The savings represents a $940 million increase over the $1.7 billion saved in 2018. In the seven years since it began in 2013, MSSP has generated more than $7 billion in savings, CMS data show.
More than 540 accountable care organizations in the MSSP served 11.2 million Medicare beneficiaries in 2019.
Clif Gaus, president and CEO of the National Association of ACOs, said the new data from 2019 "clearly show that ACOs are helping improve our health system at a time when it’s needed more than ever."
"When we emerge from the ongoing pandemic, we’ll need alternatives to fragmented fee-for-service and better cost-control strategies, which ACOs provide," Gaus said. "There should be no debate that we need to foster the growth of more ACOs so their benefits are delivered to more seniors."
Only 5% of ACOs signed on for CMS's Pathways to Success model during its rollout year in 2019. Gaus said Congress could generate more interest in the new model with better incentives under the Advanced Alternative Payment Models.
CMS also reported that:
92% of eligible ACOs earned quality improvement reward points in 2019. The greatest improvements were in patient safety and care coordination.
ACOs showed better or comparable on quality metrics when compared with physician group practices.
ACOs in both shared savings-only models and risk-based models had net savings for Medicare, as did ACOs in low- and high-revenue categories, and ACOs in the legacy MSSP models and the new Pathways to Success model.
CommonSpirit Saves $70 Million
Chicago-based CommonSpirit Health announced that its 16 MSSP ACOs in 21 states and serving 321,000 Medicare beneficiaries kept $37 million of the $70 million they generated in shared savings and also recorded quality scores averaging 94%.
CommonSpirit said its ACOs reduced short-term inpatient hospital admissions and emergency department visits by 1%, long-term inpatient hospital stays by 21%, and increased primary care services by 2%. In addition, 10 of the 16 CommonSpirit MSSP ACOs generated savings, and 56% received shared savings payments.
"Our ACOs and clinical leaders are an essential driver of this strategy, demonstrating a clear commitment to compassion across the continuum of care by building strong relationships with our patients, proactively supporting their health and wellbeing in their communities, and modeling financial stewardship for sustainability," said Bruce Swartz, CommonSpirit's executive vice president, Physician Enterprise.
PhRMA says the White House has "doubled down on a reckless attack on the very companies working around the clock to beat COVID-19."
Drug makers are irate and threatening legal action in the wake of President Donald J. Trump's executive order mandating that Medicare Part B and Part D pay no more than other developed nations for prescription drugs.
The so-called "Most Favored Nation Policy", which Trump signed on Sunday, is one of a handful of executive orders issued this summer to address the nation's spiraling drug costs, which are the highest in the world.
The executive order notes that other developed nations, often the single, biggest purchaser of drugs in their respective countries, use their buying power to negotiate cheaper prices, " leaving Americans to make up the difference — effectively subsidizing innovation and lower-cost drugs for the rest of the world."
"Americans pay more per capita for prescription drugs than residents of any other developed country in the world," the order reads. "It is unacceptable that Americans pay more for the exact same drugs, often made in the exact same places."
Specifically, the executive order directs Department of Health and Human Services Secretary Alex Azar to draft rulemaking to test a payment model for high-cost Part B drugs, and for high-cost Part D drugs with insufficient competition.
Trump has said his executive orders will reduce prescription drug costs by as much as 70%, though that assertion has been challenged by independent analysis.
Stephen J. Ubl, president and CEO of the Pharmaceutical Research and Manufacturers of America, accused the Trump administration of pursuing "an irresponsible and unworkable policy that will give foreign governments a say in how America provides access to treatments and cures for seniors and people struggling with devastating diseases."
"What's worse is that they are now expanding the policy to include medicines in both Medicare Part B and Part D, an overreach that further threatens America's innovation leadership and puts access to medicines for tens of millions of seniors at risk," Ubl said.
"Rather than emulating countries that allow politicians to arbitrarily decide what medicines are worth and what diseases are worth investing in, we should use existing trade enforcement tools to prevent them from freeloading off American innovation," Ubl said.
That sentiment was shared by Michelle McMurry-Heath, MD, president and CEO of the Biotechnology Innovation Organization, who called the mandate "dumbfounding."
