekeeping and transportation to day centers, where older people can ward off isolation and cognitive decline by socializing. (Studies have found that the intensive caretaking reduces costly hospital stays.)

Comparing the cost effectiveness of PACE against nursing homes is difficult, partly because state Medicaid agencies pay a variety of rates. But all the states are required to keep their rates below what they would pay for nursing home care. In Colorado, for example, that amounts to 7 percent less per patient.

On average, Medicare and Medicaid pay PACE providers $76,728 a person a year, about $5,500 less than the average cost of a nursing home. And the money going to PACE covers the all of the person’s health and social needs, unlike nursing-home care, which doesn’t include hospitalizations and other expensive medical care.

The flat government payment pushes the organizations to invest in maintaining a patient’s health and safety to avoid big hospital bills. Dentistry — excluded from traditional Medicare coverage — is a crucial focus: Programs invest heavily to fix broken teeth and dentures to avoid costly infections or poor nutrition that can cause cascading health problems.

Providers are also generous with rehabilitation, setting few limits on training sessions that strengthen injured muscles and sturdy patients against falls.

“If you’re neglecting these patients, the odds they’ll call an ambulance and go to the hospital and spend a week there because they’re really sick is pretty high, and that all comes out of the payment,” said Bob Kocher, a former senior healthcare adviser to President Obama.

Profits are in no way guaranteed, though. The centers still face major financial risk — it just takes a few patients with serious medical conditions to upend the books.

Dan Gray, a PACE financing consultant at Continuum Development Services, said too many trips to the emergency room or an expensive hospital stay can flip fortunes. One organization he advises had $300,000 in hospital medical claims in a month that he refers to as “Black August.”

“I had a nervous twitch,” he said.

High-Tech vs. High-Touch

In January, at the healthcare industry’s leading matchmaking event, the J.P. Morgan Healthcare Conference in San Francisco, word quickly spread that PACE programs could save states and the federal government up to 20 percent a patient. And suddenly, the program became one of the hottest topics of discussion.

“Every other conversation was, ‘What do you think we should do with PACE?’” said Bill Pomeranz, a managing director at Cain Brothers, who helped finance the nation’s first PACE program in the 1970s.

The message appeared to travel down Highway 101 as well, to the heart of the technology industry. At least eight startups have circulated PACE-related pitches to Silicon Valley venture capital firms, hoping to tap into new capital and create technology-enabled versions of the program.

The interest of the tech industry is so far only nascent. But the possibility that Silicon Valley, notoriously aggressive and extremely deep-pocketed, could play a significant role in PACE underscores the changes that may lie ahead.

Building a center requires medical offices, rehabilitation equipment, food service and fleets of handicapped-accessible vans. On average, it takes up to $12 million just to get it off the ground. That is a lot of money for most nonprofits but relatively little in the technology world. Opening new centers may become less of a hurdle.

The tech industry and nonprofit world are driven by different impulses. The early centers were closely tied to local cultures, making them difficult to replicate. An aversion to aggressive marketing among the center’s leaders didn’t help, either. Tech likes to move as fast as possible.

“PACE reminds me of religious orthodoxy,” said Mr. Pomeranz, who said he had affection for the program. The movement’s leaders come from the world of public health and have a “social work mentality,” he added.

The pitches circulating among investors envision technology-enabled programs that would rely, in part, on video visits and sensors. Some studies have found that telemedicine can help patients better control certain chronic conditions and reduce healthcare spending. But those technologies are largely untested in geriatric care.

“The entrepreneurs coming into this space all believe there are much lower-cost ways to check on patients every day than driving them all to one building,” said Mr. Kocher, who is now a partner at the venture capital firm Venrock, which invests in healthcare companies.

These sorts of pitches, while promising, have not been universally welcomed. They’ve even been used as evidence that opening PACE up to for-profit companies might lead to unwanted consequences.

Veteran PACE providers, for example, are skeptical of virtual medicine’s benefits to seniors, especially those with dementia.

“Socialization goes a long way to improve the health of the participants we serve,” said Kelly Hopkins, president of Trinity Health PACE, a nonprofit health system that operates PACE centers in eight states. “It’s naïve to think you can do it virtually.”

Supporters of the change say the necessary safeguards are in place. The for-profit centers were approved, to little fanfare, after the Department of Health and Human Services submitted the results of a pilot study to Congress in June 2015. The demonstration project, in Pennsylvania, showed no difference in quality of care and costs between nonprofit PACE providers and a for-profit allowed to operate there.

The Centers for Medicare and Medicaid Services has vowed to closely track the performance of all PACE operators by measuring emergency room use, falls and vaccination rates, among other metrics. The National PACE Association, a policy and lobbying group, is also considering peer-reviewed accreditation to help safeguard the program. Oversight is now largely left to state Medicaid agencies.

Maureen Hewitt, InnovAge’s chief executive, said, “At the end of the day, we’re held to the same quality and care standards.”

