Six months into MACRA rollout, docs are still unprepared

By Virgil Dickson  | June 28, 2017

More than halfway through the first year of the rollout of the Medicare Access and CHIP Reauthorization Act, the majority of medical practice leaders still are not ready to comply with the law, according to a survey by American Medical Association and consulting firm KPMG.

The revelation, outlined in a report released Wednesday, is based on the responses from 1,000 physicians who have been involved in practice decision-making related to MACRA. The survey found that fewer than 1 in 4 physicians interviewed were prepared to meet statutory requirements this year. The revelation could mean that many will face a financial penalty in 2019, which is when 2017 compliance will be measured.

Providers' lack of preparedness for MACRA has been a longstanding concern, but the AMA/KPMG report drilled deeper into the knowledge gaps, according to Larry Kocot, principal at KPMG's Center for Healthcare Regulatory Insight.

The survey found that that 51% of the doctors responding were only somewhat knowledgeable about MACRA and its new quality reporting system, the Merit-based Incentive Payment System, or MIPS.

In addition, 90% felt the reporting requirements were somewhat or very burdensome, given the time it would take to comply with MIPS requirements. The physicians also raised concerns about understanding requirements, how MIPS performance is scored, and the cost required to accurately capture and report performance.

Unsurprisingly, the report found that those without experience with value-based reporting systems were most likely to find MIPS requirements burdensome and feel less prepared for long-term financial success. It also found that respondents in a large practice with 50 or more physicians were more likely to feel prepared.

A CMS spokesman did not respond to a request for comment. However, a week before the AMA/KPMG report was released, the agency announced that more small providers would be exempt from MACRA.

Physician practices with less than $90,000 in Medicare revenue or fewer than 200 unique Medicare patients per year would be exempt under the new draft rule released June 20. The move will exclude about 834,000 more clinicians from complying with the quality reporting program under MACRA. The original threshold was $30,000 or fewer than 100 Medicare patients.

The move was a step in the right direction, according to Kocot.

"Penalizing these providers wouldn't make them learn this any faster," he said.

The vast majority of physicians surveyed, 83%, said they needed more educational opportunities to understand MIPS requirements. Specifically, they wanted to know more about reporting requirements, how compliance with the quality system is scored and potential financial impact of the system.

In conjunction with the findings, the AMA has developed a resources guide to help physicians work toward compliance. Clinicians will be able to view a step-by-step video on minimum reporting requirements to avoid a penalty in 2019 and a payment model evaluator that offers a brief assessment of where a practice stands.

Virgil Dickson reports from Washington on the federal regulatory agencies. His experience before joining Modern Healthcare in 2013 includes serving as the Washington-based correspondent for PRWeek and as an editor/reporter for FDA News. Dickson earned a bachelor's degree from DePaul University in 2007.

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Mental healthcare in the crosshairs of Senate health reform bill

By Steven Ross Johnson  | June 29, 2017

The Senate GOP bill to repeal and replace the Affordable Care Act could reverse progress in expanding access to behavioral health and substance abuse treatment, experts say.

An analysis by the Congressional Budget Office found 22 million Americans would lose coverage under the Better Care Reconciliation Act, mostly through an estimated $772 billion, or 26%, cut to federal Medicaid spending by 2026. The CBO said 15 million fewer people would be on Medicaid by that year.

Mental health advocates fear large cuts to Medicaid because it is the single largest payer for mental health services. On top of that, it would allow states to waive the ACA's requirement that commercial insurers and Medicaid plans cover benefits such as mental health and substance abuse treatment.

Concerns about the bill's impact on treatment for mental illness and addiction have led some GOP senators and governors, including Ohio Sen. Rob Portman and Ohio Gov. John Kasich, to withhold support for the legislation.

"This is going to affect people with mental illness and addiction disproportionately," said Dr. Jeffery Lieberman, chairman of the Psychiatry Department at Columbia University College of Physicians and Surgeons.

But supporters say the bill's Medicaid changes would prompt states to redesign their Medicaid programs to cover their residents more cost-effectively.

The bill would effectively end the ACA's Medicaid expansion to low-income adults by phasing out enhanced federal funding for expansion by 2024. It also would impose a cap on the growth of federal payments to states that experts say likely would force states to cut eligibility, benefits and provider payments.

Medicaid covers more than a quarter of all spending for mental health and substance abuse services. An estimated 30% of adults who have received coverage under the ACA's Medicaid expansion have a serious mental illness and/or substance abuse problems, and about 1.3 million people receive treatment for those disorders through that coverage.

"If the expansion goes away, and if the federal government imposes these draconian cuts, the pressure on clinics will be enormous," said Rebecca Farley David, vice president of policy and advocacy for the National Council for Behavioral Health.

According to David, Medicaid makes up anywhere from 40% to 80% of the payer mix for many of her organization's members. "Without the support of the Medicaid program, many of them cannot keep their doors open."

The uncertainty over the fate of Medicaid has caused anxiety at many behavioral healthcare facilities.