"This reckless scheme will eliminate hope for vulnerable seniors and other patients waiting for new treatments by drastically reducing investment in cutting-edge scientific research and development," she said. "That is why we will use every tool available – including legal action if necessary – to fight this risky foreign price control scheme."
It's not clear when the executive order would take effect, but with less than 50 days until Election Day, Avalere consultants Principal Matt Kazan said it's "unlikely any policy change will be implemented before votes are cast."
"With that said, you could imagine a scenario where Part B reforms are effective before Inauguration Day. Part D changes, however, will likely need to wait until the 2022 plan year," he said.
The two Chicagoland health systems have signed a letter of intent for Palos Health to join Northwestern Medicine, subject to the approval of their respective boards of directors and regulatory clearance.
Northwestern Memorial HealthCare and Palos Health announced Friday that they are considering a merger.
In a joint announcement, the two Chicagoland nonprofit health systems said they've signed a letter of intent for Palos Health to join Northwestern Medicine, subject to the approval of their respective boards of directors and regulatory clearance.
"Both health systems are guided by providing patients access to high-quality, compassionate care, close to where they live and wor," NMH CEO and President Dean M. Harrison said in a media release.
"As a member of Northwestern Medicine, Palos Health will join Chicago’s premier integrated academic health system and have access to groundbreaking clinical trials, research, and leading clinical programs," he said.
Palos Health, located in Chicago's southwest suburbs, includes a 425-bed hospital in Palos Heights and a South Campus in Orland Park that provides primary and specialty care, advanced diagnostics and a surgery center. Palos Health includes 3,000 employees and a 600 member Medical Staff.
"The proposed affiliation with Northwestern Medicine will further enhance Palos Health's already strong reputation for providing exceptional community-based care with Northwestern's world-class academic healthcare expertise," said Palos Health President and CEO Terrence Moisan, MD.
Hospital stakeholders complain that major drug makers are refusing to offer mandated drug discounts for safety-net providers.
More than 1,100 hospitals in 46 states and the District of Columbia on Thursday urged the federal government to ensure that drug makers continue to provide discounts mandated under the 340B Drug Pricing Program for safety-net providers.
"340B enables our hospitals to reduce pharmaceutical costs for millions of patients in need and stretch our scarce resources to serve more patients and offer more comprehensive services," the hospitals, members of 340B Health, said in a letterto Health and Human Services Secretary Alex Azar.
The petitioning hospitals noted that 340B hospitals provide 60% of uncompensated and unreimbursed care and 75% of hospital care to Medicaid patients.
"The recent actions of a growing number of major pharmaceutical manufacturers would undermine the very reason this program exists," the hospitals said.
The hospitals complained that several drug makers have cut off access to discounted drugs, and they singled out AstraZeneca, Eli Lilly (Azar's former employer), Merck, Sanofi, and Novartis as the most egregious offenders.
"For example, AstraZeneca has declared it no longer will provide 340B pricing for any of its drugs that will be dispensed through the vast majority of 340B contract pharmacies," the hospitals said. "Eli Lilly has also stopped providing 340B pricing to all 340B contract pharmacies for all of its drugs."
The list includes some of the priciest drugs for cancer and diabetes.
At the same time, Merck, Sanofi, and Novartis, have demanded that 340B hospitals and other safety-net providers submit millions of contract pharmacy claims, with a threat to cut off access to 340B drugs is their demands are not met.
"Providers have no legal obligation to share this data, most of which does not relate to any 340B obligation," the hospitals said. "These collective actions to deny access to 340B pricing are clear violations of the 340B statute that will set a dangerous precedent."
It's not clear whether Azar will respond to the request because he's been pushing to cut 340B payments for more than a year.
The 340B program allows qualified hospitals to buy certain outpatient drugs at or below cost to extend scarce federal resources.
However, HHS said it would cut the reimbursement by 28.5% after complaining that the 340B program has created a large profit margin between the price that hospitals pay for 340B drugs and the reimbursement paid by Medicare.
As a result, HHS said hospitals would be incentivized to overprescribe the discounted drugs. That concern was validated by a Government Accountability Office report in 2015 which showed that Medicare Part B drug spending was substantially higher at 340B hospitals.
"Since HHS took the action that the court affirmed today, we have saved more than $4.8 billion in lower drug costs and reinvested these savings in the Medicare program," Azar said in July, after the U.S.Court of Appeals for the District of Columbia reversed a district court ruling from 2018, and ruled that HHS had the statutory authority to cut the 340B program.
