{"id":2080,"date":"2021-10-12T21:08:02","date_gmt":"2021-10-12T21:08:02","guid":{"rendered":"https:\/\/thornrun.com\/health-policy-report-10-12\/"},"modified":"2023-08-08T21:25:38","modified_gmt":"2023-08-08T21:25:38","slug":"health-policy-report-10-12","status":"publish","type":"post","link":"https:\/\/thornrun.com\/health-policy-report-10-12\/","title":{"rendered":"Health Policy Report (10\/12)"},"content":{"rendered":"\n

Capitol Hill Update<\/strong><\/p>\n\n\n\n

House lawmakers will convene for legislative business today eyeing action on a short-term debt limit increase. Late last week, the Senate passed a short-term debt ceiling increase that would provide lawmakers with more time to strike a broader agreement. With less than a week left until the October 18 “X date,” Senate leadership brokered a bipartisan agreement that would hike the debt limit by $480 billion, thus punting the debt limit to December 3 and giving the Treasury Department more wiggle room to avert a default. Despite this brief flash of bipartisan cooperation, the two sides still remain far apart on a long-term solution on the debt ceiling. While the House will also be in for a series of Committee Work Days this week, the Senate has adjourned for a state work period and will resume voting on Monday, October 18.<\/p>\n\n\n\n\n\n\n\n

CMMI Director: Drug\nPricing Demos Must Wait for Reconciliation<\/strong><\/p>\n\n\n\n

Last July, the\nDepartment of Health and Human Services (HHS) published a drug pricing plan<\/a>, required by Executive Order<\/a>, that called for multiple Center for Medicare\nand Medicaid Innovation (CMMI) demonstrations to control drug prices. On\nTuesday, CMMI Director Elizabeth Fowler released a statement claiming that the\nCenter is unable to design payment models to test these proposed drug price\ncontrols, however, until after Congress finalizes its plans for drug pricing.\nMs. Fowler noted that specific aspects of models that CMMI would consider in\nterms of Part B are ever-changing, and without more concrete information, the\nCenter is unable to provide an accurate analysis. <\/p>\n\n\n\n

Earlier this year, CMS opened<\/a> a National Coverage Determination analysis \u2014 a\nprocess that will allow the agency to carefully review and determine whether\nMedicare will establish a national Medicare coverage policy for the treatment\nof Alzheimer\u2019s disease. It was rumored that CMS would use CMMI to complete this\ntask, though Fowler noted that CMMI is unable to design demonstrations for\nAduhelm, an Alzheimer\u2019s drug, until CMS determines a national Medicare coverage\npolicy for the medication. Ms. Fowler clarified that CMMI is not involved in\nthat national coverage policy and noted the administration\u2019s intent to keep\nCMMI and the coverage policy work separate from one another. <\/p>\n\n\n\n

CMS Prioritizes Equity\nOver Reducing Provider Burden<\/strong><\/p>\n\n\n\n

Under the Trump\nadministration, CMS set a goal to make all quality measure reporting digital by\n2030. At its 2021 Quality Conference in March, CMS announced that it was moving\nthat goal date up to 2025. However, CMS is now prioritizing quality measures\nthat advance equity over those that reduce burden, CMS Chief Medical Officer\nLee Fleisher indicated recently. Additionally, Mr. Fleisher noted that the\nBiden administration is prioritizing the curation of \u201cthe right\u201d quality\nmetrics, rather than carrying on the previous administration\u2019s priority of\nreducing provider burden. Mr. Fleisher went on to express that, while CMS\nintends to make quality measures digital to the fullest extent possible, the\nadministration is open to adopting structural or process measures if equity is\ndiminished in the pursuit of a fully digital landscape. <\/p>\n\n\n\n

GAO Releases Report on\nMIPS Provider Performance <\/strong><\/p>\n\n\n\n

On Wednesday, the U.S.\nGovernment Accountability Office (GAO) published a report<\/a> on provider performance and experiences under\nthe Merit-based Incentive Payment System (MIPS). The report details MIPS\nperformance and resulting payment adjustments, as well as stakeholder feedback\non the program. Overall, GAO found that the MIPS scores were high, with roughly\n93 percent of providers obtaining a small, positive adjustment from 2017 to\n2019. The largest adjustment in any year was 1.88 percent, and median scores\ncleared the performance threshold by wide margins according to the report.\nRoughly 72 to 84 percent of providers exceeded the exceptional performance\nmeasure, earning them an additional bonus. No more than 4.8 percent of\nproviders qualified for a negative adjustment. <\/p>\n\n\n\n

