Eligible providers can bill CMS for counseling services regardless of the testing venue, including doctors' offices, urgent care clinics, drive-thrus, or pharmacy testing sites.
Physicians and other healthcare providers will now be paid to counsel patients about the importance of self-isolation after testing for COVID-19, even before test results are known, the Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention announced Thursday.
CMS said it will use existing evaluation and management payment codes to reimburse providers who are eligible to bill CMS for counseling services regardless of the testing venue, including doctors' offices, urgent care clinics, hospitals and community drive-thru or pharmacy testing sites.
COVID-19 can be transmitted by both symptomatic, pre-symptomatic and asymptomatic people, and CDC said educating people about the need for self-isolation can reduced the spread of the virus significantly.
CDC models show that when people who are tested for the virus are separated from others and placed in quarantine, there can be up to an 86% reduction in the transmission of the virus compared to a 40% decrease in viral transmission if the person isolates after symptoms arise.
Providers billing CMS for COVID-19 consultations will be expected to discuss with patients the immediate need for self-isolation – even before test results are known – and to review the symptoms of the virus, and understand what services are available for them while in quarantine.
Patients who test positive will be told to wear a mask at all times and expect a follow-up call from public health officials for contact tracing. Patients are also being asked to tell their immediate household and recent contacts to be tested and self-isolate.
For the first time, Part D will cover insulin at a cost of no more than $35 a month per prescription.
The average basic Medicare Part D premium will be $30.50 in 2021, the lowest premiums since 2013, the Centers for Medicare & Medicaid Services said late Wednesday.
And for the first time, Part D will include coverage of "a broad set of insulins" that will cost Medicare beneficiaries no more than $35 a month per prescription, CMS said.
Part D premiums have decreased by 12% since 2017, saving beneficiaries nearly $1.9 billion, and Part D enrollment has grown by 16.7% over that span.
"At every turn, the Trump Administration has prioritized policies that introduce choice and competition in Part D," CMS Administrator Seema Verma said in a media release.
"The result is lower prices for life-saving drugs like insulin, which will be available to Medicare beneficiaries at this fall’s Open Enrollment for no more than $35 a month," she said. "In short, Part D premiums continue to stay at their lowest levels in years even as beneficiaries enjoy a more robust set of options from which to choose a plan that meets their needs."
Verma said the Trump administration efforts to increase competition among Medicare Advantage and Part D drug plans has also generated about $8.5 billion in program savings over the past four years, a trend she said is expected to continue into 2021.
Starting Jan. 1, 2021, Medicare beneficiaries who select Part D Senior Savings Model plans will save, on average, $446 per year, or 66%, on their out-of-pocket costs for insulin, CMS said.
Nationwide, beneficiaries will be able to choose from more than 1,600 standalone Medicare Part D prescription drug plans and Medicare Advantage plans with prescription drug coverage during the open enrollment period that runs from October 15 through December 7.
Because most Medicare Advantage plans with prescription drug coverage do not charge a Part D premium, beneficiaries will save on insulin and not pay any extra premiums, CMS said.
By a nearly 2 to 1 margin, non-white adults said they are concerned about their care costs for COVID-19.
Non-whites are far more likely to worry about how to pay for COVID-19-related healthcare than whites, according to asurvey from nonprofit West Health and Gallup.
By a nearly 2 to 1 margin, non-white adults (58%) versus white adults (32%) said they are either "extremely concerned" or "concerned" about the potential cost of care. That concern is three times higher among lower income (60%) versus wealthier households (20%).
The Gallup-West Health U.S. Healthcare Study, an ongoing survey, is based on a nationally representative sample of 1,017 adults interviewed between June 8 and June 30, 2020.
"We're seeing a significant and increasing racial and socioeconomic divide when it comes to Americans' views on the cost of healthcare and its impact on their daily lives," said Tim Lash, chief strategy officer and executive vice president for San Diego–based West Health, a group of nonprofit and nonpartisan organizations.
Those divisions appear to be widening.
"When we started polling in early 2019, close to 1 in 5 Americans were unable to pay for prescribed medication in the last 12 months," Lash said. "Today it’s 1 in 4, and disparities between race and income are growing and will continue to grow without more action from providers and policymakers."