$64 Billion in Community Benefits
Also Thursday, the American Hospital Association released an analysisshowing that safety-net providers under the 340B program provided more than $64 billion in community benefits in 2017, up from $56 billion in 2016.
"This new report once again confirms the immense value of the 340B drug savings program, which allows those eligible hospitals in particular to provide a unique range of important programs and services to their patients and communities, many of which would otherwise be unavailable," said AHA President and CEO Rick Pollack.
In July, the AHA released a separate analysis showing that all tax-exempt hospitals provided $100 billion in total benefits to their communities in 2017.
The announcement comes less than a year after the two New Jersey health systems signed a Letter of Intent to explore a partnership.
Saint Peter's Healthcare System and RWJBarnabas Health announced Thursday that they have signed a definitive agreement to merge the two New Jersey healthcare systems.
Financial terms of the deal were not disclosed.
The announcement comes less than a year after New Brunswick-based Saint Peter's and West Orange-based RWJBH signed a letter of intent to explore a strategic partnership.
Under the merger, Saint Peter's – and flagship hospital, Saint Peter's University Hospital, a 478-bed acute-care teaching hospital and acute care children's hospital – would remain as a full-service provider of acute healthcare services, and would retain its identity as Catholic.
In addition, RWJBH will make capital improvements at Saint Peter's facilities.
Sandra Jarva Weiss, a disinterested observer, and chair of the Norris McLaughlin Health Care & Life Sciences Law Practice, told HealthLeaders the consolidations "are indicative of the trend for smaller/local hospitals to join larger health networks for the benefits these larger networks can bring."
"In particular, the health networks may be positioned to make the capital commitments to specific service lines or facility or technology enhancements for the local hospital," she said.
Leslie D. Hirsch, president and CEO of Saint Peter's, said the merger agreement "assures Saint Peter's continued mission and identity as a Catholic hospital."
"We are truly excited about the potential of this opportunity to integrate with RWJBarnabas Health to create a premier academic medical center of national distinction in which Saint Peter's will share responsibility for leadership and governance," Hirsch said.
The agreement must clear state and federal regulatory hurdles, and be approved by the Catholic Church.
Barry H. Ostrowsky, president and CEO of RWJBarnabas Health, said that when the merger is finalized, "we will have the necessary foundation for the creation of our state's first and only premier academic medical center."
The settlement does not mandate a standard, five-year monitoring agreement for the hospital, nor an admission of wrongdoing on the hospital's part.
Wheeling Hospital, Inc., will pay $50 million to settle whistleblower False Claims Act allegations that the West Virginia hospital violated the Anti-Kickback Statute and the Stark Law prohibiting physician self-referrals, the Department of Justice said.
Federal prosecutors had alleged that between 2007 and 2020 R&V Associates, Ltd., former managers of the 223-bed acute care hospital, "systematically violated the Stark Law and Anti-Kickback Statute by knowingly and willfully paying improper compensation to referring physicians that was based on the volume or value of the physicians’ referrals or was above fair market value," DOJ said in a media release.
The settlement began as whistleblower complaint filed in 2017 by Louis Longo, a former executive vice president of Wheeling Hospital, who will receive $10 million of the settlement. DOJ intervened in the suit in 2019.
The fraud scheme allegedly began in 2007 after Wheeling Hospital hired CEO Ronald Violi, and R&V Associates to engineer a financial turnaround.
R&V Associates then allegedly employed many physicians to snag referrals, boost revenues, and grow market share.
The federal complaint also alleged that Wheeling Hospital paid millions of dollars to doctors based on referrals, including some who were paid annual salaries in excess of $1 million, and closely tracked the revenues physicians were generating under the referral scheme.
"Intimidation is a scare tactic often used against whistleblowers," said Longo's attorney, Jeffrey W. Dickstein, with Phillips & Cohen LLP.
Wheeling Hospital Responds
Wheeling Hospital CEO Douglass Harrison said the settlement "was in the best interest of the long-term viability of the hospital and the community."
"Prolonging the lawsuit would have paralyzed the ability of the hospital to attract the best physicians and to make the necessary capital improvements to ensure that the highest quality healthcare continues to be provided in the Upper Ohio Valley," he said.
