While some of you, like us here at HealthExec, may have been enjoying a holiday break, healthcare news didn’t get a vacation. Here are five of the biggest stories you may have missed since clocking out just before Christmas:
1. 340B cuts take effect as hospital lawsuit tossed
The planned $1.6 billion reduction in Medicare payments made to hospitals through the 340B drug discount program will move forward, as a federal judge ruled three medical groups who sued CMS did so prematurely.
The American Hospital Association, America’s Essential Hospitals and the Association of American Medical Colleges had sued HHS in November to block the change. U.S. District Court Judge Rudolph Contreras dismissed it on procedural grounds on Dec. 29, saying they’ll have to cite specific claims after the cuts go into effect.
The three groups promised to do so, noting the judge didn’t rule on the merits of the case.
2. CMS hospital star ratings released after five-month delay
The updated methodology changed the weighting of certain measures, putting less emphasis on patient experience and more on readmissions.
“We continue to refine the Star Ratings and look forward to an ongoing dialogue with hospitals and patients and their families on how we can provide beneficiaries useful information,” CMS Administrator Seema Verma, MPH, said in a statement.
A total of 337 hospital earned five-star ratings under the new methodology, a big increase from the 102 earning top marks in the 2016 ratings. Some 260 hospitals—7 percent of all facilities listed on the website—earned one-star ratings.
3. Final ACA enrollment above expectations, but still short of prior year’s totals
A surge of customers the final week of open enrollment brought the total numbers of sign-ups on the Affordable Care Act’s insurance exchanges to 8.7 million.
The final tally was only 500,000 less than the last open enrollment period under the Obama administration. The Trump administration took several actions, such as allowing only 45 days for customers to sign up instead of 90 and cutting budgets for advertising and ACA navigators, which when combined with the 34 percent average hike in premiums for popular silver-level plans, were expected to more greatly depress enrollment.
“I confess to being very surprised that ACA marketplace enrollment is down only slightly,” tweeted Kaiser Family Foundation senior vice president Larry Levitt. “That didn't seem possible with a 90 percent reduction in outreach, an enrollment period cut in half and a constant refrain that the program is dead.”
In the final week alone, 4.1 million people signed up for coverage, according to CMS. The final enrollment tally was reduced from its initial estimate of 8.8 million after some late cancellations.
4. 751 hospitals penalized for patient injuries by Medicare
Hospitals saw a year’s worth of Medicare reimbursements lowered as penalties for having the highest rates of patient injuries, with one-third of teaching hospitals around the U.S. among those penalized.
Kaiser Health News reported the teaching hospitals hit by payment cuts this year included well-known facilities like Grady Memorial Hospital in Atlanta, The Mount Sinai Hospital in New York City, Northwestern Memorial Hospital in Chicago and Stanford Health Care.
“Academic medical centers serve patients with more-complex conditions who are at greater risk of hospital-acquired infections (HAIs) compared to community health care providers,” Stanford Health Care said in a written statement. “Hospitals with a high rate of immunocompromised patients will always seem to have higher HAIs.”
5. CMS floats new risk adjustment system for Medicare Advantage in 2019
On Dec. 27, CMS released the first part of its advance notice of changes to Medicare Advantage and Medicare Part D policies for 2019. This included a proposed risk adjustment model called the “Payment Condition Count” model, which could increase risk scores by more than 1.1 percent.
Under the proposal, the risk score would take into account how many conditions a patient has, rather than looking at conditions individually, though only among conditions included in the model. It would also increase risk scores for members with substance abuse or mental health problems or those with chronic kidney disease.
CMS has proposed phasing the system in, with 25 percent of risk scores based on the new system, ramping up to full implementation by 2022.