"The consequences of this for many will be life or death," said Ken Taylor, CEO of Valley Cities Behavioral Health Care, a community mental healthcare organization with eight sites in the Seattle area.

Taylor said his clinics have doubled the number of patients receiving care since 2014 to about 12,000 patients, which he said was due to the ACA's Medicaid expansion.

The Senate bill allows states to seek waivers that would grant health insurers the option not to cover benefits such as mental health and substance abuse treatment. Those changes could remove the ACA's limits on patient out-of-pocket costs, which could deter people from seeking needed care.

Behavioral health advocates see some positives in the Senate bill. It would keep in place the requirement for health plans to cover children up to age 26 who are on their family's plan. It also bars insurers from denying coverage for people with pre-existing conditions, including mental illness and substance abuse.

Under the bill, states could extend the number of days their Medicaid program covers psychiatric hospitalizations, up to 30 consecutive days in a month and up to 90 days in a year.

Federal law has long barred Medicaid programs from covering the cost of patients receiving mental health or substance abuse treatment in residential facilities with more than 16 beds. Congress changed the limits on inpatient stays when it included a provision within the 21st Century Cures Act last year allowing Medicaid to cover the costs of up to 15 days.

John Snook, executive director for the Treatment Advocacy Center, said the bill's increase in allowed Medicaid-covered treatment days is significant.

But Snook said the bill overall could deprive people with serious mental illness of access to treatment through its provision to cap Medicaid spending. That could force states to cut eligibility and/or benefits. The CBO said the cap would reduce federal Medicaid spending by 35% in 2036.

Such large cuts would further limit access to care for many, who could end up in facilities that are detrimental to their health and more expensive for taxpayers.

"We know what happens when there isn't enough capacity," Snook said. "People end up in the facilities that will take them, and too often that's a jail."

Steven Ross Johnson has been a staff reporter for Modern Healthcare magazine since 2013 and covers issues involving public health and other healthcare news. Johnson has been a freelance reporter for the Chicago Tribune, Progress Illinois, the Chicago Reporter and the Times of Northwest Indiana and a government affairs reporter for the Courier-News in Elgin, Ill. He received a bachelor's degree in communications from Columbia College in Chicago and a master’s degree in journalism from the Medill School of Journalism at Northwestern University.

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medicaid.gov CIB

Today, the Centers for Medicare & Medicaid Services (CMS) issued an Informational Bulletin (CIB) that describes our intent to use enforcement discretion to focus on working with states to achieve compliance with the managed care regulations when states are unable to implement the July 1, 2017 requirements of the final rule.  To implement this enforcement discretion, states will need to identify for CMS those regulations of the final rule that they are unable to implement by the required compliance date.  This flexibility will not apply to the actuarial soundness, medical loss ratio (MLR), and pass-through payment provisions of the final rule because of the significant federal fiscal implications of these provisions for the Medicaid program.

The informational bulletin can be accessed on Medicaid.gov at http://www.medicaid.gov/Federal-Policy-Guidance/Federal-Policy-Guidance.html.

Health Care Battle On Hill Has Veterans Defending Obamacare Benefits

By Stephanie O'Neill June 30, 2017

Less than half of the 22 million veterans in the U.S. get their health care through the Veterans Affairs system. Many rely on Medicaid, which is slated for reductions under the health plan making its way through the U.S. Senate.

Air Force veteran Billy Ramos, from Simi Valley, Calif., is 53 and gets health insurance for himself and for his family from Medicaid — the government insurance program for low-income people. He says he counts on the coverage, especially because of his physically demanding work as a self-employed contractor in the heating and air conditioning business.

“If I were to get hurt on the job or something, I’d have to run to the doctor’s , and if I don’t have any coverage they’re going to charge me an arm and a leg,” he said. “I’d have to work five times as hard just to make the payment on one bill.”

There are about 22 million veterans in the U.S. But fewer than half get their health care through the Veterans Affairs system; some don’t qualify for various reasons or may live too far from a VA facility to easily get primary health care there. 

Many vets instead rely on Medicaid for their health insurance. Thirty-one states and the District of Columbia chose to expand Medicaid to cover more people — and many of those who gained coverage are veterans.

The GOP health care bill working its way through the Senate would dramatically reduce federal funding for Medicaid, including rolling back the expansion funding entirely between 2021 and 2024.

Medicaid coverage recently has become especially important to Ramos — a routine checkup and blood test this year showed he’s infected with hepatitis C. California was one of the states that chose to expand Medicaid, and the program covers Ramos’ costly treatment to eliminate the virus.

“Right now, I’m just grateful that I do have [coverage],” he said. “If they take it away, I don’t know what I’m going to end up doing.”

The Senate health plan — which proposes deep cuts to federal spending on Medicaid — has veterans and advocates worried. Will Fischer, a Marine who served in Iraq, is with VoteVets.org, a political action group that opposes the Republican health plan.

“If it were to be passed into law, Medicaid would be gutted. And as a result, hundreds of thousands of veterans would lose health insurance,” Fischer said.

