The rate hike is part of a broader package of proposed "refinements" for Medicare Advantage and the Part D Quality Star Rating system.
Baseline payment rates for Medicare Advantage plans will increase by 0.93% – about one-third the 2.53% increase the plans got this year – under a proposal unveiled this week by the Centers for Medicare & Medicaid Services.
The rate hike is part of a broader package of proposed "refinements" for Medicare Advantage and the Part D Quality Star Rating system under the Patients Over Paperwork initiative that CMS says will provide greater flexibility for payers and Part D plan sponsors to design plans, improve transparency in drug pricing, and which could save the federal government $4.4 billion over the next decade.
"Whether you're a senior dealing with kidney disease, living in a rural area, facing high costs because you need a specialty drug, or just want a better sense of what you'll owe for prescription drugs, these new CMS proposals will improve your Medicare experience," Health and Human Services Secretary Alex Azar said in a media release.
Stakeholders will have until March 6 to comment on the proposal.
Among other things, the proposed rule offers guidelines on enrollment in Medicare Advantage plans for beneficiaries with end-stage renal disease, who will be eligible beginning in 2021.
"By removing the barrier that beneficiaries with ESRD now face in terms of enrolling in MA plans, we are empowering them to choose the type of Medicare coverage that best meets their needs," CMS said.
CMS said its tweaking the Star Ratings to reduce the influence of outliers on cut points.
"We also propose to further increase measure weights for patient experience/complaints and access measures from 2 to 4, reflecting CMS's commitment to put patients first and to empower patients to work with their doctors to make healthcare decisions that are best for them," CMS said.
At the request of pharmacy benefits managers, CMS is also proposing the creation of a "preferred specialty tier" option that would encourage the use of cheaper drugs, reduce the out-of-pocket costs for beneficiaries, and save money for the federal government.
"In addition to giving those with kidney disease more choices, today's proposals shed desperately needed light on previously obscured out-of-pocket costs for prescription drugs," said CMS Administrator Seema Verma. "At the same time, it strengthens plans' negotiating power with prescription drug manufacturers so American patients can get a better deal."
Matt Eyles, president and CEO of America's Health Insurance Plans, said he was "encouraged" by the flexibility that would allow payers to "tailor benefits, design high-quality provider networks, and continue to innovate."
"However, we are concerned that some proposals could undermine the critical funding that protects millions of Americans' access to the benefits and care they need, including individuals with kidney disease who are newly eligible to enroll in Medicare Advantage," he said.
"We will continue to review the advance rate notice and proposed rule, and we look forward to sharing important feedback with CMS during the comment period," he said.
"This is an exciting time for Stony Brook Medicine as our upward trajectory continues into the future in terms of health system growth, reputation, quality outcomes and embracing a talented team of professionals delivering extraordinary and cutting-edge care," Gomes said.
Gomes, MS, FACHE, CPHQ, has been COO at the 624-bed academic medical center for six years and recently was named Interim CEO. She's held a number of executive positions over her 35-year career, most of it spent at SBUH.
"In every position Carol has held at Stony Brook University Hospital, she has led with passion for transformative healthcare and championed delivering the highest quality of care to our patients," said Stony Brook University Interim President Michael Bernstein.
The hospital in 2019 completed a major expansion that includes a Medical and Research Translation building, Stony Brook University Cancer Center, and a 225,000-square-foot, 150-bed Hospital Pavilion, which includes the new Stony Brook Children's Hospital.
The Long Island hospital contains Suffolk County's only Level 1 Trauma Center and Regional Perinatal Center.
CHRISTUS expands its footprint in South Central Texas with the acquisition of Central Texas Medical Center.
AdventHealth will transfer ownership of the 170-bed Central Texas Medical Center in San Marcos, Texas to CHRISTUS Health, the health systems announced Monday.
Financial terms were not disclosed for the deal, which is expected to be finalized this spring after clearing regulatory hurdles.
"The addition of CTMC to our family of hospitals further demonstrates our commitment to keeping exceptional health care close to home," CHRISTUS President and CEO Ernie Sadau said in a media release. "With hospitals in San Antonio, New Braunfels and now San Marcos we are better positioned to serve all in the rapidly growing communities in South and Central Texas."
AdventHealth President and CEO Terry Shaw said the transfer was in the best interests of the hospital and the community it serves.
"Over time we’ve realized that the interests of CTMC and the community it serves would benefit from the hospital joining a strong health system with a robust regional network," Shaw said.