The Centers for Medicare\nand Medicaid Services (CMS) administers MIPS as a mechanism to determine future\nMedicare payment adjustments for providers. The program originated in the\nMedicare Access and CHIP Reauthorization Act of 2015 (MACRA) as an attempt to\nmove toward higher quality, more efficient care through the Quality Payment\nProgram (QPP). Providers participating in the MIPS program are scored based on\nmeasures that fall into four categories: (1) cost; (2) quality; (3) improvement\nactivities; and (4) promoting interoperability. MIPS includes a wide range of\nproviders, though providers participating in an Advanced alternative payment\nmodel (APM) and those serving a low volume of Medicare beneficiaries are\nexcluded from the model. A provider\u2019s final score is compared to a performance\nthreshold and informs CMS if the provider should receive a positive, negative,\nor neutral change in their payment rates. Providers can also receive a payment\nadjustment boost if their MIPS score passes the exceptional performance\nthreshold. According to GAO, roughly 950 thousand providers, or about half of\nMedicare Part B providers, were MIPS-eligible in 2019. Payment adjustments as\ndetermined in any given year take effect two years later. <\/p>\n\n\n\n

GAO also interviewed\nseveral stakeholders to learn their perspectives on the strengths and\nchallenges of the MIPS program. Eleven stakeholders generally supported the\nprogram, and two respondents noted that bonuses help to increase scores for\nsmaller provider practices that may otherwise be disadvantaged by the scoring\nsystem. However, eight stakeholders questioned if MIPS leads to improved health\noutcomes. Specifically, they noted that providers may choose to report on their\nstrongest quality measures instead of areas in which the provider needs\nimprovement. CMS assured these stakeholders that the MIPS Value Pathways (MVP)\n\u2014 a new way that providers can meet reporting requirements \u2014 will work to\nremedy these concerns by standardizing performance measurements. Officials said\nthat more cohesive measurements will narrow the provider selection burden to\nreport for each MVP. For 2019 through 2022, MACRA directed CMS to provide an\nadditional $500 million for exceptional performance bonuses. Additionally, the new\nMVP mechanism will go into effect in 2023.<\/p>\n\n\n\n

Analysis Shows High Cost\nof Extending ACA Credits, Covering Medicaid Gap<\/strong><\/p>\n\n\n\n

The Commonwealth Fund and Urban Institute released a report<\/a> last month which found that permanently extending Affordable Care Act (ACA) tax credits under the American Rescue Plan (ARP) and allowing those in the Medicaid \u201ccoverage gap\u201d to access those subsidies would reduce the number of uninsured by 7 million and cost roughly $333 billion over 10 years. While the brief garnered little public attention at the time of its release, an Urban Institute researcher and report co-author claims that the report has been viewed by key policymakers who are working to craft a reconciliation package likely to include some version of both policies. The reconciliation bill passed by the House contains several Medicaid-related provisions, including: (1) the extension of tax credits to the \u201ccoverage gap\u201d population; (2) the requirement that the Centers for Medicare and Medicaid Services (CMS) establish a federally funded Medicaid program by 2025; and (3) the permanent extension of higher ACA tax credits. <\/p>\n\n\n\n

The analysis also found that, if both policies were enacted, overall household spending would decrease by $8.2 billion. Specifically, household spending on premiums would be reduced by roughly $8.8 billion in 2022, while out-of-pocket spending on health care services, like co-pays and deductibles, would increase by an estimated $600 million due to increased access and use.\u00a0Additionally, the report found that uninsured rates would fall in all states, but the largest declines would occur in non-expansion states like Alabama and Mississippi at 44 and 43 percent, respectively. Many expansion states would also see decreases in their uninsured rates \u2014 West Virginia\u2019s uninsured population would see a decrease of about 28 percent and Nevada would see a decline of about 18 percent. Reductions would also be concentrated in lowest income populations, and all racial and ethnic groups would gain coverage under the policies, the brief found.\u00a0 <\/p>\n","protected":false},"excerpt":{"rendered":"

Capitol Hill Update House lawmakers will convene for legislative business today eyeing action on a short-term debt limit increase. Late last week, the Senate passed a short-term debt ceiling increase that would provide lawmakers with more time to strike a broader agreement. With less than a week left until the October 18 “X date,” Senate […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11,7],"tags":[],"acf":[],"yoast_head":"\nHealth Policy Report (10\/12) - thornrun<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/thornrun.com\/health-policy-report-10-12\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Health Policy Report (10\/12) - thornrun\" \/>\n<meta property=\"og:description\" content=\"Capitol Hill Update House lawmakers will convene for legislative business today eyeing action on a short-term debt limit increase. 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