The survey also found that nearly 1 in 4 adults (24%) said they couldn't pay for at least one prescription drug in the past year, an increase from 19% in early 2019.
Among non-white adults, medication insecurity jumped 10 percentage points, from 21% to 31%, compared with a statistically insignificant three-point increase among white adults (17% to 20%).
"The statistically significant rise in Americans experiencing medication insecurity is by itself a noticeable shift," said Gallup Senior Researcher Dan Witters.
"The 10-percentage-point increase among non-white Americans between early 2019 and today serves as strong evidence that the situation is worsening more acutely for those who are already most at risk," Witters said.
The survey also found that:
About 1 in 10 (12%) workers are staying in a job they want to leave because they are afraid of losing healthcare benefits, and non-white workers are about twice as likely to feel that way versus white workers (17% vs. 9%, respectively).
Nearly 9 in 10 adults (89%), regardless of race, think the federal government should be able to negotiate the cost of a COVID-19 vaccine. Similarly, 86% of adults say there should be limits on the price of drugs that government-funded research helped develop.
Nearly 8 in 10 adults (78%) adults say political campaigns should not be allowed to accept donations from drug companies during the coronavirus pandemic.
Editor's note: This story was updated on July 31, 2020.
Given all the hard work, risk, and public advocacy that goes into a merger, those who've undertaken the enormous task are apt to accentuate the positive.
It shouldn't be surprising that 78% of healthcare executives in the HealthLeaders Intelligence Report, Healthcare M&A: Moving Forward in a Post-COVID-19 Landscapesay their organization would choose to participate in its most recent M&A again.
Given all the hard work, risk, and public advocacy given to a merger, those who've undertaken the enormous task are apt to accentuate the positive.
Ballad Health CEO Alan Levine shares that sentiment.
In 2018, as CEO of Mountain States Health Alliance, Levine oversaw the merger with Wellmont Health System that essentially doubled the size of the newly formed Ballad Health, a 21-hospital health system serving four states, based in Johnson City, Tennessee.
"There's been such an enormous benefit to the region by doing this," he says. "It's been challenging because we basically agreed to very aggressive regulations, which has made it a lot harder. But even with that, this was the right thing to do."
"Now, our goal is to operationalize what we've created and, so far, we're doing a good job of it," Levine says. "Our quality metrics have improved dramatically. Five of our 17 quality measures are now in the top-performing decile in the country, and that happened after the merger."
"We've improved our margins. We went from basically a zero percent margin to a 1.6% margin, so our margins have improved but they're still well below what the industry expectation should be."
The margin improvements have come, Levine says, even as Ballad Health has reduced physician charges by 17% across the system.
"The most important access point for patients is urgent care and their doctors, and we did a 17% average charge reduction," he said. "In fact, in some cases, it was a 50% decrease in out-of-pocket costs."
"We also expanded our charity policy. Prior to the merger, if you were up to 200% of poverty, we wrote off all the cost of your care. After the merger, we increased our charity policy up to 225%, and we provide deep discounts for up to 400% of poverty," he says. "So, we actually expanded pretty dramatically either the number of people that are eligible to have their care completely written off, or we apply deep discounts to it that weren't available before the merger."
You Can Only Sell Your Hospital Once
Tim Putnam, CEO at Margaret Mary Health, a community-owned, critical access hospital in Batesville, Indiana, has a hard-nosed theory on why executives have no post-merger regrets.
"Everyone who answered that [survey question in the HealthLeaders report] was probably employed by whomever was acquired," Putnam says. "It's not surprising that people would say that because they've got to get up in front of their communities and say, "This was a good thing for our community.' "
"One of the things that I hear from my colleagues is that you can only sell your hospital once, and you've got to do it right," Putnam says. "I'm not saying it's not the right move, but you can only do it once."
Some Buyers' Remorse
Of those respondents who were involved in M&A activity, only 10% expressed buyers' remorse for their most-recent acquisition. Of that 10%, 86% cited "incompatible cultures" as the reason their M&A fell short of expectations.
"There’s something we refer to in M&A circles called 'deal fever,' " Peggy Sanborn, system senior vice president of strategic growth, partnerships, and joint ventures for CommonSpirit Health, said in a recent HealthLeaders webinar.
"Many times, the excitement about the opportunities that a deal represents for the organizations coming together and all the possibilities they see, as well as the enthusiasm for successfully completing a transaction, can blind us to the critical review of whether or not we actually have a fit."