Irving, Texas-based CHRISTUS Health, a Catholic, not-for-profit, includes more than 60 hospitals and long-term care facilities, and more than 175 outpatient clinics and other care sites in Texas, Arkansas, Louisiana and New Mexico and internationally in Chile, Colombia and Mexico.
Not-for-profit, Altamonte Springs, Florida-based AdventHealth, which is sponsored by the Seventh-day Adventist Church, employs more than 80,000 people and operates 45 hospitals, 15 skilled nursing facilities, and 36 urgent care centers in nine states.
Stakeholders raise concerns that guidance unveiled by CMS on Medicaid block grants could lead to drastic cuts in the safety net program.
After months of anticipation, the Centers for Medicare & Medicaid Services on Thursday rolled out its block grant guidance for Medicaid. Stakeholders are already raising concerns that the proposal, which is optional for states, has the potential to cut billions of federal dollars from the program and shred the safety net.
Allison Orris, counsel for Manatt Health in Washington, D.C., and a former senior policy advisor at CMS and associate administrator for the Office of Management and Budget's Office of Information and Regulatory Affairs, offers her assessment of the proposal, and attempts to answer some of the concerns raised by stakeholders.
HealthLeaders: What's your overall impression of this proposal?
Orris: This was touted as something that would really give states a lot of the flexibility that they've been asking for. And yet, when you look at it, it appears at first read to be very much changing the fundamental bargain that states make with the federal government to share in the financing of Medicaid. And yet it doesn't give states a lot of new flexibility.
For example, some states that have not yet expanded Medicaid have wanted the authority to do a partial expansion or have an enrollment cap and still get that enhanced federal funding. That's not permitted here and there's very understandable legal reasons why CMS couldn't go that far.
What that leaves us with is guidance that appears to shift a lot of financial risk to states, giving them less money than they would get under a traditional Medicaid expansion in exchange for some new forms of flexibility, but not sweeping forms of flexibility. Still, the consequences in a state that picks up the option could be very harmful to beneficiaries
The thing that states will want to look at is the money and how the money could put them at risk, because I'm not sure they're getting a whole lot more in exchange.
HL: Provider stakeholders say this could lead to an increased number of uninsured and imperil the Medicaid safety net. Is this accurate?
Orris: There is a risk of it. This is giving states the opportunity to impose either per capita caps or aggregate caps block grants on the Medicaid expansion population and certain other non-elderly, non-disabled populations.
For those populations that would be subject to capped funding, it really would be a fundamental change in the Medicaid program. It would limit funding that's available and it would give states more flexibility to impose higher cost sharing, or changes to enrollment practices that might make it harder for people to get enrolled and stay enrolled.
Also, CMS is promising some forms of relaxed programmatic oversight, such as less oversight on managed care contracting that could lead to lower payment rates for providers and plans, which would have a serious impact on access.
HL: There are also concerns that communities could lose access to care under this proposal, especially in rural areas that depend on Medicaid funding. Is this possible?
Orris: The devil is always in the details. This is optional for states. This is different than what Congress tried to do with repeal and replace. We're not going assume that it's going to be picked up nationwide because it is not a deal for states.
But in states that do adopt it, there will be less money. States will have to make choices about how they're spending their money. They could reduce provider payments and adopt programmatic flexibilities that could reduce access to care for beneficiaries. There's also a provision for states that adopt the block grant model to divert money outside of Medicaid for other uses. So, the concerns that the stakeholders are citing are valid.
HL: How do you see this block grant option evolving over time?
Orris: The Medicaid program has been protective of patients and providers. Medicaid funding is an entitlement to states for matching funds and if you take away that promise of matching states dollar-for-dollar in their contributions, if they are increases in enrollment that aren't projected, [or] if there is an increase in an expensive cancer therapy, funding under the caps may not be adequate to pay for care that's needed for beneficiaries. So, where do the cuts come from? It could certainly come to provider rates and CMS has indicated that there'll be a little bit less oversight. So, putting all the pieces together, there is a risk that access under this program could really suffer.
HL: What incentives would a state have to take up this block grant proposal?
Orris: That it is going to be something that states are going to want to look at. CMS is saying that they are offering flexibilities, but a lot of those flexibilities are already available under regular Section 1115demonstrations. You don't need to have a block grant in order to implement work requirements. You don't need to have a block grant to have higher premiums for the Medicaid population. So, CMS has kind of packaged this together and says that there's an application template that will streamline approvals.
