November 17, 2023

Civil Rights Groups Issuing Report Cards On State Medicaid Redetermination Processes

With a large proportion of the 10M Medicaid disenrollees cut from the program for procedural reasons, a group of civil rights entities are issuing report cards to states. The report cards seek to call out whether each state has done the necessary due diligence during unwinding to ensure those who remain eligible retain coverage. While states and the Centers for Medicare and Medicaid Services (CMS) are at some fault, Congress is really to blame for not passing legislation that allowed for a longer transition time.

#medicaid #redterminations

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FTC Moves To Stop Hospital Merger in California

Kudos to the Federal Trade Commission (FTC) on taking action to stop the merger of two California hospitals. The Biden Administration, including the FTC, Justice and Health and Human Services, have been active in calling attention to the massive consolidation occurring in the hospital industry. The President issued an executive order on the subject. Plenty of unbiased studies show that hospital mergers usually lead to higher costs and no gain in quality. There is another ugly cost implication regarding hospitals: Over 50% of all physicians are now owned by hospital systems. Separate from cost increases related to mergers and acquisitions, costs are going up as hospitals urge their owned doctors to use more expensive hospital-based settings for procedures that could occur in ambulatory settings. Fierce Healthcare story at link below. Modern Healthcare story at this link: https://www.modernhealthcare.com/mergers-acquisitions/ftc-john-muir-health-tenet-deal-lawsuit . (May require subscription.)

#hospitals #pricetransparency #consolidation #mergers @acquisitions #ftc #privateequityfirms

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Congress Debating Whether Site Neutral Policies Should Pass

Consumer advocates and hospitals are both lobbying Congress on site-neutral pay reforms. Advocates want site-neutral policies to be included in Congress’ next health package. Hospitals oppose it. Key lawmakers said that they hope a compromise could be reached on the issue. The House Energy and Commerce Committee and Senate Finance Committee are actively involved in the debate. Site-neutral has supporters in both chambers and on each side of the aisle, but the hospital lobby is fighting inclusion in bills.

Of course site neutral is good. It simply means that the same service will be paid at the same reimbursement rate regardless of setting (OP Hospital, Hospital-owned off-campus ASC/OP, independent ASC, physician office, or home). Hospitals have been acquiring doctors and forcing them to perform procedures at expensive hospital-linked locations when cheaper settings exist. Hospitals’ arguments that they take care of riskier individuals is sometimes right but not the rule. Site neutral saves the healthcare system as well as consumers, who fork out huge cost-sharing for more expensive hospital or hospital-affiliated sites. (May require subscription.)

#siteneutral #hospitals #healthcarereform #medicare #medicareadvantage #commercial

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What, No Christmas Tree This Year From Congress?

Good Axios article on the implications of the just passed CR. It means government will not run out of money by the end of the year. This is the first time in over a decade. Now it doesn’t mean that Congress did its job and passed a budget on time. It just means it kicked the can a little further down the road than normal.

Usually, a massive year-end bill is passed continuing funding of government and with all sorts of Christmas goodies in it for lawmakers. In essence, lawmakers lined up to put their wish on the tree like an ornament. Sometimes the ornament was pure pork; in other cases, the late December shenanigans led to grand compromises on popular issues (often not well thought out) and included in the omnibus. All this was the price we as taxpayers pay to get a bill passed to keep government running.

Because the CR has funded government into early 2024, it has taken away the direct incentive to get to compromise on key healthcare issues, among many others. Could certain legislation and traditional addbacks pass on a free-standing basis before the end of the year? Perhaps if there is strong bipartisan support, such as with PBM reform and maybe site-neutral payments (in some form). But the overarching shadow of the House GOP caucus demanding spending cuts and deficit reduction could stymie a great deal this year and next. Oh, and there is a presidential election coming too.

#governmentshutdown #crs #healthcare #healthcarereform

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— Marc S. Ryan

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