"It requires quite a bit of leadership time talking about what it means to come together and exploring the vision and values and mission of the organizations very carefully and discussing the difficult issues quite openly, and either agreeing that those are things that clearly can be navigated or they may be real barriers to success," she said.
"We tend to avoid those difficult conversations during the M&A process because we're focused much more on the tactical issues or the economic impact issues or the legal and risk issues associated with the transaction," Sanborn said.
Levine agrees, and says, "Sometimes people want the merger so bad they overlook all these different things."
"I've seen mergers where you've got co-CEOs, and [they're] going to keep both corporate offices open. I don't know how those things even work," he says.
"Our boards at Wellmont and Mountain States—early on—knew culture eats intent for breakfast every morning. We hired a consultant that came in and did a deep dive culture audit of management, the boards, and our frontline staff."
"They did these spider diagrams where they overlaid the culture of Wellmont versus Mountain States, and below management and the board there was no difference in the cultures. The nurses [and] doctors just wanted to take care of patients, and they didn't care whose name was on the wall. You get up into senior management and the board and the cultures were very different," he says.
The merging systems used data gleaned from the consultants to deal with potential culture clashes on the front end.
"We went through serious negotiations about who was going to be on the new board," Levine says. "We embedded into the bylaws provisions that really push out System A versus System B. We made it very important at the very beginning that there was no discussion about Wellmont or Mountain States. We were Ballad."
Tim Putnam takes a bottom-up view. He says the culture clashes don’t manifest themselves in the C-suite or the boardroom, but in the hospital halls.
"The C-suite folks are going through the due diligence, not the people in radiology or scheduling," he says. "When you get down to the frontline staff, one organization may allow a lot of flexibility at the frontline to handle patients' schedules, another organization may be very rigid in that process. Minor things that you don't think are an issue ... take a while to overcome."
Putnam says he was involved in the acquisition of a small system in a deal that was rife with cultural issues.
"Everything changed," he says. "Whether you're the acquiring organization or the acquired, it changes you. ... It takes a decade to work through that culture change."
To download the full July/August 2020 HealthLeaders Intelligence Report, click here.
New data confirm that the COVID-19 pandemic is disproportionately affecting vulnerable populations, particularly racial and ethnic minorities.
African-American Medicare beneficiaries continue to be hospitalized at higher rates than other racial and ethnic groups, with 670 hospitalizations per 100,000 beneficiaries, according to an updated "snapshot" from the Centers for Medicare & Medicaid Services.
By comparison, white Medicare beneficiaries saw 175 hospitalizations per 100,000, the new data show.
CMS says snapshot confirms that the COVID-19 pandemic is disproportionately affecting vulnerable populations, particularly racial and ethnic minorities.
"This is due, in part, to the higher rates of chronic health conditions in these populations and issues related to the social determinants of health," CMS said in a media release.
American Indian/Alaskan Native beneficiaries have the second-highest rate of hospitalization for COVID-19 among racial/ethnic groups, with 550 hospitalizations per 100,000.
CMS said it has paid $2.8 billion in Medicare fee-for-service claims for COVID-related hospitalizations, an average of $25,255 per beneficiary.
"Dual eligible" Medicare and Medicaid beneficiaries – who are often poor and suffering from multiple chronic conditions – were hospitalized at a rate more than 5 times higher than Medicare-only beneficiaries (719 versus 153 per 100,000).
Beneficiaries with end-stage renal disease are hospitalized at higher rates than other Medicare beneficiaries, with 1,911 hospitalizations per 100,000 beneficiaries, compared with 241 per 100,000 for aged and 226 per 100,000 for disabled.
The updated data on COVID-19 cases and hospitalizations of Medicare beneficiaries spans January 1 to June 20 and is based on Medicare claims and encounter data CMS received by July 17.
The Republican proposal would also provide liability protections for healthcare providers.
The federal government's Provider Relief Fund would receive a $25 billion infusion, and hospitals would be shielded from COVID-19-related employee lawsuits under a $1.1 trillion bill put forward this week by Senate Republicans.
The stage is now set for what is expected to be a fiery debate with House Democrats, who in May put forward a $3 trillion relief package that differs significantly from the Republican plan.