It’s too early to know just how many veterans might lose coverage as a result of the Medicaid reductions. First, states would have to make some tough decisions: whether to make up the lost federal funding, to limit benefits or to restrict who would get coverage.

But Dan Caldwell thinks those concerns are overblown. He’s a Marine who served in Iraq and is now policy director for the group Concerned Veterans for America.

“The people who are saying that this is going to harm millions of veterans are not being entirely truthful,” Caldwell said. “They’re leaving out the fact that many of these veterans qualify for VA health care or in some cases already are using VA health care.”

About a half-million veterans today are enrolled in the VA’s health care program as well as in some other source of coverage, such as Medicaid or Medicare. Andrea Callow, with the non-profit group Families USA, wrote a recent report showing that nearly 1 in 10 veterans are enrolled in Medicaid.

“Oftentimes veterans will use their Medicaid coverage to get primary care,” Callow said. “If, for example, they live in an area that doesn’t have a VA facility, they can use their Medicaid coverage to see a doctor in their area.”

Whether a particular veteran qualifies for coverage through the VA depends on a host of variables that she said leaves many with Medicaid as their only option.

But, Caldwell said, rather than fighting to preserve Medicaid access, veterans would be better served by efforts to reform the care the VA provides to those who qualify.

“We believe that giving veterans more health care choice and restructuring the VA so that it can act more like a private health care system will ultimately lead to veterans who use the VA receiving better health care,” he said.

The Urban Institute found that the first two years after the enactment of the Affordable Care Act saw a nearly 44 percent drop in the number of uninsured veterans under age 65 — the total went from 980,000 to 552,000. In large part, that was the result of the law’s expansion of Medicaid.

This story is part of NPR’s reporting partnership with Kaiser Health News.

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CMS Proposes 2018 Policy and Payment Rate Changes for End-Stage Renal Disease Facilities

CMS NEWS FOR IMMEDIATE RELEASE June 29, 2017  Contact: CMS Media Relations (202) 690-6145 | CMS Media Inquiries CMS Proposes 2018 Policy and Payment Rate Changes for End-Stage Renal Disease Facilities Proposed rule builds patient-centered system of care to increase competition, quality and care  The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that would update payment policies for the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS). The ESRD PPS proposed rule is one of several for calendar year 2018 that reflect a broader strategy to relieve regulatory burdens for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility, and innovation in the delivery of care. “CMS is committed to transforming healthcare to empower patients and doctors so that they can make the best decisions about their health,” said CMS Administrator Seema Verma. “A focus on patient-centered care allows providers to direct their time and resources to improving health outcomes for all patients rather than complying with burdensome regulations from Washington, D.C.” This proposed rule ensures program stability through payment incentives that focus on improved quality of care at dialysis facilities. The rule covers payment rates for renal dialysis services, including updates to acute kidney injury (AKI), furnished to beneficiaries on or after January 1, 2018. The ESRD Quality Incentive Program (QIP) proposed changes are for payment years 2019, 2020, and 2021, and a number of key dialysis data methodologies and quality measures. The proposed rule also requests comment on how to include individuals with acute kidney injury in the ESRD Quality Improvement Program. These updates will help reduce regulatory burdens and allow providers to improve outcomes based on the unique needs of their patients. In addition to the proposed rule, CMS is releasing a Request for Information to welcome continued feedback on the Medicare program. CMS is committed to maintaining flexibility and efficiency throughout Medicare. Through transparency, flexibility, program simplification, and innovation, we aim to transform the Medicare program and promote the availability of high-value and efficiently-provided care for its beneficiaries. For a fact sheet on the proposed rule, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-06-29.html The ESRD proposed rule (CMS 1674-P) can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection/ For more information about the End Stage Renal Disease Program, please visit:  https://www.cms.gov/Center/Special-Topic/End-Stage-Renal-Disease-ESRD-Center.html ### Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter @CMSgovPress

Changes to the Payment Error Rate Measurement and Medicaid Eligibility Quality Control Programs