Since the suit was filed, the Wheeling Hospital dumped R&V Associates, signed a management agreement with WVU Health System, and named Harrison the new CEO.
"The settlement will not impede the hospital’s focus on patient care or its commitment to compliance, ethical conduct and integrity," Harrison said, adding that the settlement does not mandate a standard, five-year monitoring agreement, nor an admission of wrongdoing on the hospital's part.
The Stark Law prohibits a hospital from billing Medicare for certain services referred by physicians with whom the hospital has a financial relationship, unless that relationship satisfies one of the law's statutory or regulatory exceptions.
The Anti‑Kickback Statute prohibits paying physicians to refer services covered by Medicare, Medicaid, and other federal healthcare programs.
How will the coronavirus affect the seasonal influenza, and vice-versa? What do we know about the combined effects of COVID-19 and the seasonal flu? These are big questions, and the answers are unknown.
With the Labor Day weekend in its wake, the United States now sails full steam ahead into the flu season. But with COVID-19 affecting broad swaths of the nation, healthcare providers are finding themselves in uncharted waters.
How will the coronavirus affect the seasonal influenza, and vice-versa? What do we know about the combined effects of COVID-19 and the seasonal flu? These are big questions, and right now the answers are unknown.
Brian Garibaldi, MD, medical director at the Johns Hopkins Biocontainment Unit and an associate professor of medicine at Johns Hopkins University School of Medicine, provides HealthLeaders with a primer on the seasonal flu, and speculates on what the unprecedented upcoming season may bring. The following interview has been edited for brevity and clarity.
HL: When is the flu season?
Garibaldi: It varies from year to year, but usually cases start to spike in October and peak in December, January, then starts to taper off by March. But the flu season can shift from year to year. Sometimes it can last as late as May and you might start some cases in September.
HL: When do you encourage people to get flu shots?
Garibaldi: September/October is usually when we start to tell people to get vaccinated. There is a theoretical risk that if you get vaccinated too early immunity from the vaccine may be waning if the flu season goes on longer.
This year, we're much more worried about people just getting the shot. We want to make sure that as best we can, people are vaccinated against flu to reduce the possibility that people could get both flu and COVID, but also to reduce the burden on the health system from flu
HL: What's the mortality of the flu?
Garibaldi: Flu is usually in the range. 0.1%.
Depending on what studies you're looking at right now – it's always hard in the middle of an epidemic to understand overall mortality rates – COVID is at least 10 times higher, but at some series is much, much higher than that. We're still kind of learning
HL: Do the same underlying health issues that harm COVID patients harm flu patients as well?
Garibaldi: Yes. Those types of risk factors are similar; age, comorbidities, particularly things like diabetes, hypertension, heart disease, underlying respiratory issues, are all risk factors. But even the things that we're seeing with COVID, where younger people are getting sick, particularly if they're obese, those are factors that are probably at play in influenza as well.
HR: How many Americans die of the flu each year?
Garibaldi: I don't know the exact numbers off the top of my head, but the average number of deaths per year is probably on the order of 60,000 to 80,000.
HL: What sort of a flu strain are you anticipating this season?
Garibaldi: That's hard to stay. If you look at what's going on in in the southern hemisphere, South Africa for example, had a relatively mild flu season relative to normal for them, and that is probably related to their stricter COVID-19 precautions that were in place during the time that they would traditionally have their flu season.
If we're working really hard together to try to curb the spread of COVID-19, those same measures – social distancing, wearing masks, and avoiding large gatherings – the hope would be that maybe that would also tamper down the severity of our flu season.
HL: How do you respond when people say "COVID is just a virulent strain of flu."?
Garibaldi: It certainly has similar features of the flu. They both predominantly have respiratory symptoms, fever, malaise, and fatigue as their main symptoms. But by and large, the risk of having a severe outcome from COVID and the risk of mortality is substantially higher than it is with influenza. When you compare it to the flu, there's this danger of downplaying the significance of COVID.
HL: What do we know about the combined effects of COVID and influenza?
Garibaldi: There have been reported co-infections of flu and COVID, but not enough of them to really understand what that response will look like.
In the U.S., COVID peaked at the point when flu was on its way down, so we did not really get a sneak peek of what it looks like for someone to have both. The concern is that having both of those viral infections at the same time could potentially put you at risk for complications directly from the viruses and from the immune response to try to combat those two viruses.
