From HEALTHCAREDIVE

The unanimous opinion found a 2018 change in how outpatient drugs were paid out was unlawful because the HHS did not follow statute requirements.

The U.S. Supreme Court on Wednesday sided with hospitals in a case challenging an HHS cut to outpatient drug payments for hospitals that treat low-income patients.

The unanimous decision caps a four-year court battle between the American Hospital Association and the HHS, with billions of dollars in play.

The court’s opinion, written by Justice Brett Kavanaugh, found that the HHS did not follow the law when it changed the rate of payments under the 340B drug discount program from the average sales price of the drugs plus 6% to the average sales price minus 22.5%.

The AHA argued the cut amounted to $1.6 billion annually for 340B hospitals.

In a statement Wednesday the hospital group, along with America’s Essential Hospitals and the Association of American Medical Colleges, said it was pleased with the decision.

“Now that the Supreme Court has ruled, we look forward to working with the Administration and the courts to develop a plan to reimburse 340B hospitals affected by these unlawful cuts while ensuring the remainder of the hospital field is not disadvantaged as they also continue to serve their communities,” the groups said.

The law gives the HHS two options for setting outpatient drug rates. One sets a rate for all hospital groups based on the average sales price from drug manufacturers. The other allows the agency to vary the rates by hospital group, but only if it has taken a survey of hospitals and has that data available.

Until 2018, the HHS had set rates across all hospital groups. But the cut that applied only to 340B hospitals, which serve low-income and rural communities, came without survey data. Lawyers for the HHS said during oral arguments in December that such surveys were “very burdensome on the hospitals” and provided inaccurate data.

The AHA and three individual hospitals argued this violated the law, and on Wednesday the Supreme Court agreed.

In his 14-page opinion, Kavanaugh said that without a survey, the HHS should not have cut rates only for one segment of hospitals. “The text and structure of the statute make this a straightforward case,” he wrote.

The ruling reverses a 2020 decision from the U.S. Court of Appeals for the District of Columbia, which sided 2-1 with the HHS. That opinion stated the rate cut was “a fair, or even conservative, measure of the reduction needed to bring payments to those hospitals into parity with their costs to obtain the drugs.”

While 340B hospitals won out in this case, the drug discount program has not been without its critics.

Diagnosis: Debt, a Yearlong Reporting Partnership Exploring the Scale, Impact, and Causes of the Health Care Debt Crisis in America.  About 4 in 10 Adults Have Some Debt Due to Medical or Dental Bills, Finds a National KFF Survey Conducted for the Project

KFF’s Kaiser Health News (KHN) and NPR today launched a yearlong investigative project that explores the scale, impact, and causes of the health care debt crisis in the United States.

Drawing upon a special KFF poll conducted for the project, original data analysis, and hundreds of interviews, the investigation reveals a problem far more pervasive than previously reported. That’s because much of the medical debt is hidden as monthly installments paid via credit card, loans from family, and payment plans arranged directly with hospital and doctor’s offices.

About 4 in 10 adults report having medical or dental debt, the KFF poll finds, a share that roughly translates into an estimated 100 million adults. Many expect repaying the debt to take years, and about 1 in 5 say they do not expect to ever pay it all off.

The problem drives millions of Americans from their homes or into bankruptcy, but the consequences are not just financial. About 1 in 7 people with health care debt say they have been denied access to a hospital, doctor, or other provider because of unpaid bills. The toll of medical debt tends to fall most severely on the poor, the sick, and people of color, the investigation reveals.

Diagnosis: Debt is a multimedia series featuring KHN senior correspondent Noam N. Levey and NPR correspondent Yuki Noguchi. The first installment will run today on khn.org and npr.org and air on NPR’s Morning Edition, which can be found at participating member stations. It represents a fusion of the investigative power of KHN and NPR, the public opinion survey expertise of the KFF polling team, and original data analysis.

The project will feature a series of digital and audio stories to be published and aired over the rest of this year, as well as an NPR podcast and profiles of Americans whose lives have been upended by health care debt. In addition to the poll and other research, KHN and NPR reporters conducted hundreds of interviews with patients, physicians, health industry leaders, consumer advocates, and researchers.

The first installment spotlights the plight of people like Elizabeth Woodruff, of Binghamton, New York, who spent through her retirement account and worked three jobs after she and her husband were sued for nearly $10,000 by the hospital where his infected leg was amputated. There is Ariane Buck of Peoria, Arizona, near Phoenix, who was unable to get an appointment with his doctor for an intestinal infection because the office said he had outstanding bills. Nurse practitioner Allyson Ward of Chicago worked extra shifts and she and her husband loaded up credit cards, borrowed from relatives, and delayed repaying student loans after the premature birth of their twins left them $80,000 in debt.