FACT SHEET FOR IMMEDIATE RELEASE June 29, 2017  Contact: CMS Media Relations (202) 690-6145 | CMS Media Inquiries    Changes to the Payment Error Rate Measurement and Medicaid Eligibility Quality Control Programs (CMS-6068-F) Today, June 29, 2017 the Centers for Medicare & Medicaid Services (CMS) posted a final rule that will publish on July 5, 2017 to implement changes to the Payment Error Rate Measurement (PERM) and Medicaid Eligibility Quality Control (MEQC) programs to reflect changes to the way states adjudicate eligibility for Medicaid and the Children’s Health Insurance Program (CHIP) required by law, as well as to implement other changes to the PERM and MEQC programs. SUMMARY The final rule implements policy and operational improvements to the PERM and MEQC programs that will reduce state burden, improve program integrity, and promote state accountability. Changes to the PERM Program The PERM program measures improper payments in the Medicaid program and CHIP. The improper payment rates are based on reviews of the fee-for-service (FFS), managed care, and eligibility components of Medicaid and CHIP. In light of changes to the way states adjudicate eligibility for applicants for Medicaid and CHIP under current law, CMS did not conduct the eligibility measurement component of the PERM program for Fiscal Years (FYs) 2015 through 2018 in order to update the eligibility component measurement methodology and related PERM program regulation. During this time, the 2014 national eligibility improper payment rate was used as a proxy rate, and all states conducted a pilot program with rapid feedback for improvement (known as the Medicaid and CHIP Eligibility Review Pilots) to maintain oversight of state eligibility determinations. CMS made changes to the eligibility measurement component of the PERM program in this final rule, and the eligibility measurement component will resume as of the effective date of the final rule for reporting in 2019. Changes to the PERM program in the final rule include: ·         Review Period: ThePERM program will review Medicaid and CHIP payments made by states July through June of a given year. Under previous regulations, the PERM program reviewed payments made in a Federal FY (October through September). ·         Eligibility Review Responsibility: A federal contractor will conduct PERM eligibility reviews with support from each state. Under previous regulations, states were required to conduct eligibility reviews and report the results to CMS. This will help reduce state burden. ·         Eligibility Universe: The PERM program will conduct eligibility reviews (in addition to medical and data processing reviews) on FFS and managed care payments sampled for the PERM program. The eligibility review will be conducted on the beneficiary associated with the sampled claim. Under previous regulations, states created separate universes of eligible individuals that were sampled for eligibility review. ·         Federal Improper Payments: Improper payments will be cited if the federal share amount is incorrect (even if the total computable amount is correct). Under previous regulations, improper payments were only cited on the total computable amount (i.e., federal share + state share). ·         Sample Sizes: A national sample size will be calculated to meet national Medicaid and CHIP improper payment rate precision requirements. The national sample size will then be distributed across states to maximize precision at the state level, and state-specific sample sizes will be based on factors such as each state’s expenditures and previous improper payment rate. Under the previous rule, state-specific sample sizes were calculated based on the state’s previous improper payment rate and state level precision and combined to total the national sample size. ·         Corrective Action: States will continue to implement Corrective Action Plans (CAPs) for all errors and deficiencies; however, there will be more stringent requirements added for states that have consecutive PERM eligibility improper payment rates over the 3% threshold established under section 1903(u) of the Social Security Act (the Act). ·         Payment Reductions/Disallowances: Potential payment reductions/disallowances under section 1903(u) of the Act will be applicable for eligibility reviews conducted during PERM years in cases where a state’s eligibility improper payment rate exceeds the 3% threshold. CMS will only pursue disallowances if a state does not demonstrate a good faith effort to meet the threshold, which is defined as meeting PERM CAP and MEQC pilot requirements. Changes to the MEQC Program The MEQC program is a separate eligibility review program set forth in section 1903(u) of the Social Security Act (the Act) and requires states to report to the Secretary the ratio of States’ erroneous excess payments for medical assistance under the state plan to total expenditures for medical assistance.  States review Medicaid cases to determine whether the sampled cases meet applicable Medicaid eligibility requirements.  Section 1903(u) of the Act also sets a 3% threshold for eligibility-related improper payments in any fiscal year and generally requires the Secretary to withhold payments to states with respect to the amount of improper payments that exceed the threshold. Similar to the PERM program, states did not operate the MEQC program for FYs 2015 through 2018 so that CMS could update the MEQC methodology and related regulation. Through this final rule, CMS has restructured the MEQC program into a tool that more effectively compliments the PERM program and will help states lower their eligibility improper payment rates. The MEQC program will resume as of the effective date of the final rule.  Changes to the MEQC program include: The MEQC program has been restructured into a pilot program that states conduct during their off-years from the PERM program to ensure continuous oversight of both Medicaid and CHIP state eligibility determinations. States have flexibility to design their MEQC active case pilots to best meet each state’s unique needs. However, should a state have consecutive PERM eligibility improper payment rates over the 3% threshold under section 1903(u) of the Act, CMS will provide direction for active case reviews. States are required to review a number of items not fully reviewed through the PERM program (e.g., negative cases). States must submit corrective actions for identified errors. ### Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter @CMSgovPress

The updated Affordable Care Act Federal upper limits (FUL)

The updated Affordable Care Act Federal upper limits (FUL) calculated in accordance with the Medicaid Covered Outpatient Drug final rule with comment are now available on the Medicaid.gov website at https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Prescription-Drugs/Pharmacy-Pricing.html.  States will have up to 30 days from the July 1, 2017 effective date to implement these updated FULs.  

For further information on the FUL program, please see the Federal Upper Limits page at https://www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/prescription-drugs/federal-upper-limits.html.

 

32.51% ...

... of Medicare Advantage members as of June 2017 are enrolled in a contract with a 4.5-or-higher Star Rating. Only 0.89% are enrolled in contracts with a 2.5 Star Rating.

