Can new CMS policy save rural hospitals?

Presented by PhRMA: Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy.

Feb 13, 2023 View in browser   By Daniel Payne and Krista Mahr Presented by Driving the Day A Medicare policy change could help keep some rural hospital doors open. | Brynn Anderson/AP Photo A LIFELINE FOR A FEW — Some rural hospitals, facing the end of pandemic-era cash and eased regulations, are moving toward a new Medicare designation that could help keep them from closing. The Rural Emergency Hospital designation, aimed at sustaining emergency rooms, outpatient care and clinics, will be a major consideration for a significant number of hospitals, according to a new report from Chartis, a health care consulting group. The policy changes are among the largest made to the rural health system in years. Through Medicare, hospitals that agree to the program requirements are guaranteed a set amount of money for facilities and a boosted Medicare reimbursement rate. About 400 hospitals are “most likely” to consider conversion, according to the analysis, with about 80 of those “ideal” candidates for the change — often facilities on the brink of closing without growing revenues. Several dozen hospitals are expected to move toward the new designation in the next 12 to 18 months “because they’re right on the ropes,” Michael Topchik, national leader of the Chartis Center for Rural Health, told Pulse. Another group will wait and see how the first group does under the new rules, he said. Still, most of the nearly 1,600 rural hospitals aren’t interested. The designation requires giving up inpatient care, a key part of many hospitals’ business and a handful of financial incentives offered through other rural health programs. That doesn’t mean rural hospitals are thriving, though. Closures slowed significantly during the pandemic, likely because of the government’s infusion of resources through the pandemic, but are again ticking up. More than 40 percent of rural hospitals have negative operating margins, the report, presented last week to administration and congressional officials, found. But REH’s impact across the rural health landscape could change. Major provider groups have put REH in their sights for 2023, hoping to tweak the program to make it more attractive to hospitals not interested. And policymakers, just weeks into the new offering, are thinking about how the program might be changed to include more hospitals — from allowing the inclusion of the 340B drug discount program to offering a middle ground for some inpatient services. “I think they have put in place a solution that solves one major problem, which is stop the bleeding,” Topchik said. “We don’t want to lose another vital point of access in Rural America. And this really does achieve that.” WELCOME TO MONDAY PULSE. Are you working at a hospital that plans to take the new designation? Have health news or a tip? Drop us a line at dpayne@politico.com and kmahr@politico.com. TODAY ON OUR PULSE CHECK PODCAST, host Katherine Ellen Foley talks with Erin Schumaker about Biden's cancer moonshot, the $1.8 billion that Congress has appropriated for it and the cancer researchers who are less unified about the moonshot than Washington, D.C., policymakers. Listen to today’s Pulse Check podcast   A message from PhRMA: Costly out-of-pocket expenses tied to deductible and coinsurance requirements are a leading concern for patients with commercial insurance. These harmful practices put in place by insurers and pharmacy benefit managers (PBMs) are even causing patients to abandon their medicines. New IQVIA data break down how insurers and their PBMs are impacting how patients access and afford their medicines.   HEALTH TECH A new report shows how easy it can be to access patients' mental health data. | Morris MacMatzen/Getty Images MENTAL HEALTH DATA MARKETPLACE — Data brokers are willing to sell sensitive mental health data with names, addresses and demographic information, according to a new report from Duke University’s Technology Policy Lab. POLITICO’s Alfred Ng and Ruth Reader report the new findings could push regulators — already showing interest in tamping down data-sharing — to do more to police health companies. After making inquiries to 10 data brokers, researchers found they could get specific information on people’s conditions — without being vetted as a buyer. Abortion DAs IN DANGER — Republicans are clashing with district attorneys over how to enforce abortion bans, POLITICO’s Alice Miranda Ollstein and Megan Messerly report. Even after enacting near-total abortion bans, some GOP lawmakers have trouble getting prosecutors to enforce them. In Georgia, Indiana, South Carolina and Texas, conservative lawmakers have introduced bills that would allow state officials to either bypass the local prosecutors or kick them out of office if their abortion-related enforcement is deemed too lenient. The legislation comes after some DAs have publicly pledged not to bring charges against people who break laws restricting abortions. It’s an issue that goes beyond abortion. The mounting tension between Republican lawmakers and local prosecutors is also evident in recent battles over drug laws, property crimes and other offenses. As more prosecutors, particularly in progressive cities in red states, win elections by breaking with the decadeslong tough-on-crime mindset and running as a check on GOP lawmakers, conservative state officials say they need to rein in their excesses.   DOWNLOAD THE POLITICO MOBILE APP: Stay up to speed with the newly updated POLITICO mobile app, featuring timely political news, insights and analysis from the best journalists in the business. The sleek and navigable design offers a convenient way to access POLITICO's scoops and groundbreaking reporting. Don’t miss out on the app you can rely on for the news you need, reimagined. DOWNLOAD FOR iOS– DOWNLOAD FOR ANDROID.     