Archive for November, 2017


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.

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 …

Is Readmissions Reduction Program Hurting Some Patients?

A new study suggests that the decline in avoidable hospital readmissions of Medicare patients driven by the federal program’s hospital readmissions reduction program may be harming cardiac patients.

According to a new study published in the journal JAMA Cardiology, while the readmissions reduction program has reduced readmissions among heart failure patients from 20 percent before the program was launched to 18.4 percent, the mortality rate among the same patients rose from 7.2 percent to 8.6 percent – 5400 more deaths a year.

To learn more about the study, its results, why experts believe this  may be happening, and information about studies that did not reach a similar conclusion, go here to see the JAMA Cardiology article “Association of the Hospital Readmissions Reduction Program Implementation With Readmission and Mortality Outcomes in Heart Failure.”


Telehealth on the Upswing

A number of recent developments suggest that serving patients with the assistance of telehealth services will become more commonplace in the near future.

The Medicare MACRA and MIPS payment programs will include new billing codes for telehealth services, according to regulations published earlier this month.

Also earlier this month, the House passed legislation, The Vets Act (H.R. 2123), that would authorize the Veterans Administration to make greater use of telehealth.

And when the U.S. Department of Health and Human Services’ Office of the Inspector General recently announced plans to audit Medicaid programs for telehealth payments, it cited among its reasons for the audits the growing number of telehealth claims and its expectation that such growth will continue.

Learn more about government reimbursement for telehealth services and its implications for providers in this Healthcare Finance News story.


Socio-Economic Factors’ Role in Skilled Nursing Facility Finances

Skilled nursing facilities located in communities with higher-than-typical numbers of low-income and minority patients are under greater financial stress than comparable facilities located in other communities.

Nursing homes that serve higher proportions of Medicaid patients the same challenge.

And both of these conditions detract from the quality of care such facilities provide.

These are the findings of a new study published in the journal Health Services Research.

According to the study,

Medicaid-dependent nursing homes have a 3.5 percentage point lower operating ratio. Those serving primarily racial minorities have a 2.64-point lower quality rating. A 1 percent increase in the neighborhood population living in poverty is associated with a 1.20-point lower quality rating, on a scale from 10 to 50, and a 1 percent increase in the portion of neighborhood black residents is associated with a 0.8 percentage point lower operating ratio and a 0.37 lower quality rating.

 Learn more from the study “Geographic Disparities in Access to Nursing Home Services: Assessing Fiscal Stress and Quality of Care,” which appears in the Health Services Research.  Find a link to the study here.…

Bill Seeks to Block 340B Cut

Legislation introduced in Congress would block the attempt by the Centers for Medicare & Medicaid Services to slash $1.6 billion in annual payments to hospitals for prescription drugs for outpatients prescribed through the federal section 340B prescription drug discount program.

Earlier this month CMS finalized its plan to reduce controversial 340B payments and shift $1.6 billion in savings into Medicare provider payments.  If adopted, the bipartisan legislation co-sponsored by Representatives David McKinley (R-WV) and Mike Thompson (D-CA) would prevent the reduction of 340B payments, which are made to hospitals that care for especially large proportions of low-income patients.

Go here to see Rep. McKinley’s news release on the bill and here to see the bill itself, which is H.R. 4392, “To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes.”…