Memorial Hermann to cut 350 positions

By Alex Kacik  | June 28, 2017

Houston-based health system Memorial Hermann will cut 350 jobs, the organization announced Wednesday, citing escalating costs, declining reimbursements and a softened local economy.

The move is part of an overriding strategy to adapt to an uncertain healthcare environment by becoming more cost-efficient and consumer-focused, the organization said, adding that the cuts won't impact direct patient care. Memorial did not specify which of its 25,000 total employees would be losing jobs.

The news comes not long after Memorial Hermann's CEO Dr. Benjamin Chu abruptly resigned after about a year at the helm. He plans to transition to a public policy role.

Memorial Hermann is currently in the credit review process with both Moody's Investors Service and Standard & Poor's, but it does not expect the transition to lead to any material credit action, executives said.

"Our greater (credit) concerns rest with changing economic conditions in Houston, a result of the prolonged energy recession," Dennis Laraway, the system's executive vice president and chief financial officer, told Modern Healthcare last week.

Alex Kacik is the hospital operations reporter for Modern Healthcare in Chicago. Aside from hospital operations, he covers supply chain, legal and finance. Before joining Modern Healthcare in 2017, Kacik covered various business beats for seven years in the Santa Barbara, California region. He received a bachelor's degree in journalism from Cal Poly San Luis Obispo in Central California.

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Insurance claim denials cost hospitals $262 billion annually

By Dave Barkholz  | June 27, 2017

ORLANDO, Fla.—Hospitals across the country lose approximately $262 billion per year on denied claims from insurers, sparking huge cash-flow issues and recovery costs, according to new data.

Payers initially deny about 9% of hospital claims, putting about $5 million in payments per hospital at risk, said Jason Williams, vice president of analytics for Change Healthcare, which collected the data.

Although hospitals ultimately will secure payment for 63% of initially denied claims, it costs $118 per claim on average to recoup the money, not to mention the cost to hospitals of foregoing the payments while they claw back the funds, Williams said.

"Even if they're ultimately paid for 63% of the claims, that's not great," said Williams, speaking on the sidelines of the national educational forum held each year by the Healthcare Financial Management Association.

Change Healthcare merged with McKesson's healthcare information technology business in March. The company analyzed about $3 trillion in claims in 2016 as part of its Healthy Hospital program.

Hospital claims denials happen for a host of reasons, ranging from providers not obtaining authorization for procedures to faulty input of codes, Williams said.

If hospitals cannot secure a denied claim, they're left eating the cost or billing the patient for the services, which can alienate that patient and ding satisfaction scores on the unlikely bet that the hospital can collect the funds, according to Williams.

Hospitals can try to avoid claim denials by automating their revenue-cycle workflow and collecting data that flag where claims are being denied, Williams said.

"The key is avoiding the denial in the first place," he said.

Dave Barkholz is Modern Healthcare’s Southern Bureau Chief stationed in Nashville. He covers hospitals, doctors, suppliers and governance across the Southeast. A winner of numerous national journalism awards, Barkholz started his career at Modern Healthcare in 1984 covering the investor-owned hospital companies. He spent the past 10 years in Detroit at Automotive News, a sister Crain publication.

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Medicaid remains sticking point in Senate ACA repeal bill

By Mara Lee  | June 27, 2017

Facing rebellion on the left and the right, Senate Majority Leader Mitch McConnell on Tuesday delayed a vote on the Senate replacement for the Affordable Care Act.

McConnell hoped to bring the Better Care Reconciliation Act to the Senate floor for debate and a vote this week, so public outcry during next week's congressional holiday wouldn't weaken senators' resolve to repeal the ACA.

But after senators from Maine, Nevada, Utah and Wisconsin all said they would vote against a motion to begin debate, McConnell pulled the bill for continued intraparty negotiations. The announcement came during a closed-door GOP lunch.

After the lunch, McConnell told the press: "We're going to continue discussions in our conference on the differences we have. We're still working toward getting 50 people in a comfortable place."

The decision comes just one day after the Congressional Budget Office revealed its analysis of the Senate bill, saying the plan would cause 22 million to lose their health coverage by 2026. The House's American Health Care Act had a similar impact with 23 million projected to lose their coverage.

"We're optimistic we're going to get to a result that's better than the status quo," he said.

All the Republican senators were invited to the White House Tuesday to talk about replacing Obamacare.

The Senate bill does more to drive down exchange premiums than the House bill, thanks to its proposed subsidy system for individual insurance policies, which shifts subsidies to Bronze plans rather than Silver plans.

Senate Republicans say people are unhappy with the individual market and rising premiums under Obamacare.

"While the schedule may have changed a little bit, one thing that hasn't changed: Obamacare is collapsing. It's a failed system that needs to be replaced," said Sen. John Thune of South Dakota.

Thune said the Senate approach to regulating the individual market will "bring affordability to people suffering under the curse of high premiums, high deductibles and high out-of-pocket costs."

The CBO analysis of the Senate bill determined that premiums will drop for those who don't qualify for subsidies, but premiums will rise for individuals over the age of 50 who currently qualify for subsidies. In addition, fewer people will qualify for subsidies.

