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CMS confirmed Tuesday it will cancel two mandatory bundled payment programs and scale back another—and not all hospitals are happy about it.

A rule title posted to the Federal Register on Aug. 10 indicates CMS will cancel two mandatory bundled payment programs, the Advancing Care Coordination through Episode Payment Models (EPMs) and Cardiac Rehabilitation Incentive (CRI) Payment Models, while changing a separate payment program on joint replacements.

Following up on recommendations by his own White House commission, President Donald Trump said he will declare a national public health emergency on the opioid addiction epidemic, which would have an impact on healthcare providers.

In an analysis of what Affordable Care Act (ACA) exchange insurers are requesting to charge customers in 21 major cities in 2018, the Kaiser Family Foundation found the cost for the second-lowest silver-level plan will range from $244 to $631 per month, with most enrollees cushioned from the price hikes by federal subsidies.

The U.S. Senate unanimously passed a bill on Aug. 3 which would allow terminally ill patients the “right to try” experimental treatments that haven’t yet been approved by the Food and Drug Administration (FDA), but critics say it gives patients false hope without allowing for federal oversight.

 

Recent Headlines

Court ruling ends some hospitals’ discount on orphan drugs

Rudolph Contreras, judge for the U.S. District Court for the District of Columbia, has ruled the U.S. Department of Health and Human Services acted outside of its regulatory authority when it interpreted the law covering payments for pharmaceuticals with “orphan drug” status as not applying to payments when the drug was prescribed for a condition for which it was not an “orphan drug,” such as Prozac prescribed for depression (its most common use) instead of either of Prozac’s two orphan indications.

Journalists sue HHS for access to Medicare Advantage data

Last year, the U.S. Department of Health and Human Services (HHS) made Medicare hospital payment data public, followed this year by individual physician payment data. Now journalists want data on the private Medicare Advantage plans and have filed suit to get it.

AHA and three hospitals sue Sebelius over appeals backlog

The backlog of appeals of recovery audit contractor (RAC) decisions “has reached a crisis point” says the American Hospital Association (AHA) and three hospitals who have brought suit against outgoing U.S. Department of Health and Human Services Secretary Kathleen Sebelius over the length of time it now takes to have an appeal of a reimbursement claim denial decided by an adiminstrative law judge.

Ways and Means hearing focuses on controversial 2-midnight rule

Tuesday’s House Committee on Ways and Means Subcommittee on Health hearing on current hospital issues in the Medicare program demonstrated that there is broad agreement that last year’s “2-midnight rule” for determining hospital inpatient status in a more standardized way is not working as intended.

Union drops controversial ballot initiatives in exchange for concessions from California Hospital Association

The Service Employees International Union-United Healthcare Workers West (SEIU-UHW) has dropped its campaign for voter-passed laws that would have limited what California hospitals could charge their patients and what they could pay their executives. In return, the SEIU-UHW got the California Hospital Association (CHA) and its member hospitals to agree to a code of conduct that should make it easier for the union to organize hospital workers.

CMS cuts red tape to save providers millions

The Centers for Medicare & Medicaid Services (CMS), has issued a set of final regulatory changes that it says will save healthcare providers nearly $660 million annually, and $3.2 billion over five years.

AHA members bring long list of issues to the Hill

American Hospital Association (AHA) members and leaders were in Washington, D.C., this week for the AHA Annual Membership Meeting and lobbied their members of Congress on many of the top issues outlined in the association’s 91-page-long 2014 Advocacy Agenda.

2015 inpatient PPS rates rule also expands price transparency

The Centers for Medicare and Medicaid Services has issued its hospital inpatient prospective payment system (PPS) and long-term care hospital PPS proposed rule for fiscal year 2015, and included in the rule is a requirement that hospitals begin publically posting what they charge for services by October 1.

Florida legislature may double number of PAs physicians can supervise

The Florida House of Representatives has passed by a margin of 100 to 19 a bill to increase the number of physician assistants (PAs) a single physician may supervise from four to eight. The Florida Senate will consider the bill next.

Rep. McDermott pushes FTC for more guidance on health system mergers

Rep. Jim McDermott (D-Wash.) has asked the Federal Trade Commission to do more to clarify how it will approach enforcement of the Clayton Act on hospital and health system mergers when many of the provisions in the Affordable Care Act encourage healthcare consolidation.

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