Appeals court rejects hospitals’ challenge to 340B cuts

From Modern Healthcare:

A federal appellate court on Tuesday rejected the American Hospital Association’s attempt to block HHS’ $1.6 billion in Medicare 340B reimbursement cuts.

In a unanimous decision, three judges from the U.S. Court of Appeals for the District of Columbia Circuit sided with HHS and ruled the hospitals’ suit was filed prematurely since hospitals had not formally filed claims with the secretary because they were not yet experiencing cuts. The hospitals had argued that they satisfied that condition by submitting comments during the comment period.

“When the plaintiffs filed this lawsuit, neither the hospital plaintiffs, nor any members of the hospital-association plaintiffs, had challenged the new reimbursement regulation in the context of a specific administrative claim for payment,” Judge Gregory Katsas wrote. “Nor could they have done so, for the new regulation had not yet even become effective.”

Anthem Sued by Doctors in Dispute Over Emergency-Room Coverage

From Bloomberg:

The health insurer Anthem Inc. was sued by doctors in Georgia for declining to pay for some emergency-room care, escalating a long-running battle over how far insurance plans can go to push patients to seek lower-cost treatment.

The American College of Emergency Physicians and the Medical Association of Georgia filed suit on Tuesday in U.S. District Court in Atlanta against Anthem’s Blue Cross and Blue Shield of Georgia unit over the denied payments. The doctors asked the court to require Anthem to halt its policy and cover the claims.

“Providers and patients alike are operating in fear of denial of payment by defendants when patients seek emergency department care,” the groups said in the filing.

“Emergency Physicians Save More Than Lives”

ACEP Press Release:

Patient satisfaction with emergency care is high, according to a new poll by Morning Consult that found more than three in four people (79 percent) reported being satisfied with their most recent emergency department visits.  Eighty percent said they trusted emergency rooms to provide patients with high-quality care, and nearly three in four people correctly said that emergency physicians are medical experts who are residency trained and board certified.

In celebration of its 50th anniversary, the American College of Emergency Physicians (ACEP), the organization instrumental in developing the specialty of emergency medicine, re-released a video to educate the public about emergency physicians and what they do.  https://www.youtube.com/watch?v=lsx3rnD9mbE

“We are all a heartbeat away from needing emergency care” is one of the key messages of the Saving Millions campaign, highlighting the incredible value of emergency medicine to every community and the efficiency and economic benefits of medical care provided in the nation’s emergency departments.  http://www.acep.org/savingmillions/.

“Emergency physicians provide 24-hour treatment and diagnosis with a broad spectrum of knowledge that is not available anywhere else in our health system,” said Paul Kivela, MD, MBA, FACEP, president of ACEP. “When an emergency occurs, nearly every doctor will tell patients to go to the emergency room. Quick thinking, access to care around the clock and unrivaled expertise make emergency physicians a critical resource for every community.”

Survey Methodology: This survey of 2,200 adults was conducted online by Morning Consult from June 13-15, 2018 on behalf of the American College of Emergency Physicians.  There is a margin of error of ± 2 percent.  For complete poll results, please click here or contact Steve Arnoff at sarnoff@acep.org.

ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.

Report finds 90 percent of rural hospital closures happen in states that did not expand Medicaid

From the Times:

A recently released report found that hospitals are six times more likely to close in states that did not expand Medicaid than those that did.

A report compiled and released by Protect Our Care, a pro-Affordable Care Act coalition, found that 90 percent of rural hospitals that have closed since 2010 have been in states that had not expanded Medicaid at the time of the hospital’s closure.

Of the 84 rural hospitals that have closed since 2010, four have been in Missouri. SoutheastHEALTH Center of Reynolds County, Parkland Health Center–Weber Road in Farmington, Sac-Osage Hospital in Osceola, and Twin Rivers Regional Medical Center in Kennett — which closed June 11, 2018 — have all closed in the last four years.

According to the report, Medicaid expansion expands access to health care in rural communities, reduces rural hospitals’ uncompensated care costs, and helped rural health providers keep their doors open.

Family members of Dr. Henry Heimlich say Red Cross guidance on choking victims could end in death

From the Herald & Review:

You’re dining in a restaurant when someone at a table nearby starts choking. As they gasp for air — and help — a bystander rushes to their aid.

If the bystander in this dramatic scene were trained in first aid at the American Red Cross, then the choking victim could be in trouble, say Janet and Phil Heimlich, adult children of the late Dr. Henry Heimlich, whose namesake maneuver to help choking victims was developed in 1974.

Current Red Cross guidelines advise administering five blows to a conscious choking victim’s back with the heel of the hand, and then performing abdominal thrusts _ the Heimlich maneuver. Heimlich, who said his technique saved thousands of lives, spent decades condemning the mixture of methods, arguing that the blows could actually drive an object lodged in someone’s windpipe deeper into the airway.

Heimlich, who died in 2016 at 96, also maintained that there wasn’t scientific evidence proving the back blows actually work. Citing this, and recent high-profile uses of the Heimlich maneuver, Janet and Phil Heimlich this month launched their “Hug, Don’t Hit” campaign to educate the public on the technique’s significance. The announcement is the latest development in a long-running disagreement between some members of the Heimlich family and the Red Cross.

CMS physician payment proposal nudges open the door for telehealth

From Fierce Healthcare:

Telehealth advocates are rejoicing over last week’s physician payment proposal that would reimburse physicians for certain virtual interactions, a move that some see as a significant first step in overcoming the telehealth payment obstacle.

Buried in the 1,473-page proposed rule released last week by the Center for Medicare & Medicaid Services are several new proposals to pay physicians for virtual check-ins and reviewing patient photos or videos using asynchronous or “store-and-forward” transmission.

CMS also proposed adding new billing codes for “prolonged preventative services,” along with three new remote monitoring reimbursement codes recommended by ACT, The App Association.

Jennifer Breuer, a partner with Drinker Biddle, said the proposed rule is a “game-changer” for the telehealth industry if it is finalized in its current form.

“What this really would do is create some pretty broad-based reimbursement for telehealth services not just in rural locations and not just in a healthcare facility, as is currently the case,” she told FierceHealthcare.

 

Emergency Physicians Offer Recommendations for Identifying and Managing Opioid Use Disorder

From Clinical Pain Advisor:

American emergency medicine physicians have been taking measures to address the ongoing opioid crisis, which affects emergency departments (EDs) throughout the country, according to a clinical review article published in the Annals of Emergency Medicine. After assessing current ED protocols for dealing with patients diagnosed with or suspected of opioid use disorder (OUD), the investigators formulated 4 recommendations aiming to better identify individuals with OUD, treat acute withdrawal syndrome, implement medication-assisted therapy (MAT), and transition those affected to outpatient care.