HL: Are hospitals prepared for this double-whammy?
Garibaldi: The health system is very strained to provide care for all the patients who get hospitalized with flu. Close to 800,000 people a year get hospitalized for influenza. If you add the normal influenza burden on hospital capacity while COVID is surging, there are very few health systems that would be able to effectively deal with both at the same time.
COVID patients and flu patients are going to be competing for the same resources, the same providers, the same ER beds, the same hospital beds, the same personal protective equipment. That's probably the most important message to get out there is that there's a lot of uncertainty about what COVID plus flu looks like for an individual, but also for our community and health system.
HL: Could the tactics used to reduce COVID transmission reduce flu transmission too?
Garibaldi: That's my hope. It's still a little bit early to know for sure what the specific effectiveness of those interventions are, cut flu and COVID are spread through very similar mechanisms. It stands to reason that if you're successful at decreasing COVID transmission, you're at the same time probably going to reduce flu transmission.
HL: Is the flu as contagious as COVID?
Garibaldi: That's a complex question for two reasons. The first is that COVID itself probably has a higher attack rate than the flu. Let's say a given person with COVID probably infects more people than a given person with flu. Flu itself tends to last a little bit shorter but spread a little bit faster. The average time of incubation is only two to three days. But people can spread flu while asymptomatic, just as they can look COVID. So it's hard to compare the two.
COVID is probably a little bit more contagious in terms of the ability of one person to infect more people, but the flu potentially can spread more rapidly because of its faster cycle time.
HL: Do you think that public awareness of COVID might prompt more people to get vaccinated for the flu? Or, could it have the opposite effect, owing to public skepticism about the efficacy of a COVID vaccine?
Garibaldi: That's an important question that I don't have the answer to. I hope that people's awareness of COVID as a severe respiratory infection and the publicity that the flu season and COVID have been getting makes people reconsider getting their flu shot if they haven't on a routine basis.
Obviously, there's a concern with how quickly things are being pushed forward with certain treatments for COVID, particularly with worries about vaccine safety. There are some people who are going to be skeptical about any vaccine this year. But I hope the number of people who have been awakened to the risk of flu plus COVID and are willing to look at the data on safety for the flu vaccine and will get vaccinated this year.
HL: Is it possible that the COVID "second wave" could hit just as flu season is peeking?
Garibaldi: We're worried about a potential spike related to Labor Day. We saw spikes after Memorial Day. We saw spikes after the Fourth of July. So, if there's going to be a post-Labor Day spike, it's going to happen probably right as the flu season kicking off.
We're also not yet sure what role children play in the spread of COVID. There's very clear evidence that children are one of the primary drivers of influenza season. We're going to have to pay careful attention to what's happening in schools with COVID. If schools get shut down because of COVID, I suspect that that will mean that influenza transmission will decrease because children.
HL: What advice would you give to hospital leadership heading into flu season?
Garibaldi: As they've already been doing for COVID, making sure that they're paying attention to supply chain issues that are going to be related to personal protective equipment for respiratory viruses, testing equipment, to be able to make sure that they can continue testing both for COVID and for flu. And making sure that, as almost all hospitals do, they have easy access and requirements for the flu vaccine for their employees and their staff, to try to minimize the number of healthcare workers and providers who might miss time off work for being sick, but also to minimize the spread of respiratory viruses within the hospital environment.
We also need to recognize that there's a lot of uncertainty about what's going on and so being prepared for the worst while hoping for the best is a good strategy.
Most of the jobs came in the ambulatory sector, which had been all but shuttered this spring because of the coronavirus pandemic.
Healthcare sector job growth continued to rebound in August as the nation slowly emerges from the coronavirus pandemic shutdown, but the pace is slowing, according tothe latest federal jobs report.
The August gains included 14,000 jobs in hospitals, 49,000 jobs in physician and dentist offices, and 12,000 jobs in home and health services. Those gains were offset by the loss of 14,000 jobs in the nursing and residential care sector, BLS said.
Healthcare employment is down 679,000 jobs in 2020, including 348,000 job losses in the ambulatory sector, and 104,000 jobs losses in hospitals.