But it will be somewhat difficult for CMS and states to negotiate the details of cap funding. States are going to want to dig in and make sure that the funding calculations that CMS is approving as part of the deal makes sense for the state. That is not going to necessarily be a speedy endeavor.
While there are some new flexibilities that a state might want to take advantage of as a part of this, there are also new forms of oversight. There are continuous performance indicator reporting requirements. This isn't a free lunch for states. They're going to have to monitor quality, monitor spending, and report to CMS.
What is it the states are getting and what will the states have to do, and what risks will the state take on in order to get "flexibility," much of which they could get under a regular demonstration?
HL: Is this block grant option similar to what Tennessee proposed a couple of months ago?
Orris: No. One thing that is notably different is that Tennessee proposed its block grant for its mandatory population. It kept on the table that maybe some savings in the program could be used later to expand Medicaid. But it was really about block granting spending for the current Medicaid population, which is limited to mandatory Medicaid populations.
The other difference is that Tennessee has constructed its block grant using spending data and a trend rate that is different than what this guidance proposes. This guidance is more aggressively designed to constrain Medicaid spending over time.
HL: What sort of resistance should be anticipated if states adopt block grants?
Orris: States that opt into this and apply to CMS for a block grant are likely walking into a prolonged legal fight. This is a new use of the Section 1115 demonstration authority and, just as we've seen with work requirements, I would anticipate that litigation will follow. That is a consideration that states will want to have top of mind as they think about the cost and the uncertainty that litigation would present.
HL: What would be the grounds for a lawsuit?
Orris: There is an argument that limiting otherwise available funding and forcing states to make trade-offs in terms of provider payments or levels of benefits may not further the objectives of the Medicaid program and, therefore, might not be an appropriate use of the Secretary's demonstration authority.
It is also possible that there could be a challenge that issuing this guidance through a state Medicaid director letter is not the appropriate avenue and that it should be done through rulemaking.
The Dublin, Ohio-based medical equipment supplier estimates the cost of the recall at about $96 million.
Cardinal Health this week said it has launched "two voluntary field actions" for Cardinal Health Presource® Procedure Packs containing gowns that were part of last week's recall of AAMI Level 3 surgical gowns.
Cardinal Health customers will receive detailed instructions for handling the affected procedure packs on February 3.
"I apologize to patients and our customers. We understand the gravity of this situation and the disruptions to the healthcare system that will impact patient care," Cardinal Health CEO Mike Kaufmann said in a media release. "We are fully committed to making this right, and we are doing everything we can to ensure it never happens again."
Cardinal Health said it expect to record a $96 million charge for the recall in the second quarter of Fiscal 2020, which the Dublin, Ohio-based medical supply company said is its "best estimate of costs for the recall, including inventory write-offs and other remediation costs, such as costs to replace recalled products."
The recall involves 2.9 million procedure packs manufactured between September 2018 and January 2020 that contain affected gowns, including:
A voluntary correction of 374,794 procedure packs with components separated from the affected gown by inner, sealed packaging or other packs within the sterilization pouch.
Cardinal said these packs can be "over-labeled," allowing the components within inner, sealed packages to be used after the gown is discarded. All other components including the gowns are to be removed and discarded. Approximately 62,976 of these packs remain in Cardinal's inventory.
A voluntary recall of 2,518,653 procedure packs containing gowns with components that are not separated from the affected gown by inner, sealed packaging. Those procedure packs should not be used and must be returned. Approximately 357,127 of these packs remain with Cardinal.
Earlier this month, Cardinal asked healthcare providers to stop using some types of surgical gowns and packs after learning of potential "cross contamination" at the Siyang Holymed manufacturing plant in China. Cardinal said the gown maker had shifted production to sites with "uncontrolled enviromments" that were not approved by the U.S. Food and Drug Administration. Cardinal has since terminated its contract with Siyang Holymed.
To address shortages prompted by the recall, Cardinal Health is:
Increasing its manufacturing production of similar and replacement products;
Offering more protective AAMI Level 4 gowns to help bridge the supply gap;
Working to identify alternatives – including in many cases working with industry partners who offer comparable products; and
Mobilizing employees from all parts of the company to work directly with health care providers to replace gowns and procedure packs.
The CMS administrator suggested that some healthcare electronic records vendors are acting to protect "short-term profits."
