IHA Daily Briefing: Jan. 14

Tuesday, January 14, 2020
AHA Files Reimbursement Rate Lawsuit
CMS Consolidates Hospital, Psych Surveys
CDC Issues Flu Health Advisory
Middle-, Low-Income Adults More Burdened in Life

AHA Files Reimbursement Rate Lawsuit
On Jan. 13, AHA, the Association of American Medical Colleges and several member hospitals filed a lawsuit against the U.S. Dept. of Health and Human Services over a second set of reductions for hospital outpatient services provided at excepted off-campus provider-based departments (PBDs).  A similar calendar year (CY) 2019 lawsuit was decided in favor of hospitals, with Federal Judge Rosemary Collyer ruling that the Centers for Medicare & Medicaid Services (CMS) exceeded its statutory authority when it reduced CY 2019 payments for hospital outpatient services provided at excepted off-campus PBDs by 30%.

In response, CMS stated it would automatically reprocess CY 2019 claims and repay hospitals impacted by the reimbursement cut. However, CMS also moved forward with plans to phase in a second cut, bringing reimbursement for hospital outpatient services down to 40% of outpatient prospective payment system rates in CY 2020 at excepted off-campus PBDs, resulting in the Jan 13 AHA lawsuit.

On Dec. 16, 2019, Judge Collyer stated that although CMS clearly disregarded the substance of her ruling regarding CY 2019 reimbursement cuts, CMS was nonetheless within its rights to attempt to phase in the second cut.

More information on AHA’s current lawsuit is available on the AHA website.


CMS Consolidates Hospital, Psych Surveys
Yesterday, the Centers for Medicare & Medicaid Services (CMS) announced that beginning in March 2020, psychiatric hospitals will only require one comprehensive hospital survey performed by the State Survey Agency to review compliance. Essentially, CMS is integrating the psychiatric hospital program survey into the hospital program survey and moving additional components of the survey activities to the states.

Medicare Conditions of Participation (CoPs) regulations for hospitals and psychiatric hospitals will not change. However, the CoPs will be consolidated into a set of regulatory and guidance documents with a single survey team. CMS says online training materials related to this change will be released soon.

CMS says this effort is part of its Patients Over Paperwork initiative.

Details can be found in a CMS memo and fact sheet.


CDC Issues Flu Health Advisory
The Centers for Disease Control and Prevention (CDC) recently issued a health advisory providing clinical recommendations for providers due to the elevated activity of the influenza B/Victoria viruses and increased circulation of influenza A(H1N1) viruses. The advisory is reminding clinicians to start early antiviral medication treatment for suspected cases of influenza, including those who are severely ill and hospitalized patients and high-risk outpatients, including children younger than age 2.

The CDC also provided an influenza testing guide and antiviral medication guide for clinicians use. The CDC also recommended that clinicians continue to offer the flu vaccine to those over six months of age and older who have not yet been inoculated.


Middle-, Low-Income Adults More Burdened in Life
Findings from a recent survey shows that the nearly half of middle-income adults and a majority of lower-income adults’ families have trouble paying for medical bills and prescriptions. The findings are from a national survey of nearly 1,900 adults through an NPR/Harvard T.H. Chan School of Public Health/Robert Wood Johnson Foundation collaborative.

According to the poll, nearly half (48%) of middle-income adults and a majority (57%) of lower-income adults’ families experience serious problems paying medical and dental bills and affording prescription drugs compared to less than one in 10 of the highest adult earners.

The report also notes that housing is not affordable for many, food insecurity is a serious problem and people believe that having a higher income allows access to better healthcare. One in five adults across all income groups see drug addiction as the biggest health problem in their local communities. Obesity is also one of the biggest health problems cited by the wealthiest people.