Providers wary of capped Medicare system

On the Hill

In response to overtures from congressional Republicans regarding an intended transformation of Medicare in the coming term, providers are voicing their concerns over a program capping federal spending. The proposed changes from congressional Republicans offer two different approaches, both departures from the current system. The first would cap federal funds on a per person basis. The second is to distribute funds via block grants which give block sums to states to cover low-income residents, regardless of the number of enrollees. However, providers are warning that such alterations would have a negative impact, forcing hospitals to take deep funding cuts and leave millions of low-income patients without access to affordable care. According to providers, other calls to avoid cuts include cuts to Medicaid, which is already unable to adequately cover costs, would lead to massive reductions in services.

On Nov. 29, President-elect Donald Trump officially announced his selection of Representative Tom Price (R-GA) to serve as his Secretary of Health and Human Services. Rep. Price is a board certified surgeon who has served as the House Budget Committee Chairman since last year and serves on the Ways & Means Subcommittee on Health. He is a vocal opponent of the Affordable Care Act (ACA) and has stated his intentions to repeal it. He has served in the U.S. House of Representatives since 2004. President-elect Trump has also selected Seema Verma to serve as Administrator of the Center for Medicare and Medicaid Services (CMS). Ms. Verma is currently the President,Founder and CEO of SVC, Inc., a health policy consulting firm. Ms. Verma previously served as the head of Indiana’s healthcare overhaul following the passage of the ACA and is credited as the architect of Healthy Indiana Plan, a Medicaid policy program.

House and Senate lawmakers have introduced a compromise 21st Century Cures bill in hopes of passing the legislation during the lame duck period. The compromise includes several measures friendly to drug and medical device industries without containing offsets or measures aimed at controlling drug pricing. Lawmakers plan on using the ACA’s prevention fund to pay for the costs of implementing the legislation. In other updates to the bill, a provision that would have weakened the Physician Payments Sunshine Act has been dropped after protests from the Act’s main architect, Senator Chuck Grassley (R-IA), and a new measure exempting Medicare site-neutral pay cuts to hospital outpatient departments that were in development when the site-neutral law took effect on Nov. 2, 2015. The provision would have ended requirements that physicians and teaching hospitals report payments from drug and device companies to continuing medical education or for medical journal reprints and textbooks.

In the courts

Since 1981 the Center for Disease Control has mandated that all healthcare workers be vaccinated annually, but it was not until 2010 that the Department of Health and Human Services called for the flu vaccination rate to reach 90 percent by the end of the decade. However, as hospitals push towards mandatory vaccines, more workers are pushing back claiming religious exemptions. The Equal Employment Opportunity Commission has seen a spike in complaints stemming from workers who allege that they were fired for refusing a vaccine, creating a growing body of litigation. Additionally, hospitals are struggling with Title VII claims, which obligates employers to “reasonably accommodate” employees who assert a religious exemption to the flu vaccine.

On Nov. 15, the Pennsylvania Supreme Court passed down five orders that vacated lower courts’ rulings in instances where the estates of deceased persons won wrongful death and survival claims against nursing home operators. The state Supreme Court referred to its own ruling in September that found that a lower court’s decision to consolidate these types of claims against nursing home operator Extendicare violated the Federal Arbitrations Act. The state Supreme Court sent back all five cases to be reconsidered, saying that survival claims brought as part of a wrongful death suit can be severed for separate arbitration hearings.

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