IHA Daily Briefing: Oct. 10

Illinois ACA Marketplace Rates Dropping for Many Plans
Urge Your U.S. Rep. to Sign Site-Neutral Cuts Letter
CMS Announces Payment Model Participants
IHA Offers Medicare 201 Course Nov. 5
Briefly Noted

Illinois ACA Marketplace Rates Dropping for Many Plans
Consumers purchasing health insurance for 2019 on the Affordable Care Act marketplace in Illinois will see lower premiums for many plans, according to an analysis released today by the state Dept. of Insurance.

Key findings include:

  • An average 4 percent rate decrease for the lowest cost silver plans across the state;

  • An average 3 percent rate decrease for the second lowest cost silver plans across the state;

  • An average 6 percent rate decrease for the lowest cost gold plans across the state; and

  • An average 6 percent rate increase for the lowest cost bronze plans across the state.

Rates and changes in the rates for 2019 vary from county to county. For example, the lowest cost silver plan rate for a 21 year old non-smoker in Cook County will be $287.57 a month, a decrease of 9 percent from 2018; in the Metro East area (Madison, Monroe, St. Clair counties), the rate will be $421.18 a month, a decrease of 1 percent.

Most areas of the state will have two insurers offering plans; Cook, DuPage and Kankakee counties will have three insurers; Carroll, DeKalb, Jo Daviess, Lake, Lee, Madison, McHenry, Monroe and St. Clair counties will have one insurer.

A total of 151 individual plans will be available from five insurers: Blue Cross Blue Shield of Illinois; Celtic Insurance Company, CIGNA Healthcare of Illinois; Gundersen Health Plan; and Health Alliance Medical Plan. Twenty-one small group (SHOP) plans will be available from Health Alliance Medical Plan.

The ACA marketplace open enrollment period will be from Nov. 1 to Dec. 15.  The Illinois health insurance marketplace portal is getcovered.illinois.gov.

Urge Your U.S. Rep. to Sign Site-Neutral Cuts Letter
U.S. Representatives Peter Roskam (R-6) of Illinois, chair of the House Ways and Means Health Subcommittee, and Mike Thompson (D) of California, are asking their House colleagues to sign a letter to the Centers for Medicare & Medicaid Services to reconsider proposals to cut payments for evaluation and management services and expand certain site-neutral payment policies to grandfathered off-campus hospital provider-based departments.  AHA estimates that implementation of these proposals would cut hospital payments under the Outpatient Prospective Payment System by $760 million in calendar year 2019 ($29 million for Illinois hospitals).

The deadline for House members to sign the letter has been extended to this Friday. Contact your U.S. Representative now and ask him/her to sign the House letter to CMS on OPPS site-neutral cuts. To call or send an email message to your U.S. Representative, click here. See IHA's Advocacy Alert for more information.

CMS Announces Payment Model Participants
Yesterday, the Centers for Medicare & Medicaid Services (CMS) announced that 1,299 Medicare entities in 49 states (106 in Illinois), including Washington, D.C. and Puerto Rico, are participating in the agency’s Bundled Payment for Care Initiative (BPCI)-Advanced bundled payment model. The Model participants include 832 Acute Care Hospitals and 715 Physician Group Practices – a total of 1,547 Medicare providers and suppliers. The BPCI-Advanced model, which replaces the original BPCI model that began in 2013, runs Oct. 1, 2018 through Dec. 31, 2023.

According to CMS’ listing, participating hospitals and systems in Illinois include: Adventist Health System; Advocate Healthcare;  Alton Memorial Hospital; AMITA Health; Edward-Elmhurst Healthcare; Loyola University Medical Center; MacNeal Hospital; Mercy Hospital & Medical Center; Northshore University HealthSystem; Northwestern Healthcare; Javon Bea Hospital Rockton (Rockford Memorial Hospital); Sarah Bush Lincoln Health Center; Silver Cross Hospital; Swedish American Hospital; Swedish Covenant Hospital; and University of Chicago Medicine.

Differences between the original and the advanced models include:

  • The BPCI-Advanced model offers bundled payments for additional clinical episodes not offered in the BPCI model, including outpatient episodes;

  • The BPCI-Advanced model provides preliminary target prices before the start of the model year to participants to facilitate more effective planning; and

  • The BPCI-Advanced model qualifies as an Advanced Alternative Payment Model, which entitles participating clinicians to receive additional incentive payments while exempting them from the reporting requirements under the Merit-Based Incentive Payment System program.

Initially, BPCI-Advanced will include 32 episodes—29 inpatient and 3 outpatient.  The top three clinical episodes selected thus far by participants are: Major Joint Replacement of the Lower Extremity, Congestive Heart Failure and Sepsis.

IHA Offers Medicare 201 Course Nov. 5
Gain expert insight into major Medicare payment changes and learn about other "hot topics" for Medicare in 2019 during IHA's Medicare 201 course on Nov. 5 in Naperville and Springfield via videoconference.

The program, from 9 a.m. to 12:30 p.m., builds on IHA's popular Medicare 101 course last fall and will address more specific Medicare policies and their financial implications for different providers. Attendance at Medicare 101 is not required for Medicare 201, though knowledge of basic Medicare coverage and payment policies is beneficial.

Medicare 201 is designed for frontline and management staff in:

  • Patient financial services;

  • Finance and reimbursement;

  • Corporate compliance;

  • Revenue integrity;

  • Marketing and public relations;

  • Government relations; and

  • Strategic planning.

Tom Jendro, IHA senior director of finance, will teach the course. Jendro specializes in financial analyses of Medicare payment legislation and regulation. He also evaluates the impact of current and proposed legislation to inform IHA's federal advocacy agenda. In addition to his work at IHA, Jendro is an adjunct faculty member at the University of St. Francis College of Business and Health Administration, Masters of Science in Health Administration program.

Jendro will present the course material through a combination of lectures and class discussion, covering:

  • Medicare Graduate Education payments;

  • Medicare Disproportionate Share payments;

  • Medicare Value-Based payment adjustments;

  • MACRA physician payment reform;

  • IHA's 2019 Medicare advocacy priorities;

  • Medicare audits; and

  • Centers for Medicare & Medicaid Services Hospital Compare websites that share provider-specific Medicare information with the public.

Registration is limited to staff at IHA-member hospitals and health systems. Register today.

Briefly Noted
A Commonwealth Fund study of cardiac implants from 2006-2014 found that U.S. hospitals paid more for cardiac implants than European Union hospitals. German hospitals typically paid the least. Some U.S. prices were six times as high as German prices. For instance, the mean price of a dual-chamber pacemaker in 2014 was $1,400 in Germany, but $4,200 in the U.S. That same year, the mean price for a drug-eluting cardiac stent was $340 in Germany versus $1,400 in the U.S. Read more here.