August marks the fourth consecutive month of job growth for the healthcare sector, which suffered epic job losses in the spring owing to the coronavirus pandemic. In May, the sector saw 312,000 payroll additions, mostly in outpatient care venues.
The August job report largely reflects the state of the economy in mid-month and is considered preliminary and subject to considerable revision.
In the overall economy, BLS reported that payroll employment grew by 1.4 million in August, down from 1.8 million in July, and the unemployment rate fell to 8.4%.
"These improvements in the labor market reflect the continued resumption of economic activity that had been curtailed due to the coronavirus (COVID-19) pandemic and efforts to contain it," BLS said.
Upgraded design eases patient access when shopping for healthcare services.
The Centers for Medicare & Medicaid Services on Thursday launched a "streamlined redesign" of eight existing healthcare compare tools on Medicare.gov.
The Care Compare provides a single user-friendly interface that allows patients easier access to data on cost, quality of care, volume of services, and other data.
"By aggregating all eight of CMS' quality tools into a single interface, patients can easily research different providers and facilities before they entrust themselves to their care," CMS Administrator Seema Verma said in a media release.
"Today's launch of Care Compare is the next step in fulfilling our eMedicare promise. Our Administration is committed to ensuring our tools are robust and beneficial to patients," she said.
Under the existing framework, a patient planning to have bypass surgery would need to visit Hospital Compare, Nursing Home Compare, and Home Health Compare to research providers for the different phases of their surgery and rehabilitation.
Under the new system, patients can search at Care Compare to find and compare providers that meet their healthcare needs. The page will include information about quality measures presented similarly and clearly across all provider types and care settings.
"With just one click, patients can find information that is easy to understand about doctors, hospitals, nursing homes, and other health care services instead of searching through multiple tools," CMS said.
The final rule also re-emphasizes CMS's push for "pricing strategies based on real world market forces" under the Medicare Fee For Service program.
Medicare spending on acute inpatient hospital services will increased by about $3.5 billion (2.7%) in fiscal 2021, the Centers for Medicare & Medicaid Services said.
Thenew final rule applies to about 3,200 acute care hospitals and approximately 360 long-term care hospitals across the nation.
The final rule also re-emphasizes CMS's push for "pricing strategies based on real world market forces" under the Medicare Fee For Service program.
"Medicare generally pays hospitals a rate that is weighted by the relative cost of providing certain services based on a patient's diagnosis," CMS said. "These weights are currently based in large part on the charges that hospitals report to the federal government, which often have little relevancy to the actual rates paid by insurance companies."
Hospitals already are required to report negotiated rates under a Trump administration price transparency mandate. CMS is now finalizing a mandate for hospitals to report the median rate negotiated with Medicare Advantage Organizations for inpatient services to use instead of the charge-based data, starting in 2021.
CMS said it will use the pricing data to calculate inpatient hospital payments beginning in 2024.
Ashely Thompson, senior vice president for public policy at the American Hospital Association, said hospitals are "deeply disappointed that CMS continues to require hospitals and health systems to disclose privately negotiated contract terms with payers."
"By continuing to focus on negotiated rates rather than expanding access to a patient’s out-of-pocket costs, the Administration fails to meet the goal it set for itself – assisting consumers in becoming more prudent purchasers of healthcare," she said.
"Additionally, this policy will require hospitals to divert critically needed resources during this historic pandemic to administrative tasks that will not benefit patients," she said. "We do not believe CMS has the authority to compel the disclosure of these terms and our legal challenge remains ongoing.
The final rule also creates a Medicare Severity Diagnostic Related Group (MS-DRG) that "provides a predictable payment to help adequately compensate hospitals for administering Chimeric Antigen Receptor (CAR) T-cell therapies," CMS said.
FDA-approved CAR-T-cell cancer therapies use patients' genetically modified immune cells to treat specific types of cancer.
Thompson said hospitals "appreciate the agency's focus in addressing cost issues for life-saving CAR T therapy," but suggested that the funding was inadequate.
"We remain concerned that the policy the agency has put forth in this final rule is not adequate to address the extraordinary level of resources necessary to provide CAR T therapy to patients," she said. "We continue to urge CMS to consider an alternative method of determining the cost of CAR T therapy, as well as to consider carving out these very costly new technologies from the MS-DRG and paying for them on a pass-through basis."