A key fight will center around the money allocated for unemployment relief. Democrats want to maintain the $600 weekly supplemental unemployment payments, while Republicans would reduce that to $200.
Specific to healthcare, in addition to the $25 billion in new funds and liability protections, the Republican proposal would delay from 120 days to 270 days the start of repayments for accelerated Medicare payments, and would extend the repayment period from 12 months to 18 months.
The Democrats' package provides $75 billion for testing, tracing and treatment of the coronavirus, $1 trillion for cash-strapped state and local governments to help pay for first responders, healthcare workers, teachers and other vital employees, and $200 billion for a "Heroes' fund" that provides hazard pay for essential workers who've risked their lives to work during the pandemic.
A big fight is expected over liability protections.
The Democrats' proposal mandates federal protections for vital workers, and shields employees from retribution for reporting workplace safety violations.
The GOP proposal shields healthcare providers from liability for COVID-19-related injuries. Those liability protections would also be extended to doctors, nurses, administrators, and volunteers beginning on Dec. 19, 2019 through the end of the national emergency declaration, or Oct. 1, 2024.
Chip Kahn, president and CEO of the Federation of American Hospitals, said the nation's for-profit hospitals "strongly support Majority Leader (Mitch) McConnell's efforts to protect frontline healthcare workers and hospitals from COVID-19 lawsuit abuse, and appreciate additional resources for the Provider Relief Fund."
However, Kahn complained that the GOP bill "does not sufficiently ease the burden of the Medicare Accelerated and Advance Payment Programs loan repayment."
"It is critical that truly sustainable terms for loan repayment are provided by Congress," he said. "Time is running out for providers, and action is critical before hospitals lose 100% of Medicare fee for service payments. The Federation has been warning of this impending threat."
The 31st annual version of the widely read rankings features mostly the same top 20 hospitals that made the list in years past.
For the fifth straight year, Mayo Clinic sits atop the 20 Best Hospitals rankings published Tuesday by U.S. News & World Report.
The 31st annual version ofwidely read rankings, which emphasizes outcomes, patient experience and risk adjustment, featured mostly the same top 20 hospitals that make the list in year's past.
The hospitals were ranked on 26 adult specialties, including: cancer, cardiology and heart surgery, diabetes and endocrinology, ear, nose and throat, gastroenterology and GI surgery, geriatrics, gynecology, nephrology, neurology and neurosurgery, ophthalmology, orthopedics, psychiatry, pulmonology and lung surgery, rehabilitation, rheumatology, and urology.
The study evaluated nearly every community hospital in the nation. Only 134 hospitals out of more than 4,500 were nationally ranked in one specialty, while 563 were ranked among the Best Regional Hospitals in a state or metro area based on their performance in delivering complex and common care, U.S. News said.
The data used in this year's rankings predates the COVID-19 pandemic and were not affected by the pandemic's impact on hospitals.
Here’s the 2020-21 Best Hospitals Honor Roll. The numbers in parentheses are the 2019-20 rankings.
1. Mayo Clinic, Rochester, Minnesota (1)
2. Cleveland Clinic (4)
3. Johns Hopkins Hospital, Baltimore (3)
4. New York-Presbyterian Hospital-Columbia and Cornell, New York (tie) (5)
4. UCLA Medical Center, Los Angeles (tie) (6)
6. Massachusetts General Hospital, Boston (2)
7. Cedars-Sinai Medical Center, San Francisco (8)
8. UCSF Medical Center, San Francisco (7)
9. NYU Langone Hospitals, New York, N.Y. (9)
10. Northwestern Memorial Hospital, Chicago (10)
11. University of Michigan Hospitals-Michigan Medicine, Ann Arbor (11)
12. Brigham and Women’s Hospital, Boston (13)
13. Stanford Health Care-Stanford Hospital, Palo Alto, California (12)
14. Mount Sinai Hospital, New York (14)
15. Hospitals of the University of Pennsylvania-Penn Presbyterian, Philadelphia (18 tie)
16. Mayo Clinic-Phoenix (18 tie)
17. Rush University Medical Center, Chicago
18. Barnes-Jewish Hospital, Saint Louis (tie)
18. Keck Medical Center of USC, Los Angeles (tie) (16)
CMS reported that 10.7 million consumers had gained coverage through the Exchanges in February 2020.
