BISBEE'S BRIEF:  Yes, The Olympics Matter

The opening ceremony for the XXIII Winter Olympics was held Friday in Pyeongchang, South Korea.  It commenced sixteen competition-filled days. 

In the lead up to the games, several writers asked "whether the Olympics still matter."  With the end of the Cold War, generational moments like Al Michaels and his “Do you believe in miracles?” call of the 1980 U.S. hockey team triumph against the Soviet Union are no longer.  As the Atlantic wrote, the games now “are less about geopolitical struggles and more about made-for-TV storylines.” 

It is my view, however, that the Olympics have as much to offer us as ever.  They are a tribute to competitive excellence, showcasing the top female and male athletes in the world.  They give us a chance to see competitive struggle as the very best in their respective sports face adversity and remind us to never give up.  Finally, the Olympics speak to unity at a time of far too much division and rancor.

On Friday evening, we watched the two Koreas march into Pyeongchang Olympic Stadium together.  It was a wonderful moment in what will be more than two exceptional weeks of competition.  Yes, the Olympics still matter.   

For comment or reaction, please write: gary@hmacademy.com

THE WEEK THAT WAS, February 5, 2018

On Friday President Trump signed into law the Bipartisan Budget Act of 2018, which contains a multitude of healthcare provisions that will have impact across the industry. The legislation extends funding for the government through March 23, raises the federal debt limit until March 2019 and increases funding for the defense department, but it is the 378 pages of healthcare legislation that will receive attention from the healthcare industry. The legislation is a net-positive for providers and includes the CHRONIC Care Act, adjustments to the Quality Payment Program (“QPP”) and the so-called “Medicare Extenders.” Specifically, areas of interest to providers include:

  1. Changes to the Quality Payment Program, which was created through the passage of the Medicare Access and CHIP Reauthorization Act (“MACRA”)
    1. Eliminates Medicare Part B drug costs and allows the Centers for Medicare and Medicaid Services (“CMS”) flexibility to set the weight for the overall cost category for the next four years;
    2. Allows CMS to set the “performance threshold” for the next three years;
    3. Clarifies the Physician Focused Payment Model Technical Advisory Committee’s (“PTAC”) authority, allowing it to provide earlier feedback on proposed alternative payment models.
  2. The inclusion of the CHRONIC Care Act, which was passed by the Senate last fall, but was not voted on in the House:
    1. Allows Accountable Care Organizations (“ACOs”) the option to have beneficiaries assigned prospectively rather than retrospectively;
    2. Allows certain ACOs to offer incentive payments (up to $20) to beneficiaries for receiving primary care services;
    3. Allows Medicare Advantage plans to include telehealth services in their annual bids;
    4. Gives ACOs more flexibility in providing telehealth services and beneficiaries more flexibility in utilizing telehealth services;
  3. A two-year delay of reductions to the Medicaid Disproportionate Share Hospital Allotment;
  4. A repeal of the Medicare Independent Payment Advisory Board (“IPAB”), which providers have sought since the passage of the Affordable Care Act;
  5. A four-year extension to the Children’s Health Insurance Program (“CHIP”), which was already extended by six years a few weeks ago;
  6. A two year extension of the 2 percent Medicare reduction to providers that originated from the budget sequester (it was scheduled to sunset in 2025);

The healthcare legislation did not include any funding or fixes to the Affordable Care Act individual marketplace, nor did it include a moratorium on reductions to the 340B Drug Discount Program. The healthcare legislation can be found here, a section by section summary can be found here and the federal budget impact of the healthcare provisions can be found here. A summary brief of the implications for Leading Health Systems can be found here. https://www.nytimes.com/2018/02/08/us/politics/budget-deal-health-care.html; http://www.modernhealthcare.com/article/20180209/NEWS/180209895/beacon-of-light-healthcare-additions-in-budget-law-pleasantly;

On Friday the White House released Reforming Biopharmaceutical Pricing at Home and Abroad, a white paper outlining the administration’s plans to reduce drug prices in the U.S. The drug pricing proposals are expected to be included in the Trump administration’s budget proposal, which is scheduled to be released Monday. Of most significance to Leading Health Systems is support for the recent payment changes by the Centers for Medicare and Medicaid Services to the 340B drug discount program, increasing restrictions on program eligibility and the potential for a single agency to set prices. (The paper mistakenly claims that profits from the 340B program can be used to fund shareholder dividends – investor owned hospitals are not eligible for the program). The proposal also suggests increasing competition for pharmacy benefit managers, moving Medicare Part B drug coverage into Medicare Part D coverage and revising the methodology of how Medicaid reimburses drug manufacturers. The report from the White House Council of Economic Adviser can be found here. https://www.bloomberg.com/news/articles/2018-02-09/drugmakers-dodge-another-bullet-in-trump-s-drug-pricing-report; https://www.nytimes.com/2018/02/09/health/trump-drug-prices-medicare.html;

On Tuesday former CMS Administrator Andy Slavitt announced the formation of a new group called United States of Care, which he said will focus on lowering healthcare costs and broadening access. Slavitt, who was a vocal critic of Republican efforts to repeal and replace the ACA last year, has served as an advisor to AVIA and the Bipartisan Policy Center since leaving office. The Board of Directors and Founder’s Council includes representatives from across the healthcare industry, including several Health Management Academy member CEOs. https://www.cnn.com/2018/02/08/politics/what-is-united-states-of-care-andy-slavitt/index.html

America’s Health Insurance Plans released the results of a national survey on employee opinions on employer sponsored health insurance coverage. Approximately 175 million Americans have coverage through their employer or the employer of a dependent, though the percent of Americans with employer sponsored coverage has dropped over the past two decades. The survey found that 71 percent of those with employer sponsored coverage are satisfied with their plans and 60 percent believe the cost of their coverage is reasonable. Comprehensiveness in coverage, affordability and provider choice are the three benefits employees value most and a majority (56 percent) say the coverage they have is impactful in their decision to stay at their current job. 56 percent of respondents support the tax exemption employers receive, which is estimated to cost $260 billion a year, while just 13 percent oppose the tax exemption. The survey report can be found here.

THE WEEK AHEAD, February 12, 2018 

Attention will center on the release of the President’s budget proposal in the early part of the week. There are several healthcare hearings scheduled on Capitol Hill, as new HHS Secretary Alex Azar will testify twice about the HHS provisions contained in the President’s FY 2019 Budget.

  • Monday-Wednesday: The Health Management Academy will host its Physician Leadership Program and Advanced Analytics Collaborative
  • Wednesday: The Subcommittee on Oversight and Investigations of the House Committee on Energy and Commerce will hold a hearing entitled “Examining the Impact of Health Care Consolidation”
  • Wednesday: The House Committee on Ways and Means will hold a hearing on the Department of Health and Human Services’ Fiscal Year 2019 Budget Request
  • Wednesday-Friday: The Health Management Academy will host its Population Health Collaborative and Chief Nursing Information Officer Forum
  • Thursday: The Subcommittee on Health of the House Committee on Energy and Commerce will hold a hearing entitled “Oversight of the Department of Health and Human Services”
  • Thursday: The Senate Committee on Finance will hold a hearing on the Department of Health and Human Services’ Fiscal Year 2019 Budget Request
  • Thursday: The Subcommittee on Immigration and Border Security of the House Judiciary Committee will hold a hearing entitled “The Effect of Sanctuary City Policies on the Ability to Combat the Opioid Epidemic”

SELECTED READINGS FROM THE PAST WEEK