Dr. Si France, a founder of WelbeHealth, an early-stage company based in Menlo Park, Calif., says startups can use technology to improve clinical communication, help caregivers make treatment decisions and monitor patients at home or in a hospital. But he insists that even a high-tech PACE program cannot veer from its origins.

“It’s not a way to get rich or generate outsize returns,” said Dr. France, the former chief executive of GoHealth, a chain of urgent-care centers acquired by TPG Capital, a private-equity firm. “We think this is an arena for missionaries, not mercenaries.”

Will Money Change Things?

Families enrolled in InnovAge’s PACE program in Denver appeared to be unaware of its conversion into a for-profit enterprise. The company did not announce the change directly to its participants, but notified a patient advisory group.

Kathy Baron, 68, who lives in subsidized senior housing, was left disabled by breast cancer and debilitating nerve pain. Her daughter, Leah van Zelm, struggled to take care of her. So Baron, fearful she would be deemed unfit to stay in her apartment, signed up for InnovAge’s program.

“I would rather be dead than go into a nursing home,” Baron said.

She says InnovAge has been generous with services, echoing interviews with other patients. Each week, an InnovAge housekeeper changes the sheets on her bed, launders her clothes and cleans her apartment, a service provided to those unable to tidy their own homes. The few times her requests for special equipment or services were denied, Baron appealed and won.

But she worries new investors will skimp on what outsiders might view as unwarranted services. The company’s commercials, promising “Life on Your Terms” and voiced by the actress Susan Sarandon, have reinforced those concerns.

It’s a concern echoed by Malveaux’s family. “Anytime you involve money,” said Malveaux’s grandson Jermaine, “there’s always the concern for greed, especially with the elderly.”

At least in the near future, the number of companies getting into PACE programs will be limited. Most states currently cap enrollment in PACE centers. And each state — as Colorado did, opening the window for InnovAge — likely needs to amend its law to allow the for-profit companies. So far, it appears only California has done so.

Yet there is a growing realization among longtime PACE providers that new competition looms.

In a newsletter to the generally placid PACE community, one adviser warned that providers who failed to become bigger would face new entrants who “will find a way to meet the needs of persons in your community.”

Those needs will only grow as the adult children of Baby Boomers face difficult decisions about how to care for their parents.

In the meantime, for people like Van Zelm, the anxiety that once pervaded her daily life has diminished.

“When she’s stable,” Van Zelm said of her mother, “my daily life stress is reduced.”

 


Proposed CMS changes would be boon for primary-care clinicians

primary

The Centers for Medicare & Medicaid Services plans to make a renewed push over the next year to boost primary care with new incentive programs.

“In the United States, we have historically invested far more in treating sickness than we do in maintaining health,” CMS acting Administrator Andy Slavitt said in a blog post. “The result of this imbalance is not only poorer health, but more money spent in institutions, hospitals, and nursing homes.”

“The road to a better healthcare system means correcting this imbalance. We should reinvest in what we value — primary care — as a practice, as a profession, and as an abundant resource for patients.”
“Today, we are proposing significant actions to improve how we pay primary-care physicians, mental-health specialists, geriatricians, and other clinicians. By better valuing primary care and care coordination, we help beneficiaries access the services they need to stay well.”

The proposed changes include:

  • Increasing  payments to primary-care providers for routine office visits of  patients with mobility-related disabilities to $119 from $73 a visit.
  • Increasing payments to geriatricians and family physicians. “We anticipate that these clinicians could receive a 2 percent increase in their payments for providing the care we propose to recognize under the Physician Fee Schedule,” Mr. Slavitt said. “Over time, if all of the practitioners that can provide these services provide them to all eligible patients, we estimate that the payment increase could be as much as 30 percent and 37 percent, respectively, to these specialties.”
  • Paying for mental-health care using the Collaborative Care Model, which “supports mental and behavioral health through a team-based coordinated approach involving a psychiatric consultant, a behavioral healthcare manager, and the primary care clinician, and which extends beyond the scope of an office visit,” he said.

To read a longer story in this, please hit this link.


CMS chief’s tour d’horizon

 

Acting CMS Administrator Andy Slavitt discussed a wide range of issues at a forum in Boston this week, including new CMS payment systems, soaring drug prices and physicians overwhelmed by new regulations. As The Boston Globe noted in its coverage of Mr. Slavitt’s talk:

“The federal government has imposed numerous new healthcare regulations in recent years, prompting doctors to describe them regulations as time-consuming burdens that hamper patient care. Earlier this year, Slavitt acknowledged regulators have lost the ‘hearts and minds’ of physicians. ‘I do think it can be won back,’ he said Tuesday.


‘4 things to know’ about CMS star ratings

stars

Becker’s Hospital Review has come up with “four things to know” about CMS’s star ratings for hospitals, whose launch has been postponed to July.

1. “CMS had planned to release a new star ratings system on {its} Hospital Compare on April 21. The current star ratings, which went live in April 2015, incorporate only patient experience scores, and the new overall star ratings intend to include quality measures such as readmissions, mortality, effectiveness of care and timeliness of care in addition to patient experience scores.”

