NCHC Applauds Senate Vote to End SGR, Looks Ahead to Post-SGR Priorities

“The National Coalition on Health Care (NCHC) and its member organizations applaud important steps taken by Congress moving from volume to value as the basis for physician reimbursement. That’s good for physicians, good for patients, and potentially good for a more sustainable Medicare program. We are all pleased that an end to SGR’s mandated Medicare cuts and an additional two years of secure children’s coverage are headed to President Obama’s desk.

“NCHC has expressed reservations regarding H.R. 2’s offsets. But after years of gridlock, it’s important that lawmakers chose a common path forward—a path built around value-based payment, transparency, and innovative models of care. With cost pressures growing for employers and families, our nation will soon face a similar choice again: embrace additional policies that accelerate our progress toward value or slip backwards to additional beneficiary cost-shifting and blunt provider cuts.

“NCHC is already working hard to ensure that we keep moving forward—starting with our Capitol Hill Forum tomorrow morning, Health Policy after the SGR:  What’s Possible in Value-Based Payment and Benefits. And in the coming months, NCHC and its members look forward to working with Congress and the administration to build and improve upon H.R. 2’s reforms.”

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NCHC Applauds House Vote to End SGR, Advance Health Care Delivery and Transparency Reforms

“The House has now voted overwhelmingly not just to end SGR’s automatic Medicare cuts but to enact delivery reform and transparency measures that can make health care more affordable for all of us. We applaud them for their leadership.

“This compromise bill is not perfect. NCHC has long supported an alternative approach to offsets through stronger delivery and prescription drug reforms, not cost-shifting to beneficiaries or others. We also prefer a longer CHIP extension and a long-term solution for Medicare therapy caps.

“But failure to act could jeopardize care for seniors, children, and disabled Americans while leaving unchecked the fee-for-service incentives at the heart of our health care cost problem. In the next few days, Congress must work together to get these important reforms to the President’s desk.”

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NCHC President and CEO John Rother Urges House Passage of SGR/CHIP Legislation

WASHINGTON, DC – National Coalition on Health Care (NCHC) President and CEO John Rother urged House passage of H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015 in a letter to the members of the House of Representatives today.

“This legislation is far from perfect, but Speaker Boehner and Leader Pelosi have crafted a strong compromise that can make health care more affordable–for families and the country as a whole,” wrote Rother. “I urge you to act this week to strengthen Medicare and finally consign the Sustainable Growth Rate (SGR) to the history books.”

The full text of the letter can be found here.

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House SGR/CHIP Deal Enhances Health Care Affordability

“Congress now has the opportunity to strengthen Medicare and end the annual need to cut the program to avoid drastic physician reimbursement reductions. Speaker Boehner and Leader Pelosi have crafted a framework that, over time, can make health care more affordable–for families and the country as a whole. Without action, Medicare physicians will see their reimbursement slashed, children could see their coverage taken away, and an outmoded fee-for-service system will continue to drive up the cost of health care.

“The House strategy is to pair a repeal of threatened  provider cuts with real, long-term reform. The full legislative package would:

  • Move Medicare past its current fee-for-service system by encouraging physicians to embrace new care and payment models, which are driving down costs in the private sector;
  • Introduce new transparency reforms that will help Americans know exactly what they’re paying for at the hospital and doctor’s office;
  • Preserve CHIP and its investments to ensure the next generation is healthier (and less costly long-term);
  • Make permanent beneficiary protections for those moving from welfare into a job or for those who make under $15,750 a year; and
  • Yield substantial reductions in federal spending over the next two decades… without broad-based cuts to benefits or increases to original Medicare’s deductibles.

These are important legislative achievements.

“But in Washington as in life, nothing good comes free. Those physicians who prosper simply by ordering more procedures and tests will have to accept having a greater share of their reimbursements tied to value. The hospital and nursing home industries will have to accept $30 billion in lower payments over ten years.  And, it may be that 2% of Medicare beneficiaries who make more than $133,000 a year will have to accept a higher premium, and, beginning in 2020, that those who purchase certain new Medigap policies will have to shoulder a small deductible in their supplemental plan.

“NCHC has repeatedly urged Congress to pursue offset alternatives that achieve savings through better care, not shifting costs. And over the next few days, we will continue working with our member organizations to ensure final legislation does more to curb wasteful or unnecessary costs and offer the best possible deal for kids and seniors.

Failure to act now will only increase the cost of a solution later—for taxpayers and beneficiaries. If you’re a working parent who needs CHIP to keep your kid covered, or if you’re a senior who wants your Medicare to be there for the long haul, you need this deal to get done. These important reforms must not wait.”

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Broad Support for Bipartisan Data Sharing Legislation

Washington, D.C. (March 11, 2015) – Today, 37 organizations representing patients, providers, insurers, employers and researchers called on Congress to quickly pass bipartisan legislation that amends the Qualified Entity (QE) statute to allow for broader sharing of Medicare data. The Quality Data, Quality Healthcare Act was introduced on March 9th by Senators Tammy Baldwin (D-WI) and John Thune (R-SD). The House version of the proposal was introduced on February 6th by Congressman Paul Ryan (R-WI) and Congressman Ron Kind (D-WI).