Centers for Medicare & Medicaid Services Administrator Seema Verma on Wednesday scolded "bad actors" opposing an interoperability proposed rule, accusing them of protecting the status quo for profits' sake, frustrating the public, and providing "fuel" for advocates of a government takeover of healthcare.
"Access to one's data can be a matter of life and death, and this administration will not waver in ensuring that patients enjoy full ownership of their data," Verma told the 2020 CMS Healthcare Innovation Industry Day audience, in Washington, D.C.
However, she warned that "the sort of consumer-oriented revolution that will make the healthcare system more affordable and accessible is undermined by those bad actors throughout the system that continue to guard the status quo because it's in the interest of their short-term profits."
At the top of Epic's webpage, the company warns that "by requiring health systems to send patient data to any app requested by the patient, the ONC rule inadvertently creates new privacy risks."
"According to a recent study, 79% of healthcare apps resell or share data[i], and there is no regulation requiring patient approval of this downstream use. There are two highly likely patient privacy risks," Epic said.
Verma scoffed at the HIT lobby's concerns that the proposed rule could put at risk patient confidentiality.
"The disingenuous efforts by certain private actors to use privacy, as vile as it is, as a pretext for holding patient data hostage is an embarrassment to the industry," she said.
"The short-sightedness of such efforts is deeply troubling considering the broad frustration of the American people with the status quo, and it's the fuel that is driving the calls for the destruction of the entire private healthcare system," Verma said.
On Monday, Health and Human Services Secretary Alex Azar used an address at the annual meeting of the Office of the National Coordinator to take shots at "scare tactics" used by EHR vendors, "some (who) are defending the balkanized, outdated status quo and fighting our proposals fiercely."
The Detroit native is currently a top executive at Trinity Health Michigan.
Bronson Healthcare has named Bill Manns, MHSA, as its new president and CEO.
He succeeds Frank Sardone who retired in December. Manns' first day at the four-hospital, not-for-profit Kalamazoo, Michigan-based health system will be March 30.
A Detroit native and veteran healthcare executive, Manns, 52, is currently president of Trinity Health Michigan's St. Joseph Mercy Ann Arbor, a 537-bed tertiary care and academic medical center, and St. Joseph Mercy Livingston, a 136-bed community hospital in Howell.
"I am honored to be chosen to lead this prestigious regional healthcare system," Manns said in a media release.
"Bronson's reputation for quality, collaboration, its culture of positivity and putting patients first, its growth and investment in programs and services to meet community needs and its local governance are all qualities that attracted me," he said. "I can't wait to get started and meet all of the wonderful people who are moving health forward in southwest Michigan."
Bronson Healthcare board chair Nelson Karre said Manns was selected from a field of 70 candidates in a national search.
"Bill is one of the most dynamic and personable individuals you'll ever meet," Karre said. "He brings an analytical mind and a passion for excellence that aligns with Bronson's vision and culture along with a track record for building strong relationships with his colleagues and community."
Community-governed Bronson Healthcare serves nine counties in southwest and south central Michigan, with 8,500 employees, more than 1,400 medical staff members, and 836 licensed beds.
The San Francisco-based EHR vendor admitted that it took $1 million in kickbacks from opioid makers in a scheme to increase prescriptions.
Electronic health records vendor Practice Fusion Inc. will pay $145 million for its role in a five-year criminal scheme that colluded with opioid makers to trick physicians into prescribing their addictive pain medications, the Department of Justice announced.
The case is the first ever criminal action against an EHR vendor.
According to federal prosecutors, the San Francisco-based software vendor accepted "sponsorship" payments of $1 million from pharmaceutical companies between 2014 and 2019 that allowed the drug makers to design and develop and implement clinical decision support alerts that recommended the companies' products.
Prosecutors said Practice Fusion bragged to drug makers about the expected profits that would come from gaming CDS alerts.
The opioid makers selected the guidelines used to develop the alerts, set the criteria that would determine when a healthcare provider received an alert, and even drafted the language used in the alert itself, DOJ said.
"Practice Fusion's conduct is abhorrent," said Christina E. Nolan, U.S. Attorney for the District of Vermont, who led the investigation.
"During the height of the opioid crisis, the company took a million-dollar kickback to allow an opioid company to inject itself in the sacred doctor-patient relationship so that it could peddle even more of its highly addictive and dangerous opioids," Nolan said.