Federal Health Insurance Exchange enrollment in early 2020 held steady for the third year in a row, with the number of consumers who paid for coverage in February 2020 up 1% compared to February 2019, the Centers for Medicare & Medicaid said.
CMS reported that 10.7 million consumers had effectuated enrollment through the Exchanges in February 2020, which means they selected a plan, paid their first month's premiums, and had coverage in February 2020.
Those 10.7 million consumers represent 94% of the 11.4 million consumers who picked a plan in the 2020 enrollment period.
The average monthly premium for Exchange enrollees in February 2020 was $576.16, a drop of 3% from the February 2019's average premium of $594.17, CMS said.
About 9.2 million (86%) of Exchange enrollees in February received Advance Premium Tax Credit, a decrease of 1 percentage point from February 2019. The average monthly APTC fell by 4% from February 2019, to $491.53.
The Trump administration has maintained that CMS has the authority to impose payment cuts as a way to reduce unnecessary and costly increases in hospital procedures.
Hospital plaintiffs said Friday they will ask a federal appeals court in to reconsider its ruling last week that reversed a lower court ruling and upheld the Trump administration's legal authority to impose site-neutral payments under the Outpatient Prospective Payment System final rule.
OPPS had reduced reimbursement rates for clinic visits at hospital-owned outpatient provider departments by 40%, to match the rates paid for clinic visits in physician offices. The Centers for Medicare & Medicaid Services estimates that the OPPS final rule could save the Medicare program about $760 million in 2020.
In AHA v. Azar, the U.S. Court of Appeals for the District of Columbia Circuit ruled unanimously in favor of the Department of Health and Human Services, reversing district judge's ruling last September that CMS acted in a way that was "manifestly inconsistent with the statutory scheme" when it finalized the site-neutral payment as part of the OPPS final rule for 2019.
The Trump administration has maintained that CMS has the authority to impose payment cuts as a way to reduce unnecessary and costly increases in hospital procedures.
The American Hospital Association, the Association of American Medical Colleges, Olympic Medical Center in Port Angeles, Washington, Mercy Health in Muskegon, Michigan, and York Hospital in York, Maine, said that the appeals court did not strictly construe the statutory authority that binds the agency, "unaccountably deferring to impermissible agency decisions."
"These illegal cuts directly undercut the clear intent of Congress to protect hospital outpatient departments because of the many real and crucial differences between them and other sites of care," the plaintiffs said in a joint statement.
"These hospital outpatient departments are held to higher regulatory standards and are often the only point of access for patients with the most severe chronic conditions, all of whom receive treatment regardless of ability to pay. We look forward to a prompt rehearing of our case to overturn these unlawful cuts," the plaintiffs said.
The blood test, called PanSeer, detected cancer in 91% of people who had been asymptomatic when the samples were collected.
Researchers from China and the United States say they've developed a noninvasive blood test that can find five common cancers in people four years before the disease can be diagnosed with existing methods.
The blood test, Called PanSeer, detected cancer in 91% of people who had been asymptomatic when the samples were collected and were diagnosed with cancer one to four years later.
The test, which detects stomach, esophageal, colorectal, lung and liver cancer, also found cancer in 88% of samples from 113 patients who were already diagnosed when the samples were collected, and recognized cancer-free samples 95% of the time, according to the study, which was published this week in Nature Communications. .
"The ultimate goal would be performing blood tests like this routinely during annual health checkups," said study corresponding author Kun Zhang, a professor and chair of the Department of Bioengineering at the University of California San Diego.
"But the immediate focus is to test people at higher risk, based on family history, age or other known risk factors," he said.
Zhang said the study is unique because researchers could access blood samples from patients who were asymptomatic and undiagnosed. This allowed the researchers to develop a test that can find cancer markers much earlier than conventional diagnosis methods.
The samples were collected under a 10-year longitudinal study begun in 2007 by Fudan University in China.
The study is a collaboration between UCSD Jacobs School of Engineering, Fudan University and Singlera Genomics, a San Diego- and Shanghai-based startup.
The researchers said the PanSeer test can't predict which patients will later develop cancer, and is better suited to identifying patients who already have cancerous growths but who remain asymptomatic under existing detection methods.
The researchers said more and larger longitudinal studies are needed to confirm their findings.