Joel C. White, President of the Council for Affordable Health Coverage and head of the Clear Choices Campaign, said, “This bill will put data in the hands of experts who will be able to identify and correct many of the problems plaguing our health system – high cost, poor quality, bad health outcomes. We are encouraging Congress to take the bill up immediately.”

The legislation will provide more flexibility to data crunchers, known as Qualified Entities, by permitting them to use and share actionable data with providers, payers and health care consumers. The bill revises the QE program by broadening non-governmental access to claims data collected under the Medicare program. Current law, enacted in 2010, gives QEs access only to Medicare claims data (Parts A, B and D), and requires that all analyses be published. The reforms would permit QEs to provide analyses and, in some cases, data for a range of non-public uses, such as assisting providers in developing and participating in quality and patient care improvement activities, population health management, disease monitoring and insurance network development and selection.

As a result, the legislation will:

  • Double the amount of data available for analysis;
  • Expand the number of experts who can analyze the data; and
  • Permit more uses of the data, such as for developing new models of care, improving benefit design, or identifying wasteful or unsafe practices.

John Rother, President and CEO of the National Coalition on Health Care said, “By enabling consumer transparency tools to draw on Medicare’s vast trove of cost and quality data, these reforms will bring us closer to the day when every consumer can access clear understandable cost and quality information on their provider and treatment choices.”

The bill has been included in numerous proposals, including:

  • SGR Repeal and Medicare Provider Payment Modernization Act of 2014
  • House Ways and Means Health Subcommittee Chairman Kevin Brady’s Hospital Improvements for Payment (HIP) Act of 2014 Discussion Draft
  • House Energy and Commerce Committee Chairman Fred Upton’s 21st Century Cures Discussion Document White Paper

In addition, the President’s FY 2016 Budget included a proposal to expand data sharing through the QE program.

“Healthcare costs are rising faster than quality is improving,” says Dr. John Toussaint, CEO of ThedaCare Center for Healthcare Value. “Healthcare cost and quality data, including Medicare data, are largely unavailable to purchasers and consumers, so the market can’t reward the ‘good guys.’ Medicare’s qualified entity program was a well-intended program to make Medicare data available for assessment of cost and quality, but there are limits in the statute as to how the data can be used.”

Elizabeth Mitchell, CEO of the Network for Regional Healthcare Improvement, added, “We believe that Medicare data contains critical information that if made more fully available would help empower communities across the country to identify opportunities to improve value in healthcare.”

White concluded, “The QE language is a product of many compromises carefully crafted over years of intense, bipartisan negotiations,” he said. “There aren’t many things Republicans and Democrats agree on these days, but providing additional data to promote a better, lower cost health system is clearly one of them. With such overwhelming support for better tools to shop for better, more efficient care, health care transparency is a win for consumers, payers and politicians.”

Endorsing the QE language is a diverse group of stakeholders, from AARP to the National Association of Manufacturers, including both supporters and critics of the Affordable Care Act. The letter can be found here.

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The Time is Now for Action on SGR and CHIP

“Congress has to get moving on the Medicare Sustainable Growth Rate (SGR) and the Children’s Health Insurance Program (CHIP).

On Friday of this week, Congressional advisors from MedPAC will urge the rollback of SGR’s automatic physician payment cuts. Their counterparts at MACPAC will ask Congress to keep bipartisan CHIP funded for all of the 8 million kids that depend on it.

Yet at this moment, all signs point to  another short-term SGR patch, paid for by yet another year of meat-ax sequestration cuts. Moreover, partisan maneuvering is threatening to derail action on CHIP, which would leave kids’ coverage in limbo and huge holes in state budgets.

It doesn’t have to be this way. Billions in savings can be found by curbing waste in Medicare—without shifting costs to beneficiaries or slashing provider reimbursement across the board. Reauthorization of CHIP is also entirely possible—without squeezing kids coverage. But both will require bipartisan dialogue and cooperation. NCHC is prepared to work with Congressional leaders to identify smart savings.

In the next two years, our divided government will have to grapple seriously with the challenge of rising health costs. Responsibly addressing SGR and CHIP would be a great way to start.”

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NCHC Pushes for Affordability Measures in 21st Century Cures Bill

WASHINGTON, DC – National Coalition on Health Care (NCHC) President and CEO John Rother urged the Energy and Commerce Committee to include measures to improve prescription drug affordability in 21st Century Cures legislation in a letter to Chairman Fred Upton (R-MI) yesterday.

