IHA Daily Briefing: Sept. 30

Monday, September 30, 2019
IHA Comments on OPPS Proposed Rule
CDC Update on Vaping
State Working on Medicaid SUD Treatment Strategies
NIH Funds Almost $1B for Research on Opioid Crisis
Briefly Noted

IHA Comments on OPPS Proposed Rule
On Friday, IHA submitted two comment letters on behalf of our more than 200 member hospitals and nearly 50 health systems to the Centers for Medicare & Medicaid Services (CMS) on the Calendar Year (CY) 2020 Medicare hospital outpatient prospective payment system (OPPS) and ambulatory surgical center payment system proposed rule.  

IHA commented on proposed price transparency requirements, as well as additional proposed changes to the OPPS. Key recommendations made by IHA in the two letters include:  

  • Do not finalize the price transparency requirements as they do not improve patients’ understanding of out-of-pocket obligations and exceed CMS’ legal authority;
  • Immediately compensate 340B program providers for the payment amounts withheld thus far, and reimburse 340B drugs at average sales price + 6% moving forward;
  • Discontinue the phased-in payment decrease for clinic visits to excepted off-campus provider based departments and compensate such providers for last year’s payment decrease;
  • Address the wage index disparity without applying budget neutrality;
  • Consider separate payments for non-opioid pain management alternative drugs in the hospital outpatient department setting in addition to ambulatory surgical centers;
  • Require National Quality Forum endorsement for future additions to the Hospital Outpatient Quality Reporting Program measure list;
  • Do not remove total hip arthroplasty from the inpatient-only list, and consider revising the methodology used for removing services from the inpatient-only list;
  • Postpone the inclusion of all claims in calculating the cost-to-charge ratio for computed tomography and magnetic resonance imaging cost centers for one additional year;
  • Reconsider whether changes to the clinical laboratory fee schedule date of service exception policy are necessary, and provide ample education and support if changes are finalized; and
  • Finalize changes to minimum supervision requirements for outpatient therapeutic services from direct to general.

The CY 2020 Medicare OPPS final rule is expected in November. Hospital-specific reports comparing estimated changes in outpatient payments under the CY 2020 proposed rule to the payments made under the CY 2019 final rule are available via the C-Suite on the IHA website.

CDC Update on Vaping
The Centers for Disease Control and Prevention (CDC) issued two reports on Friday with the latest findings from the investigation into lung injuries associated with e-cigarette use, or vaping. Both reports—one focusing on national data and the other on findings from Illinois and Wisconsin—suggest THC products play a role in the outbreak.

Most of the people (77%) in this outbreak reported using THC-containing products, or both THC-containing products and nicotine-containing products, according to a report published in the CDC’s Morbidity and Mortality Weekly Report (MMWR). A second MMWR from Illinois and Wisconsin had similar findings regarding THC use and contains more details on the characteristics of cases in those states, including demographics, as well as substances and product types used.

Based on this recent data, CDC recommends people consider refraining from use of e-cigarette or vaping products, particularly those containing THC.

“CDC is committed to finding out what is causing this outbreak of lung injury and death among individuals using vaping products” said Robert R. Redfield, MD, director of the Centers for Disease Control and Prevention. “We continue to work with FDA and state partners to protect the nation from this serious health threat.”

State Working on Medicaid SUD Treatment Strategies
Illinois will receive a $4.5 million grant from the Centers for Medicare & Medicaid Services to examine and improve substance use disorder (SUD) treatment strategies for Medicaid members, the Dept. of Healthcare and Family Services (HFS) announced last week.

According to an HFS press release, working with stakeholders, a needs assessment will be developed, leading to the creation of effective strategies for building more infrastructure and capacity and reducing gaps in Medicaid-covered SUD treatment and recovery services. Following the 18-month planning phase, Illinois will be eligible for a 36-month implementation grant, which would support increased access to medication-assisted treatment (MAT) and other critical recovery supports for Medicaid beneficiaries in Illinois.

"Like most states, Illinois has experienced a dramatic increase in drug overdose deaths that can primarily be attributed to the misuse of opioids," said HFS Director Theresa Eagleson. "We know that one of the most effective tools to combat this crisis is medication-assisted treatment, often in combination with counseling. Understanding the gaps in access to these services is critical so that we can build treatment capacity where it is most needed."

HFS will work closely with Cook County Health, Southern Illinois Healthcare and the University of Illinois Office of Medicaid Innovation in providing training and technical assistance to providers in order to increase statewide access to high quality, evidence-based SUD treatment.

"It is critical for the state to understand barriers, such as staffing shortages, that substance use disorder treatment providers face when trying to increase the number of patients they serve," said Medicaid Director Doug Elwell. "These additional resources will help develop the behavioral health workforce so that Medicaid beneficiaries have access to evidence-based services with a track record of proven effectiveness."

According to HFS, improving behavioral health care is a high priority of the Medicaid program, since Medicaid members with substance use and mental health disorders make up 25% of the Illinois Medicaid population, but account for 56% of the total Medicaid spend.

NIH Funds Almost $1B for Research on Opioid Crisis
To reverse the opioid crisis that continues to grip the nation, the National Institutes of Health announced late last week that it has awarded $945 million in total fiscal year 2019 funding for approximately 375 grants, contracts and cooperative agreements across 41 states through the Helping to End Addiction Long-term Initiative or NIH HEAL Initiative. The trans-NIH research effort aims to improve treatments for chronic pain, curb the rates of opioid use disorder and overdose and achieve long-term recovery from opioid addiction. Among the grant recipients in Illinois are Chestnut Health Systems in Bloomington, Northwestern University, Rush University Medical Center, the University of Chicago, and the University of Illinois in Chicago and Urbana.

“President Trump’s approach to the opioid crisis and HHS’s strategy have both been based in the best science we have,” said Health and Human Services Secretary Alex Azar. “We have effective tools, such as medication-assisted treatment, but we still need better ways to treat opioid addiction and manage pain in an effective, personalized way. This historic investment by NIH was made possible by funding secured from Congress by President Trump, and will support our work in the current crisis and lay the work for a healthier future.”

In 2016, an estimated 50 million U.S. adults suffered from chronic pain and in 2018, and an estimated 10.3 million people 12 years and older in the United States misused opioids, including heroin.

Briefly Noted
President Trump on Friday signed a stopgap government funding bill to keep the federal government open through Nov. 21.