Other analysts say that deductibles and out-of-pocket costs will rise, not fall, thanks to their changing actuarial value.

The CBO predicted that virtually no low-income people who currently qualify for very low deductibles and co-pays will buy policies under the Senate proposal's regime, since their out-of-pocket costs would rise too high.

But Senate Republicans say the current system is unsustainable.

Sen. John Barrasso of Wyoming, a physician, said he had a constituent visit his office this morning complaining she and her husband pay twice as much for their policies now, with $6,500 deductibles, than they did before Obamacare. That policy "wasn't good enough for the Democrats," but it was good enough for her, he said.

One of the sticking points among Republicans is how to rework the Medicaid program, which some states expanded under the Affordable Care Act. Lawmakers in those states are wary of rescinding the benefits to their constituents and facing a tougher road to re-election.

Barrasso said covering childless adults gets away from Medicaid's original purpose and that states need the flexibility to design their own programs.

The bipartisan National Governors Association sent a letter to the Senate saying it opposes the proposal to withdraw more than $770 billion in federal Medicaid funding over 10 years by ending enhanced support for the expansion population and constraining the growth in the federal contribution.

Those cuts are why Republicans can repeal taxes on health insurers, earners making more than $200,000 annually and investment income, among others, without increasing the deficit.

Providers will feel the impact of Medicaid cuts far greater than changes to the individual market. Dr. Atul Grover, executive vice president of the Association of American Medical Colleges, said that his member hospitals, which are 5% of all hospitals, cover 24% of Medicaid patients.

Although the Senate bill preserves and increases disproportionate-share hospital funding in non-expansion states, that won't make up for the Medicaid cuts. If Congress rolls back Medicaid support and millions are pushed off the program, "We're not going to turn these patients away," Grover said. "That's not who we are."

Mara Lee covers developments in health care policy in Congress and around Washington. This is her second time covering the Hill. In a previous life, she covered Midwestern delegations for Scripps and Gannett newspapers in Indiana and Michigan. Over her 20-year-plus-career, she’s spent more time outside the Beltway, both as a business reporter for The Hartford Courant and nine years in Ohio, mostly at the Dayton Daily News. She won an award for coverage of Oxycontin addiction Ohio in 2003, as well as for Census, business and breaking news coverage in Ohio and Connecticut. She’s a Virginia native, and graduated from the University of North Carolina-Chapel Hill. Twitter handle: MaraRhymesSarah

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Providers ramp up pressure to scuttle Senate repeal bill

By Harris Meyer  | June 27, 2017

Healthcare industry groups opposed to Senate Republicans' Obamacare replacement bill plan to step up their lobbying of GOP senators now that Majority Leader Mitch McConnell has delayed a vote until after the July 4 recess.

McConnell announced Tuesday afternoon he was delaying a vote to proceed on the Better Care Reconciliation Act until senators return from the recess on July 11. He was stymied when GOP senators from Maine, Nevada, Utah and Wisconsin all said they would oppose a motion to begin debate. Under the Senate's budget reconciliation rules, he needs the support of 50 of the 52 GOP senators to pass the bill.

"The delay is good in the short run, but this bill isn't dead and probably will come back," said Margaret Murray, CEO of the Association for Community Affiliated Plans, which represents safety-net insurers. "We will continue to educate lawmakers about problems we see with the bill and its effect on low-income people and states."

On Tuesday, CEOs from 50 of her organization's members were in Washington meeting with their home state senators and representatives.

Arizona's two GOP senators, Jeff Flake and John McCain, face pressure from the state's providers and its Republican governor to protect the state's Medicaid expansion, which covers nearly 400,000 low-income adults.

"We're happy there's a delay," said Greg Vigdor, president of the Arizona Hospital and Healthcare Association. "We think the Senate bill is flawed policy, and we'll use the extra time to understand it better and urge our senators to oppose it."

It's expected that McConnell will try to negotiate changes with Republican moderates and conservatives who have expressed doubts about the bill, which was written by McConnell and his staff behind closed doors and unveiled last Thursday.

McConnell has nearly $200 billion over 10 years in enhancements to dole out to win over moderates concerned about the Congressional Budget Office's politically damaging report Monday. That report estimated the bill would lead to 22 million more Americans without insurance in 2026. The CBO also said that people buying coverage in the individual market would face significantly higher out-of-pocket costs under the bill, though some people would pay lower premiums.

Since the CBO scored the bill as saving $202 billion more than the House bill, McConnell could richen the bill's coverage provisions by that amount and still comply with Senate budget reconciliation rules.

Moderate Republicans like West Virginia's Shelley Moore Capito and Ohio's Rob Portman may press for a slower phase-out of the ACA's Medicaid expansion and additional billions in funding for substance abuse treatment for their drug-ravaged states. Conservatives like Utah's Mike Lee and Kentucky's Rand Paul want more rollbacks of ACA insurance rules, which they argue would bring down premium costs.