Forthcoming stories will examine U.S. hospital billing and collections practices as well as the flourishing medical debt industry that is now an integral part of American health care.

“From our joint Bill of the Month series with NPR, we knew that debt was a major byproduct of the American medical system. But in this investigation, we sought to quantify the scale of the problem and detail its impact on families’ financial health,” said KHN Editor-in-Chief Elisabeth Rosenthal. “It was a huge task, pulling in the reporting muscle of both our teams, outside data help, and an important survey performed by our colleagues at the KFF polling team.”

“This series represents the culmination of months of investigations and reporting by NPR and KHN,” said NPR’s Chief Science and Health Editor Andrea Kissack. “In addition to some of these stunning findings, the project will explore some of the little-known ways to avoid debt traps and how the mental health and substance abuse crisis is impacting debt and how the pandemic may influence racial disparities.”

A novel poll

In the national poll conducted for the project, KFF survey researchers found that about 1 in 4 four adults with health care debt (translating to 1 in 10 adults overall) owes at least $5,000, including about 1 in 8 who owe $10,000 or more (1 in 20 adults overall). Those who are uninsured, with low incomes, and Black and Hispanic adults are among the groups most likely to carry health care debt.

The survey used a broad lens to measure health care debt, including medical and dental bills people are unable to pay as well as different forms of debt accruing from health care bills such as payment plans, credit cards, bank loans, and borrowing from family and friends. About 1 in 5 adults (21%) say they are paying off health care bills through an installment plan with a hospital or other provider. One in 10 say they owe money to a friend or family member who covered their medical or dental bills.

Most people with health care debt (63%) say they or a household member had to cut spending on food, clothing, and basic household items as a result. Nearly half (48%) say they used up nearly all their savings. About 4 in 10 increased their credit card debt (41%), took on an extra job or worked more hours (40%), or skipped or delayed paying other bills (37%).

Having insurance is not a panacea. While 62% of working-age uninsured adults report having health care debt, so do 44% of working-age adults with health coverage, according to the poll.

A link between medical debt and chronic illness

Also published today is an interactive graphic showing where debt is concentrated in the U.S., based on original research the Urban Institute conducted for this project analyzing credit report data. The graphic features county and state maps as well as charts comparing counties and showing the link between medical debt and chronic illness.

Researchers find that chronic illness is a strong predictor of debt. In the 100 U.S. counties with the highest levels of chronic disease, nearly a quarter of adults have medical debt on their credit records, compared with fewer than 1 in 10 in the healthiest counties.

Patient debt is growing despite increased access to insurance through the Affordable Care Act, the investigation finds. Over the past decade the medical industry has posted record profits as hospitals, physicians, and other providers steadily raised prices, while health insurers have shifted costs onto patients through higher deductibles.

KHN is KFF’s award-winning news service with a national newsroom in Washington, D.C., and a rapidly growing network of regional bureaus in California, the Midwest, the Mountain States, and the South. Earlier this year KHN established a Rural Health Desk to produce and distribute stories on health care issues relevant to rural communities.

NPR and KHN have partnered for over a decade to bring important health stories from NPR member stations around the country to NPR and KHN’s audiences and to improve and expand health reporting at these stations. They also maintain a long-standing collaborative investigative project entitled “Bill of the Month,” which examines surprising medical bills and what they tell us about the U.S. health care system.

KHN works with many editorial partners, and media outlets can publish KHN stories at no charge. KHN also will publish the stories on khn.org and promote them through its social media platforms. KHN journalists also are available for interviews about their stories. News organizations interested in working with KHN should contact the news service at KHNPartnerships@kff.org, and those interested in helping to expand and improve health journalism around the country should contact KFF at healthjournalism@kff.org.

This past spring, the Centers for Medicare & Medicaid Services (CMS) released the latest enrollment figures for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). These programs serve as key connectors to care for millions of Americans.

Medicare

As of November 2021, 64.1 million people are enrolled in Medicare. This is an increase of nearly 111,000 since the last report.

• 36.2 million are enrolled in Original Medicare.
• 28.0 million are enrolled in Medicare Advantage or other health plans. This includes enrollment in Medicare Advantage plans with and without prescription drug coverage.
• 49.1 million are enrolled in Medicare Part D. This includes enrollment in stand-alone prescription drug plans as well as Medicare Advantage plans that offer prescription drug coverage.

Detailed enrollment data can be viewed here: https://data.cms.gov/summary-statistics-on-beneficiary-enrollment/medicare-and-medicaid-reports/medicare-monthly-enrollment

Medicaid and Children’s Health Insurance Program (CHIP)

As of September 2021, 84,828,543 of people are enrolled in Medicaid and CHIP. This is an increase of 1,213,766 since the last report.