Public Health STATE OF CANCER RESEARCH — President Joe Biden’s pledge to “end cancer as we know it” is one of the few issues that enjoys solid support from Democrats and Republicans alike, with Congress appropriating $1.8 billion for the cancer moonshot program. But POLITICO’s Erin Schumaker and Ruth Reader report that cancer researchers are less unified on the initiative than federal policymakers, with some asking whether the money is being well spent. Cancer research is funded well enough, a group of researchers said, and increased investing in high-tech individualized treatments is more likely to help the wealthy live longer than it is to save those most likely to die from the disease: the poor and people of color. The White House is pressing ahead, though, as some researchers developing new technologies say treatments have been changing significantly in recent years. Others have pushed instead for more work to prevent cancer risks like drinking, smoking, pollution and poor nutrition. SUICIDES AGAIN ON THE RISE — After declining for two years in a row, the number of suicides increased in 2021, according to new data from the CDC. That growth was particularly pronounced among Native American, Black and Hispanic people. White Americans saw a slight decline. Disparities by age groups were also notable in the data, with people ages 45 to 64 seeing a significant decline and the rate of those 25 to 44 increasing. Some health experts worry the pandemic’s effect on mental health in the U.S. will only now begin to be fully seen — a concern also reflected in the CDC analysis. In Congress LAWMAKERS ASK FOR CONTINUED TEST COVERAGE — In a letter to be sent today to CMS Administrator Chiquita Brooks-LaSure, more than 20 lawmakers are asking the administration to continue coverage of at-home Covid tests for Medicare beneficiaries after the public health emergency ends. The request comes as HHS releases details of policies that will change at the PHE’s end set for May 11. The administration said Medicare beneficiaries’ access to free over-the-counter tests will end “consistent with the statute … set by Congress.” But the lawmakers are asking for more information about the agency’s authority to continue the program beyond the PHE.   A message from PhRMA:   On K Street PPE MAKERS LOOK FOR AN ASSIST — American manufacturers of personal protective equipment have formed a new coalition to press for federal policy change, POLITICO’s Caitlin Oprysko reports. The group is looking for a fairer shake in the procurement process to address vulnerabilities in the PPE supply chain exposed during the pandemic’s early days. The American Medical Manufacturers Association will lobby for increased market access and manufacturing capacity for PPE made in the U.S. but also work to highlight what the group says are unfair marketing practices by Chinese manufacturers, leading to the sale of cheaply made products that are successfully competing with those made in the U.S. Initial members of the new group include Altor Safety, Aquaspersions USA, Blue Star NBR, Lutema, Ochsner Health, Premium-PPE, SafeSource Direct, United Safety Technology and Vizient, who will back the coalition’s push to incentivize purchases of American-made PPE in both the private and public sectors at the federal, state and local levels.   STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president’s ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today.     Names in the News Sen. Mike Crapo (R-Idaho) will serve as ranking member of the Senate Finance Committee. Joining him as committee staff: Rebecca Alcorn, policy adviser; Gable Brady, senior health policy adviser; Erin Dempsey, deputy health policy director; Kellie McConnell, health policy director; Stuart Portman, senior health policy adviser; Charlotte Kaye Rock, health policy adviser; and Conor Sheehey, senior health policy adviser. Aaron Cohen is now VP of government affairs at Neurocrine Biosciences. He previously was a partner at Capitol Counsel and is an alum of former Sen. John Ensign. Lizzy Letter is now staff director for Sen. Bob Casey (D-Pa.) on the Senate Aging Committee. She previously was deputy assistant secretary for oversight at HHS’ Office of the Assistant Secretary for Legislation. Matt Cournoyer will be policy analyst for the CFPB’s Section for Public Engagement and Community Liaison. He previously was a social science analyst at HHS’ Office of the Assistant Secretary for Planning and Evaluation. What We're Reading NPR reports that Johns Hopkins’ influential Covid tracker is shutting down. The Wall Street Journal reports on growing waits at abortion clinics drawing out-of-state patients.   A message from PhRMA: Every day, patients at the pharmacy counter discover their commercial insurance coverage does not provide the level of access and affordability they need. New data from a study by IQVIA reveal the harmful practices of insurers and their pharmacy benefit managers (PBMs) can lead to significantly higher out-of-pocket costs for medicines — causing some patients to abandon their medicines completely. Learn more.     Follow us on Twitter Dan Goldberg @dancgoldberg Katherine Ellen Foley @katherineefoley Lauren Gardner @Gardner_LM Ben Leonard @_BenLeonard_ David Lim @davidalim Krista Mahr @kristamahr Megan Messerly @meganmesserly Alice Miranda Ollstein @aliceollstein Carmen Paun @carmenpaun Daniel Payne @_daniel_payne Ruth Reader @RuthReader Erin Schumaker @erinlschumaker Megan R. Wilson @misswilson   Follow us

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