The majority leader is dancing on a knife edge. If he adds costly coverage enhancements to please the moderates, he risks losing the support of conservatives. If he relaxes insurance rules and weakens consumer protections, he could lose the moderates.

Murray said her organization is urging senators not to accept temporary grants for substance abuse treatment as a trade-off for phasing out Medicaid coverage.

"We don't want senators to think they've taken care of the problem by accepting a grant," she said. "Forty percent of medication-assisted treatment is paid for by Medicaid, and we want to make sure people have Medicaid coverage entitling them to treatment, not a limited pot of money."

Two moderates, Maine's Susan Collins and Nevada's Dean Heller, have said they can't support the Senate bill in its current form, while Paul has said the same thing from the conservative side. Heller, who faces a tough re-election campaign in 2018, is seen as a bellwether. If McConnell can win him over, many political observers think the bill will pass. But Heller has staked out a tough public position against cutting Medicaid.

For McConnell, the silver lining to the delay is it gives balky GOP senators time to publicly justify a switch from opposition to support, said Rodney Whitlock, a Republican healthcare lobbyist and former Senate staffer.

The downside is that during the recess break, Republican senators are going to hear a lot of fierce opposition to the bill—particularly to its restructuring and funding cuts in Medicaid—but not a lot of support. And the bill's provision locking people out from buying insurance for six months if they have a lapse in coverage will be a hard sell with the public, he warned.

"It will be harder and harder on members to hear all that from people and then come back to Washington and feel they're doing the right thing" by voting for the bill," Whitlock said.

Republican leaders want to pass their bill to repeal and replace the ACA as quickly as possible to so they can move on to tax and budget legislation. The Senate has 15 more working days before its long August recess. They have said that the end of July is the absolute deadline for the bill.

If McConnell makes changes to win over wavering senators, the bill will have to be evaluated again by the CBO and scored on its cost and coverage impact.

In addition, its provisions still have to be vetted by the Senate parliamentarian for whether they comply with budget reconciliation rules. That process could knock out nonbudgetary provisions such as insurance regulatory changes and bans on federal funding for Planned Parenthood and abortion coverage that are strongly supported by conservatives.

The bill's path looks rocky, but healthcare industry leaders aren't relaxing their guard, knowing McConnell is a savvy and determined legislative leader. They're particularly focusing their efforts on Senate GOP moderates who have expressed strong concerns about the bill's Medicaid provisions and coverage losses.

"We assume they'll make another run at the bill, just like when the House bill initially went down," Murray said. "We won't let up the pressure."

Harris Meyer is a senior reporter providing news and analysis on a broad range of healthcare topics. He served as managing editor of Modern Healthcare from 2013 to 2015. His more than three decades of journalism experience includes freelance reporting for Health Affairs, Kaiser Health News and other publications; law editor at the Daily Business Review in Miami; staff writer at the New Times alternative weekly in Fort Lauderdale, Fla.; senior writer at Hospitals & Health Networks; national correspondent at American Medical News; and health unit researcher at WMAQ-TV News in Chicago. A graduate of Northwestern University, Meyer won the 2000 Gerald Loeb Award for Distinguished Business and Financial Journalism.

http://www.modernhealthcare.com/article/20170627/NEWS/170629893?utm_source=modernhealthcare&utm_medium=email&utm_content=20170627-NEWS-170629893&utm_campaign=am

Colonial Life Report Encourages Bigger View Of Employee Benefits

Business Wire

Research shows employers can create stronger benefits plans by avoiding health care reform distraction

COLUMBIA, S.C.--(BUSINESS WIRE)-- Employers can create more competitive and cost-effective benefits programs by taking a broader view and avoiding the distractions of health care reform legislation, according to a new white paper released today by Colonial Life.

“Big-Picture Benefits” uses industry and internal company research to illustrate solutions available to employers that help control rising insurance costs, protect their workers’ financial wellbeing and offer greater choice for today’s increasingly diverse workforce.

“Health insurance is a major employer expense, but a competitive employee benefits plan includes far more than that,” says Steve Hesler, assistant vice president, product development at Colonial Life. “Employers who want to attract and retain the best talent can take active steps today rather than waiting to see what does or doesn’t change down the road.”

Rising costs create financial burden

As health care premiums continue to rise — up more than 300 percent since 1999¹ — employers are increasingly shifting costs to employees, through a higher share of premiums, higher coinsurance or higher deductibles. However, that heavier burden increases employees’ already-fragile financial state, the report points out. The average deductible for employer-sponsored health plans surged 13 percent in 2016¹ while workers’ wages increased only 2 percent.²

That comes at a time when nearly half of surveyed Americans say they couldn’t cover a $400 emergency expense or would have to sell something or borrow the money. And close to a third went without some medical care in the past year because they couldn’t afford it.³

Redesigned programs close gaps, offer choices

Employers who pair voluntary benefits with a high-deductible health plan find they can reduce employees’ financial exposure while expanding their benefits program. Employees can select and pay for the coverage they want, or employers can fund it — often at the same or lower cost than before with the premium savings from the higher-deductible health plan.