"The companies illegally conspired to allow the drug company to have its thumb on the scale at precisely the moment a doctor was making incredibly intimate, personal, and important decisions about a patient's medical care, including the need for pain medication and prescription amounts," she said.
Attempts to contact Practice Fusion for comment were unsuccessful.
Under a deferred prosecution agreement with DOJ, Practice Fusion will admit that it asked for and received the kickbacks in exchange for rigging the software and will pay more than $26 million in criminal fines and forfeiture.
In separate civil settlements, Practice Fusion will pay $118.6 million to the federal government and states to resolve the kickback allegations that caused the software's users to submit false claims for federal incentive payments by misrepresenting the capabilities of their EHR software
The Deferred Prosecution Agreement requires Practice Fusion to ensure acceptance of responsibility and transparency as to its underlying conduct, and to invest in compliance overhauls and independent oversight.
The agreement also requires Practice Fusion to make documents relating to its criminal conduct available to the public through a website.
The new format is designed to facilitate access through a single-entry point.
The Medicare website will combine its eight separate Compare tools under one combined, standardized and simplified format in the coming months, the Centers for Medicare & Medicaid Services announced.
In a blog posting this week, CMS Administrator Seema Verma said the new format will launch this spring, and will "allow users to access the same information through a single point of entry and simplified navigation to find the information that is currently divided in places like Nursing Home Compare and Hospital Compare."
"The new 'Medicare Care Compare' on Medicare.gov will offer Medicare beneficiaries and their caregivers and other users a consistent look and feel, providing a streamlined experience to meet their individual needs in accessing information about healthcare providers and care settings," Verma said.
Currently, Medicare uses eight separate Compare tools – Hospital, Nursing Home, Home Health, Dialysis Facility, Long-term Care Hospital, Inpatient Rehabilitation Facility, Physician and Hospice – on Medicare.gov to find and compare doctors.
"In the new, unified experience, patients will be able to easily find the information that is most important to help make healthcare decisions, like getting quality data by the type of healthcare provider," Verma said.
Verma said CMS is also developing an improved "companion portal" that Medicare researchers and stakeholders can use to access the more detailed data, that will also launch this spring.
"This new 'Provider Data Catalog' will reside on CMS.gov," Verma said. "It will have an improved interface and intuitive search features to allow users to easily search and download CMS' publicly reported data, better serving stakeholders who use the interactive and downloadable datasets like those currently found on data.Medicare.gov."
All of the data sets will be made available through an Application Programming Interface from the Provider Data Catalog.
"Even though we’re making these enhancements, it doesn’t change our public reporting requirements, and we will continue to meet every reporting mandate," Verma said.
Following a transition period after the launches, the existing tools will be terminated.
The model will expand and improve the Primary Children's Hospital care network for Intermountain West, which now serves children in six states.
Intermountain Healthcare has committed $500 million to build "the nation's model health system for children."
"To address the growing need for health issues facing children, we must create a new model of pediatric care that will cater to the unique challenges that we see across our large geographic area," Katy Welkie, RN, MBA, CEO of Primary Children's Hospital and Vice President of Intermountain's Children's Health, said in a media release.
"In building the nation's model health system for children, we are positioning Utah as the home for the nation's healthiest kids," she said.
The plan, financed in part by a $50 million donation from Utah Jazz owner and businesswoman Gail Miller, will invest $500 million to launch, advance, and coordinate pediatric-specific programs around the Salt Lake City-based health system's free-standing Primary Children's Hospital and a network of 160 clinics and 24 hospitals, and pediatric specialty expertise from University of Utah Health.
The model will expand the Primary Children's care network for Intermountain West, which now serves children in Utah, Wyoming, Montana, Idaho, Nevada, and Alaska.
The model will include: a new 66-bed pediatric hospital in Lehi, Utah; an enlarged and upgraded Level 4 Neonatal ICU; an advanced fetal care center that will offer in-utero treatments' advanced and innovative pediatric cancer therapies; improved access to behavioral and mental health services; improved telehealth and response capabilities; and targeted chronic disease management.
Intermountain Foundation will be tasked with raising the bulk of the money for what the health system called "the largest commitment to the care and health of the region's children since Primary Children's was envisioned in the early 1900s."
"This effort comes at a critical time," Welkie said, "as the number of children served by Intermountain Healthcare continues to rapidly grow, and their needs continue to change and become more complex."