“…the speedier introduction of treatments will mean nothing if patients and our health system cannot afford them. NCHC is gravely concerned that the discussion draft ignores the fundamental challenge of affordability,” said Rother in the letter. “Just nine months after its launch last June, the 21st Century Cures Initiative has helped bring the stakeholder community, lawmakers of both parties, executive branch agencies, and the White House together in a common effort to support innovation. But moving forward with legislation that fails to address affordability would not be reflective of the spirit of cooperation…”

The letter was sent in response to an open call for feedback from stakeholders on the 21st Century Cures Discussion Draft, released at the end of January.

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NCHC Urges Prompt House, Senate Action on Bipartisan Health Care Fraud Bill

“This legislation provides the tools necessary to fight the up to $60 billion in fraud and abuse that impacts Medicare beneficiaries every year. NCHC urges the House and Senate to act quickly on this important legislation.

“PIMA is an example of what can be achieved when legislators from both parties stop arguing about health care costs, and actually do something about them. On issues like physician payment reform and children’s health coverage, we will need more such leadership very soon.”

The legislation incorporates elements from a number of other proposed bills including the Medicare PRIME Act which had previously been endorsed by NCHC. PIMA would

  • Require a single national prescriber identifier for pharmacy claims to allow better tracking and identification of prescription drug diversion and fraud;
  • Improve the Senior Medicare Patrol program which engages Medicare beneficiaries in reporting and combatting fraud;
  • Incentivize state participation in the Medicare-Medicaid Data Match program, which allows authorities to better identify those perpetrating fraud across both programs; and
  • Enable Medicare drug plans, for the first time, to establish pharmacy management programs designed to limit abuse or diversion of opioids and similar medications.

The legislation was co-sponsored by Ways and Means Health Sub-Committee Chairman Kevin Brady (R-TX) and Ranking Member Jim McDermott (D-WA).”

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NCHC Joins ACOs, Other Providers to Urge Improvements to Medicare Shared Savings Program

The National Coalition on Health Care (NCHC) joined with prominent organizations representing physicians, hospitals, and ACOs to push for reform to the Medicare Shared Savings Program (MSSP) in a comment letter submitted today.

“If we’re going to evolve beyond today’s costly, underperforming volume-based health care, Medicare must do more to expand the MSSP and help providers move to more advanced models,” said John Rother, NCHC’s President and CEO.

Along with NCHC, the letter’s signatories include American Academy of Family Physicians, American College of Physicians, American Medical Association, American Medical Group Association, Association of American Medical Colleges, Collaborative Health Systems, Medical Group Management Association, National Association of ACOs, Premier healthcare alliance, Trinity Health, and a subsidiary of Universal American. The letter was submitted in response to the Centers for Medicare and Medicaid Services (CMS)’s proposed rule on the MSSP, Medicare’s premier ACO initiative.

To ensure the MSSP delivers on its potential, the letter offers 35 pages of detailed recommendations aimed at five key priorities:

  • Strengthening the process of assigning Medicare beneficiaries;
  • Establishing a more appropriate balance between risk and reward;
  • Adopting payment waivers to eliminate barriers to care coordination;
  • Modifying the current benchmark methodology to promote ACO participation; and
  • Providing better and timelier data.

The proposals outlined in the letter would also allow beneficiaries to choose an ACO to be responsible for their care and, at the ACO’s prerogative, receive certain primary care services without cost-sharing.

According to Rother, much depends on CMS’ forthcoming ACO rule: “The signatories to this letter represent physicians, hospitals, and ACOs that are ready to deliver the better care at lower cost our nation needs. CMS must enable them to do so.”

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American College of Physicians Joins Campaign for Sustainable Rx Pricing

The American College of Physicians, the largest medical-specialty organization and second-largest physician group in the United States, has joined the Campaign for Sustainable Rx Pricing (CSRxP), a broad-based coalition working for solutions to skyrocketing prescription medicine prices.

“ACP members work on the front lines of our health care delivery system and have witnessed firsthand the harm caused to patient health and personal finances by unsustainable pharmaceutical drug prices, especially those for new specialty drugs,” says John Rother, President and CEO of the National Coalition on Health Care, which leads CSRxP. “Exorbitant drug prices deny patients access to life-enhancing medicines and result in higher out-of-pocket costs, premiums, and taxes. To prevent our health care system from going bankrupt, we need to establish a drug pricing structure based on value and data-driven evidence and balance between the interests of innovative drug manufacturers and those of society and our health care system.”

“The pricing of specialty drugs increasingly lacks transparency and rationality,” says ACP President David A. Fleming. “We’re seeing the introduction of many patent-protected drugs with monopolistic pricing power that fail to demonstrate a relationship between their price and their value to the health care system. Though many of these medications offer great promise, the price tag for health care clinicians and patients is simply too much to bear. We look forward to working with the Campaign for Sustainable Rx Pricing to address these challenges.”

In 2013 specialty drugs accounted for less than 1 percent of U.S. prescriptions but for more than 25 percent of prescription spending. By the end of the decade, just 2 to 3 percent of all prescribed medications will be specialty drugs, but they will account for roughly 50 percent of the total drug spend, according to CVS Health.

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