IHA Daily Briefing: May 9

Thursday, May 9, 2019
Senate Holds Hearing on MACRA Implementation
Appropriations Bill Includes Rural Workforce Funding
Community Mental Health Center Training Webinars
Study: Switch to MA Lowers Healthcare Spending

Senate Holds Hearing on MACRA Implementation
Yesterday, the U.S. Senate Finance Committee held a hearing on the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 Quality Payment Program, which is now in its third year of implementation and first year of payment impact.  Testimony was provided by:  the American Hospital Association, the American Medical Association, the American Academy of Family Physicians, the American College of Surgeons, the American Medical Group Association and the Brookings Institution.

While witnesses expressed satisfaction with several of the Centers for Medicare & Medicaid Services' (CMS’) implementation policies to date, they indicated several areas of concern and need for improvement, including:
While witnesses expressed satisfaction with several of the Centers for Medicare & Medicaid Services' (CMS’) implementation policies to date, they indicated several areas of concern and need for improvement, including:

  • The need to reinstate and make permanent the annual Medicare Physician Fee Schedule payment update, which is scheduled to be eliminated in calendar year 2020;
  • The need to extend and make permanent the 5% incentive payment for participation in Advanced Alternative Payment Models, which is due to sunset in 2024;
  • The need to simplify the performance measures reporting process, which currently reduces the time spent with patients significantly;
  • The need to improve the incentive payment methodology under the Merit-Based Incentive Payment System (MIPS) for high performers, as budget neutrality and high numbers of exempt clinicians resulted in very low increased payments in 2019;
  • The need to incentivize high-performing, MIPS-exempt clinicians;
  • The need to improve the electronic health record exchange, which is not working well, especially in rural areas; and
  • The need to better promote the “virtual groups” participation option. So far, there has been little participation among rural providers.

A brief question and answer session followed, after which the Committee thanked witnesses and indicated more discussions could be forthcoming.


Appropriations Bill Includes Rural Workforce Funding
The U.S. House Appropriations Committee passed legislation yesterday that would fund several federal agencies, including the Department of Health and Human Services. Among other priorities for hospitals, the measure includes an IHA-requested provision to increase funding for the National Health Service Corps (NHSC), which provides loan repayment and scholarships to healthcare professionals who commit to serve in underserved areas. Critical access hospitals (CAHs) and Rural Health Clinics (RHCs) are eligible to receive NHSC professionals, as are numerous other provider sites located in rural and urban areas that are designated as health professional shortage areas.

Importantly, the bill also includes a request for the Health Resources and Services Administration to review the eligibility requirements and application process for the NHSC. IHA hopes a review and subsequent changes would result in an increase in the number of CAHs and RHCs participating in the program.

“Illinois’ rural hospitals and communities often struggle to recruit and retain health care professionals, and the National Health Service Corps can offer a lifeline by providing loan repayment to professionals who agree to serve in certain underserved areas,” said IHA President and CEO A.J. Wilhelmi. “We applaud Congresswoman Cheri Bustos (IL-17) for her relentless efforts to help address the pressing healthcare workforce challenges, and thanks to her leadership, increased funding for the NHSC is included in this bill.

"We also appreciate Congresswoman Bustos’ work to include language to review how the NHSC can most effectively meet the needs of patients, providers and communities that need it most. Ultimately, we hope to see an increase in the number of rural hospitals participating in this program. IHA looks forward to partnering with Congresswoman Bustos to advance this critical legislation until it’s signed into law.”


Community Mental Health Center Training Webinars
The Illinois Depts. of Human Services (IDHS) and Children and Family Services (DCFS) will hold training webinars later this month on the rule for certification reviews of Community Mental Health Centers under the Medicaid Community Health Services Program.

The training webinars will be held via WebEx on:
May 21 at 10 a.m. (click here to register); and
May 23 at 1 p.m. (click here to register).

The certification rule (Rule 132), approved by the Joint Committee on Administrative Rules on Jan. 1, 2019, applies to entities seeking to maintain certification as a Community Mental Health Center. The webinars will focus on describing how the certifying state agencies will operationalize the rule for certification reviews.  Of special interest will be the areas in which entities may need to identify policies, procedures and practices to be adjusted prior to the certification review.  Excerpts of the rule will be referenced during the training; participants are urged to review the rule and have a hard copy available to follow along.

One of the two sessions will be recorded and posted on the IDHS and DCFS websites, along with a Q&A of all questions from the sessions. Those unable to attend the webinars can send questions about Rule 132 to dhs.mh@illinois.gov.


Study: Switch to MA Lowers Healthcare Spending
According to a new Kaiser Family Foundation (KFF) analysis, Medicare Advantage (MA) plans gain beneficiaries from traditional Medicare who have lower average spending and use fewer health services than similar beneficiaries who choose to remain in traditional Medicare. The analysis finds that people who switched from traditional Medicare to Medicare Advantage in 2016 had health spending in 2015 that was $1,253 less, on average, than the average spending for beneficiaries who remained in traditional Medicare (after adjusting for health risk).

KFF says that the findings raise questions about whether Medicare Advantage plans tend to attract healthier and lower-cost beneficiaries and whether lower rates of service use among Medicare Advantage enrollees is attributable to care management or self-selection. Most notably, the study findings suggest that the current method of setting payments to Medicare Advantage plans based on spending for people in traditional Medicare may systematically overestimate expected costs of Medicare Advantage enrollees. Adjusting payments to reflect Medicare Advantage enrollees’ prior use of health services could potentially lower total Medicare spending by billions of dollars annually.