• 77,879,760 are enrolled in Medicaid
• 6,948,783 are enrolled in CHIP

For more information on Medicaid/CHIP enrollment, including enrollment trends, visit https://www.medicaid.gov/medicaid/program-information/medicaid-chip-enrollment-data/medicaid-and-chip-enrollment-trend-snapshot/index.html

*Over 11.8 million individuals are dually eligible for Medicare and Medicaid, and are counted in the enrollment figures for both programs.

Every day, CMS ensures that people across the U.S. have coverage that works. See the latest coverage totals across all CMS programs at https://www.cms.gov/pillar/expand-access. This information is updated on a monthly basis. Enrollment data for CMS programs are compiled on different timelines owing to the unique nature of each program.

The Centers for Medicare and Medicaid Services (CMS) National Quality Strategy focuses on a person-centric approach from birth to death as individuals journey across the continuum of care, from home or community-based settings to hospital to post-acute care, and across payer types, including Traditional Medicare, Medicare Advantage, Medicaid and Children’s Health Insurance Program coverage, and Marketplace plans. It builds on our previous efforts to improve quality across the health care system, incorporates lessons learned from the COVID-19 Public Health Emergency (PHE), and endeavors to foster and promote the expanded levers used during the pandemic such as interoperability and data sharing, data collection specific to social determinants of health and social risk factors, telehealth, emergency preparedness, leadership, and organizational governance among others. The CMS National Quality Strategy also embraces the anticipated acceleration of consumer demand for data and information to make informed care decisions. Overall, the CMS National Quality Strategy will help create a more equitable, safe, and outcomes-based health care system for all individuals.

Access more information here.

The Federal Office of Rural Health Policy (FORHP) awarded approximately $1.9 million to twenty awardees for the 2022 Rural Health Network Development Planning (Network Planning) Program. The Network Planning program, administered by HRSA’s Federal Office of Rural Health Policy (FORHP) focuses on the planning and development of integrated health care networks, specifically network participants who do not have a history of formal collaborative efforts in order to (i) achieve efficiencies; (ii) expand access to, coordinate, and improve the quality of essential health care services; and (iii) strengthen the rural health care system as a whole. The intent is that rural health networks, comprised of both rural and urban organizations, will expand access to care, increase the use of health information technology, explore alternative health care delivery models, and continue to achieve quality health care across the continuum of care.

Recipients from 14 states received up to $100,000 for a one-year project period that will focus on building, strengthening, and formalizing integrated health care networks and systems, coordinating service delivery, conducting community health needs assessments, and increasing service capacity.

You can view the list of awardees here.

With FORHP support, these organizations will work towards becoming operational and sustainable beyond the one-year project period, achieving long-term outcomes such as coordinating care, addressing behavioral health conditions, establishing services for the elderly, and strengthening housing services for those experiencing substance use disorders. These value-added services will ultimately create incentives to develop regional systems of care that preserve local autonomy for rural communities, while also ensuring access to the appropriate continuum of care for the local service population. These funded organizations are helping to change how health care is being delivered in rural communities.

If you have questions about the program, please contact Nkem Osian:  nosian@hrsa.gov or 301-443-2751.

From FIERCE Healthcare

Hospitals located in more concentrated healthcare markets, rural hospitals and those with higher per patient-day revenue could require “greater scrutiny” to ensure compliance with federal price transparency rules, according to a new analysis.

The warning comes alongside yet another review of hospital websites finding low industry-wide adherence to the mandate, which requires hospitals to post the prices for their most common procedures as well as a patient-friendly tool to help shop for 300 common services.

Across 5,239 hospital websites evaluated six to nine months after the Centers for Medicare & Medicaid Services’ (CMS’) Jan. 1, 2021, effective date, roughly 51% of hospitals did not adhere to either price transparency requirement, researchers wrote in a JAMA analysis published recently.

The study, based upon a survey of over 5,000 hospital websites, found that only about half of all hospitals met two key transparency requirements and that only 6% of all hospitals were fully compliant. The regulatory requirements state that anything less than full compliance could subject a hospital to penalties.

Read more.

From FIERCE Healthcare

Eighteen months after its final rule on price transparency went into effect, the Centers for Medicare and Medicaid Services issued its first penalties to a pair of Georgia hospitals that did not update their websites or reply to the agency’s warning letters.

Northside Hospital Atlanta and Northside Hospital Cherokee have been issued civil monetary penalties of roughly $880,000 and $214,000, respectively, according to letters published on CMS’ Hospital Price Transparency website. Both hospitals are part of the same health system.

The agency calculated the penalties based on the hospitals’ size and how long their websites were non-compliant (up to $300 per day). The hospitals may submit a request for a hearing to have their penalties appealed.