The growing awareness of the impact of social determinants of health comes at a time when health care providers are assuming unprecedented degrees of risk for the health of their patients, leaving many providers wondering how best to invest resources that will meet both their own needs as well as the needs of their high-cost, high-need patients.

A new document from the Commonwealth Fund, “Investing in social services as a core strategy for healthcare organizations:  Developing the business case,” seeks to serve as a manual for providers seeking to move into this relatively new territory.

The report takes providers through key steps in the process, including establishing a common definition of social service investment; identifying common barriers to social service investments; and building the business case for such investments.  It also addresses six aspects of building that business case:

• identifying potential social investment options
• defining success
• measuring costs
• determining an investment model
• developing a return on investment approach
• sensitivity analysis and investment launch

Finally, it identifies the major social determinants of health providers might seek to address:

• economic stability
• neighborhood and physical environment
• education
• food
• community and social context

For a closer look at the considerations that go into the …

The Senate Health, Education, Labor, and Pensions Committee (HELP) held a hearing last week on the 340B prescription drug discount program.

The hearing was prompted by complaints from pharmaceutical companies about the discounts they are required to provide to eligible providers and by concern that hospitals are insufficiently accountable for how they use the savings they derive from those discounts to serve their low-income patients.  In addition, the Centers for Medicare & Medicaid Services recently reduced its Medicare payments to participating hospitals.

During the hearing, Senate Republicans expressed support for the program but spoke of the need for greater transparency in the use of the savings the 340B program generates for hospitals and a clearer sense of how those savings benefit low-income payments.  Committee Democrats expressed similar concern but with less urgency.

Hospital industry representatives expressed concern that any new requirements could weaken the program and rejected the idea that savings are misused.  Committee members pushed back against these contentions.

The Senate HELP Committee intends to hold additional hearings about the 340B program.

Learn more about the 340B hearing and the concerns that led to in this Healthcare Dive article.

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The Medicare Payment Advisory Commission has issued its 2018 report and recommendations to Congress.

The report includes MedPAC’s recommendations for next year’s Medicare fee-for-service payments; a review of the Medicare Advantage and Medicare Part D programs, with recommendations; and a report telehealth required by the 21^st Century Cures Act.

For Medicare fee-for-service rates, MedPAC proposes:

• the inpatient and outpatient rate increases, physician and other health professional rate increases, and outpatient dialysis increase included under current law
• no increase for ambulatory surgical centers, long-term-care hospitals, and hospice providers
• no rate increase for skilled nursing facilities
• a five percent reduction of payments for home health providers and the introduction of a two-year rebasing of home health rates beginning in 2020
• a five percent reduction of inpatient rehabilitation facility payments

In addition, MedPAC recommends that Medicare base future payments to post-acute providers on a blend of “each sector’s setting-specific relative weights and the unified post-acute care prospective payments system’s relative weights.”

MedPAC also recommends that Medicare abandon its merit-based incentive payment system (MIPS) in favor of an alternative approach for achieving “the shared goal of high-quality clinician care for beneficiaries in traditional Medicare.”

MedPAC is a non-partisan legislative branch agency that advises …

The Medicaid and CHIP Payment and Access Commission has published its annual report and recommendations to Congress.

MACPAC’s report addresses three primary areas:  Medicaid managed care, telehealth, and Medicaid disproportionate share payments (Medicaid DSH).

With 80 percent of Medicaid beneficiaries now enrolled in managed care plans, MACPAC offers three major recommendations for improving Medicaid managed care efforts:

• permit states to require all of their Medicaid beneficiaries to enroll in a managed care plan
• extend Medicaid managed care section 1915(b) waivers from two to five years
• permit states to obtain waivers to waive freedom of choice and selective contracting restrictions

MACPAC notes the growing use of telehealth by state Medicaid programs and encourages states to continue this expansion while learning more from the efforts of one another to use telehealth effectively.

Finally, MACPAC notes that it

…continues to find little meaningful relationship across the country between DSH allotments and number of uninsured individuals, hospitals’ uncompensated care costs, and the number of hospitals providing essential community services that have high levels of uncompensated care. Total hospital charity care and bad debt continue to fall, especially in states that expanded Medicaid coverage, but Medicaid shortfall showed an uptick as a result of increased …

The Centers for Medicare & Medicaid Services has published a new report detailing the progress of health care providers in meeting Medicare quality standards and improving their performance under those standards.

The report, required every three years, focuses on 17 key indicators of quality in the delivery of health care as defined by 247 individual quality measures.

The analysis found that:

• 670,000 patients improved their control of their blood pressure
• 510,000 fewer patients have poor control of their diabetes
• 12,000 fewer people died following hospitalization for a heart attack
• there were 70,000 fewer unplanned hospital readmissions
• nursing home residents suffered 840,000 fewer pressure ulcers

In addition, the study reported cost savings associated with better compliance with quality standards, including:

• $4.2 billion to $26.9 billion saved because of better compliance with medication instructions
• $2.8 billion to $20 billion saved through fewer treatments for pressure ulcers
• $6.5 billion to $10.4 billion saved because patients manage their diabetes more effectively

The study also looks hospital and nursing home performance variations based on race and ethnicity, income, sex, urbanicity, region, and age for many quality measures.

Learn more about Medicare’s quality measures and how hospitals and nursing homes are performing under these measures in …