The increased choice of voluntary benefits also creates greater flexibility and customization demanded by today’s increasingly diverse workforce, the report says. Research shows there are large gaps between what employees list as “must-have” benefits compared with what employers offer, especially for accident, critical illness and hospital confinement insurance.⁴In fact, one recent study showed a third of employees tend to enroll in every type of coverage offered.⁵

“A strong benefits program is one of the most important tools employers have to compete for and keep their talented workforce,” Hesler says. “Those who broaden their vision beyond major medical coverage to include voluntary benefits will be ideally positioned to both manage the bottom line and give their business a competitive edge.”

Download a copy of the “Big-Picture Benefits” white paper at ColonialLife.com.

1 Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2016.
2 Bureau of Labor Statistics, Employment Cost Index, April 2017.
3 Board of Governors of the Federal Reserve System, “Report on the Economic Well-Being of U.S. Households in 2014,” 2015.
4 MetLife, 14th Annual U.S. Employee Benefit Trends Study, 2016.
5 Customer Benefits Analytics and Lodestar Advisory Partners, 2016 Employee Benefits Enrollment Study.

About Colonial Life

Colonial Life & Accident Insurance Company is a market leader in providing financial protection benefits through the workplace, including disability, life, accident, dental, cancer, critical illness and hospital confinement indemnity insurance. The company’s benefit services and education, innovative enrollment technology and personal service support more than 86,000 businesses and organizations, representing 3.7 million of America’s workers and their families. For more information visit www.coloniallife.com or connect with the company at www.facebook.com/coloniallifebenefits, www.twitter.com/coloniallife and www.linkedin.com/company/colonial-life. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.

View source version on businesswire.com: http://www.businesswire.com/news/home/20170626005790/en/

Colonial Life

Jeanne Reynolds, 803-678-6274
jdreynolds@coloniallife.com

Source: Colonial Life

https://insurancenewsnet.com/oarticle/new-colonial-life-report-encourages-bigger-view-of-employee-benefits

Worldwide cyberattack: Here's how to protect yourself

by Selena Larson   @selenalarsonMay 15, 2017: 9:09 AM ET

Europol: Ransomware preying on 'poor digital hygene'

One of the biggest-ever ransomware attacks continues to take computers hostage.

Friday's attack largely hit businesses and large organizations: U.K. hospitals, a Spanish telecom, FedEx (FDX), the Russian Interior Ministry, and more. And it's expected to cause more problems on Monday. Researchers recorded infections in tens of thousands of machines, and Europol estimated Sunday that the attack had spread to about 150 countries.

Ransomware is a type of malicious software that takes over a computer and locks the user out, preventing them from accessing any files until they pay money. This particular program, called WannaCry, asks for about $300, though the price increases over time.

Experts are advising infected users not to pay the ransom, because it is unlikely they will get their files back.

Businesses and large organizations are mostly at risk of this attack because of a flaw in a Windows protocol that many businesses use to share files.

WannaCry takes advantage of a vulnerability discovered by the NSA and made public by hackers in April. Microsoft (MSFT, Tech30) released a patch for the vulnerability in March. But computers and networks that didn't update their systems are still at risk.

On Friday, a security researcher inadvertently created a "kill switch" to help stop the spread of this ransomware. However, a hacker could rewrite the code to omit the kill switch and start trying to infect new machines with a new version of it.

Businesses sometimes take longer to install critical updates and patches, often to avoid impacting any older software they are running. In a surprise move over the weekend, Microsoft released a patch for versions of Windows it no longer supports -- because many businesses and organizations use legacy technology as critical infrastructure.

Matthew Hickey, cofounder of security firm My Hacker House, created a virtual inoculation for companies to use to prevent ransomware while they work on patching. The tool is called WCRYSLAP and can be found here.

"It gives you a little piece of the virus so that when your machine gets infected, the virus sees you already have an infection and quits. It stops the damage being caused," Hickey told CNNTech.

The tool doesn't stop the worm from spreading, but it prevents files from getting encrypted. Businesses need to patch to be completely protected, but Hickey's solution works for organizations that might need more time to upgrade.

Though the worm is primarily affecting business, individuals with PCs running Windows should still take a few precautions.

First, install any software updates immediately and make it a regular habit. Turn on auto-updaters where available (Microsoft offers that option). Microsoft also recommends running its free anti-virus software for Windows.

If you don't already have a backup routine, start now: Regularly save copies of all your files. That way, if your machine gets infected and your photos and documents are encrypted, you don't need to worry about losing them.

Finally, always stay alert. Don't click on links that you don't recognize, nor download files from people you don't know personally.

The cyberattack highlights how critical infrastructure and major organizations can be harmed by outdated software and technology. So while your own machine is clean, basic services that impact your life could still be at risk.

Heather Kelly contributed reporting.

CNNMoney (New York)First published May 15, 2017: 8:35 AM ET

http://money.cnn.com/2017/05/15/technology/ransomware-cyberattack-protect-myself/index.html?iid=EL