2. After the program’s final methodology was announced in January, several stakeholders spoke out against the ratings system. 60 senators sent a letter to Andy Slavitt, acting administrator of CMS, urging CMS to delay releasing the ratings because of concerns the system “may not accurately take into account hospitals that treat patients with low socioeconomic status or multiple complex chronic conditions.”

Members of the House sent a similar letter.

3.” …{T}HE agency said it developed its methodology in coordination with many stakeholders, but it would delay the overall star ratings release in response to ‘targeted concerns about specific calculations’ and feedback from stakeholders.”

4. Prior to the new July release date, the specific date  of which has not been announced, “CMS plans to listen to stakeholders — people with questions on the methodology can email cmsstarratings@lantanagroup.com — and work with hospitals on their data — a national provider call is scheduled for May 12. After the star ratings go live ‘in their first iteration,’ the agency plans to ‘refine and improve the site….”’


Senators urge delay in star standards release

 

The Centers for Medicare & Medicaid Services is  scheduled to reveal overall star ratings for hospital quality on April 21, but 60 senators have urged the agency to delay the release amid concerns about allegedly incomplete and misleading data. It is unknown how much of this call for delay is due to political pressures from hospitals in the senators’ home states.

In a letter to Acting CMS Administrator Andy Slavitt, the senators say that flawed quality measures can cause wide variations between CMS’s quality ratings and other reports.

The senators added: “It is clear that additional time is necessary for hospitals and stakeholders to thoroughly review the data and understand the impact of the current methodology to ensure the validity and accuracy of the information before it is publicly released,” the letter states.

They also expressed concerns that the ratings methodology didn’t properly include providers that treat low-income or disadvantaged patients.

 

The star ratings and the methodology used for them have long been a source of controversy.


Effort underway to rescue health cooperatives

rescue

The Obama administration  is moving to help struggling health cooperatives set up under the Affordable Care Act even as it seeks to recover federal funds from the failed ones.

The nonprofit co-ops were meant to offer health insurance to consumers on ACA marketplaces and to lower costs by giving established insurers more competition. But more than half of the 23 operating state co-ops have failed after receiving about $1.17 billion in federal loans.

Co-op officials have complained that the ACA has restricted their ability to acquire capital.

But Andy Slavitt, the acting director of the Centers for Medicare & Medicaid Services, has told Congress that administration  has ideas for helping co-ops to attract capital or merger partners.

The  Wall Street Journal reported that the Senate Finance Committee’s chairman, Sen. Orrin Hatch (R.-Utah), called the co-op program poorly designed and  said that it lacked adequate safeguards to protect taxpayer money. “He also questioned the co-ops accounting practices, specifically whether loans were recorded as assets.”

The WSJ reported that “Mr. Slavitt said three-quarters of consumers who were covered by co-ops that failed have now been able to maintain coverage through new plans. He also outlined steps being taken to help ensure the financial health of the surviving organizations, including a financial audit of the remaining co-ops after the end of the current open-enrollment period wraps up Jan. 31.”

The paper added:

“The agency will hold a March meeting with co-op leaders and others involved regarding a formula that spreads out risk among insurers. That program … distributes money from plans with healthier and younger enrollees to plans with sicker and older customers.”

“Co-op officials said the formula used to determine payments left them and smaller insurers at a financial disadvantage compared with larger insurers, and they have been pressing the Obama administration to make revisions they say are necessary to ensuring their survival going forward.”

 


The world after Meaningful Use

sunrise

While acting CMS head Andy Slavitt said this week  that the Meaningful Use program, at least as it existed, will end,  providers will still be held accountable for using technology in patient care.

The end of Meaningful Use  as we know it means no more incentives  (as opposed to penalties) from Medicare for adopting it,  although Meaningful Use-style incentives  will continue for Medicaid.

Still, an eligible  Medicare provider who fails to attest to Meaningful Use will  face a penalty.

However, Becker’s Hospital Review says that the recently passed blanket “hardship exemption permitting any Meaningful Use participant to apply for an exemption from Meaningful Use penalties in 2017 may bring the reimbursement penalties that year close to zero.”

 

 

 

 


Meaningful Use program to end soon

 

CMS acting administrator Andy Slavitt said at a healthcare investors conference in San Francisco that the agency plans to end the Meaningful Use program soon.

“The meaningful use program as it has existed will now effectively be over and be replaced with something better,” he said Monday at the J.P. Morgan Healthcare Conference, adding that the new program’s details will be  disclosed in the next few months.

“Now that we effectively have technology in virtually every place care is provided, we are now in the process of ending Meaningful Use and moving to a new regime culminating with the MACRA implementation.” Mr. Slavitt was referring to  the Medicare Access and CHIP Reauthorization Act, which  repealed the Sustainable Growth Rate reimbursement formula. Most of MACRA’s provisions take effect in 2019.
“Providers will be able to customize their goals so tech companies can build around the individual practice needs, not the needs of the government.”


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