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Member News: Pennsylvania is currently considering a bill to change the prior authorization process in the state. Many insurers say prior authorization can combat misuse of medical tests and treatments, but doctors often argue long waits for care can lead to negative patient outcomes. When it comes to improving prior authorization, Geisinger Health Plan Chief Medical Officer Dr. John Bulger says the best way to is to work with the provider community instead of legislation.
CBO analysis will examine impact of cutting CSR subsidies
Later today, the CBO will release an analysis on the effects of ending CSR subsidies including the impact on the budget, coverage numbers, marketplace stability and premium costs. President Trump has threatened to halt the payments, although Congressional Republicans are considering legislation that would fund the subsidies.
Administration extends deadline for insurers deciding on individual exchange plans
The Trump Administration extended the deadline for insurers to decide whether they will offer plans on the ACA exchanges. In a memo, HHS says it is offering an additional three weeks so companies can plan for the possible end of CSR payments. Many insurers warn unfunded CSRs could result in double-digit premium increases for patients.
House Republicans aim to revive health care effort
Members of the House Freedom Caucus are petitioning Republicans to vote on a repeal of the ACA without a replacement. The proposal is a version of a repeal bill that passed the House in 2015. Speaker Paul Ryan and other House leaders have warned that there are not enough votes to pass a health care measure, but conservatives say House Republicans have voted for repeal in the past and should be challenged to do so again. The strategy involves getting a majority of House members to sign a petition asking Ryan to bring the bill to the floor.
Rural California counties expand services to mental health patients
Throughout California mobile mental health care units are being deployed to service hard-to-reach patients who are uninsured or on Medicaid. Mobile care units are rare among local health departments, but the trend is growing in California due to state funds provided by the Mental Health Services Act. The units have had success providing psychiatric help, prescriptions, case management and counseling to vulnerable populations. In one county, 3.4 percent of mobile unit patients were hospitalized compared to 9.6 percent of mental health clinic patients in the county overall last year.
Medicare pays for more than 500,000 end of life consultations in program’s first year
Federal data show that more than half a million Medicare beneficiaries held end of life consultations with their physicians in 2016, the first year Medicare reimbursed the service. While twice as many people used the program as expected, it is still less than one percent of Medicare enrollees that had the end of life consultations. Experts attribute low usage of the program to a lack of awareness among providers and controversy stemming from the 2009 health care debate. Critics allege the program is financially motivated and impedes life-sustaining care patients were promised; proponents argue such consultations help patients make informed decisions and ensure providers respect patient values.
Readmission reduction program draws pushback from hospitals
Hospitals are questioning whether it’s time to scrap a readmission reduction program rolled out by CMS as part of the ACA. The program aims to improve quality by imposing financial penalties on facilities that see high readmission rates. From 2011 to 2014, the program helped CMS save $9 billion and helped lower readmission rates for Medicare beneficiaries. However, since 2014, readmissions have only dropped by about 0.1 percent. Hospitals believe the program overestimates how effective facilities can be in curbing readmissions and point out most hospitals participate in other reimbursement programs designed to drive quality care.
Investors cut health care stocks
Several major hedge fund investors cut their stakes in health care companies in the second quarter. Health care stocks have trailed the rest of the market since lawmakers took up the repeal and replace effort, but have recently rallied in the second quarter.