From: Miceli, CharlesTo: Gobeille, Al; Keating, Todd; Schapiro, Howard M.; Miller, Eric S.; Network VP; UVMMC Operations Team; Supply Chain

Contracting Distribution List; Sullivan, Zachary; Dussault, ChrisSubject: FW: Trends and Health Policy Developments, 7/12/20, Insights to keep our members ahead

Premier is a group purchasing organization (GPO) like Vizient; a few years ago, Premier purchased the ERPsystem(Supply Chain/AP/GL) Mediclick/Aperek/now Premier Connect., the UVMHN ERP is PremierConnect, we now have access to this weekly report out

From: Childs, Blair <Blair_Childs@PremierInc.com> Sent: Sunday, July 12, 2020 6:36 PMSubject: Trends and Health Policy Developments, 7/12/20, Insights to keep our members ahead Two things stand out as we go into the next week.  First, is the exponential growth ofCOVID cases.  It took the U.S. 97 days to reach the first 1M cases, 44 to reach the 2nd millionand only 27 days to top the most recent million. Increased testing definitely explains part ofthis increase as seen in the chart below, but the trend underscores the effectiveness of thelock down as well as the need for greater conscientiousness now by Americans andorganizations and targeted policy actions. 

 In fact, hospital systems have again suspended elective surgeries in hot spots in surgingstates, including Alabama, California, Florida, Mississippi and South Carolina.  Texas Gov.Greg Abbott mandated suspension of elective surgeries in an additional 105 of the state’s 254counties (surgeries had already been suspected in 8 counties). Overall, while hospital bedsand ICUs are stressed in some locations, most states, and nationally, there is capacity. Second is the professionalism and rapid learning by America’s healthcare providers.  In spiteof the increase in the number of cases, outcomes as measured by hospitalizations perconfirmed case and deaths have declined. Therapeutic discoveries, insights learned fromthe care of early cases and rapid information sharing speaks to the remarkable capabilities ofyou and our other members.  Thank you for your work. 

You can subscribe for these Nephron reports at this link. Congress remains in recess this week.  Here are this week’s major developments withmore details below. First, all eyes are on the Senate to begin the process to hammer out an agreement on thenext COVID relief package.  The administration announced that it wants to cap the amountspent on this package at $1T, well below the House’s $3.5T Heroes Act price point.  This willbe a challenging negotiation with flash points being overall cost, support for state andlocal government, provider relief, liability protection.  Legislation should be unveiled by Senate Republican in the next 2 weeks.  Odds still favoraction because: ·         Surging COVID cases will drive action, particularly around support for COVID mitigation

provisions focused on testing, contact tracing, vaccines...

 ·         Lawmakers will not want to return to their districts to campaign without having

demonstrated further action. 

·         State and local governments are financially stressed. 

·         Expiration of the employer Payroll Protection Program as well as expiring expandedunemployment benefits and eviction protections.

 This is a critical week to communicate to lawmakers about your priorities.  Here areissues being advanced by the hospital and provider community: ·         Additional Provider Relief Fund payments, as well as fixes to the Medicare accelerated

payment program and forgiveness accelerated hospital payments.

 ·         Protection against loss of eligibility for 340B drug pricing program during the public

health emergency (see more on that below).

 ·         Telehealth reforms removing originating site requirements and expanding Medicare

allowed codes. Reforms, however, will be modest with CMS having ultimate authority.  

·         Liability protections for facilities and front-line medical providers amid the pandemic.

 ·         Banning implementation of the administration’s Medicaid Fiscal Accountability and

Responsibility (MFAR) rule, which is slated to be finalized in September.

 ·         Inclusion of the Resident Physician Shortage Reduction Act of 2019 (S. 348/H.R.

1763), provides an increase in Medicare support for physician residency training throughgraduate medical education (GME) to address physician workforce shortages.

 ·         A permanent hospital emergency fund in anticipation of future public health emergencies

and increased funding for the Hospital Preparedness Program. Premier is also pushing our key priorities, including: ·         Adjusting the APM incentive payment and patient count thresholds in MACRA to

ensure more clinicians have the opportunity to become a Qualifying APM Participant (QP)and participate in Advanced APMs (AAPMs). Email Duanne Pearson and/or Aisha Pittmanto help advance this provision. 

·         Fixing the benchmark formula for ACOs so that success in saving money will not countagainst their future success. The Rural ACO Improvement Act (S. 2648) and theAccountable Care In Rural America Act (H.R. 5212) address this problem.

·         Securing funding to expand syndromic surveillance to detect, identify, model andtrack emerging infectious disease in ambulatory, hospital and non-acute settings.

 

Premier also continues to be heavily engaged with both lawmakers and administration officialson improvements to the healthcare supply chain and the Strategic National Stockpile,which will be addressed in legislation later in the year. Second, there were several new developments regarding the COVID-19 Provider Relief Fund: ·         HHS announced it is expanding the criterion to qualify for payments for safety net

hospitals, adding $3B in Provider Relief Fund payments to an estimated 215 acute carehospitals that did not qualify for funding from the initial June 9 announcement. Thesehospitals must meet a revised profitability threshold of <3% averaged consecutively over ≥2of the last 5 cost reporting periods, as reported to CMS in its Cost Report filings.  This willbring the total payments for safety net hospitals from the Provider Relief Fund to $12.8B to959 facilities. Here is a state-by-state breakdown of these payments. 

·         HHS is also revising the existing payment formula for a May funding tranche so as toinclude certain special rural Medicare designation hospitals in urban areas as well asothers who provide care in smaller non-rural communities. These may include somesuburban hospitals that are not considered rural but serve rural populations and operatewith smaller profit margins and more limited resources than larger hospitals. HHS estimatesit will distribute $1B to 500 of these hospitals. Here is a state-by-state breakdown of thesepayments.

 ·         HHS is also opening the provider portal to dentists who may not have previously been

eligible to receive funding through the Provider Relief Fund. HHS indicated this 2nd phase ofGeneral Distribution will continue to expand to include other providers submittingapplications for future relief funding opportunities or as directed by HHS. 

·         HHS posted a new factsheet on the $15 billion Medicaid and CHIP ProviderDistribution from the Provider Relief Fund. This distribution, which was announced on6/9, is intended for eligible Medicaid and CHIP providers who had not received paymentfrom the earlier General Distribution. Each eligible Medicaid and CHIP provider will receiveapproximately 2% of reported gross annual revenue.

 

To receive funding from the Medicaid and CHIP Provider Distribution, eligibleproviders must apply by 7/20/20. HHS will make payments on a rolling basis. Similarto earlier distributions, providers will need to attest to certain Terms and Conditions.

 

·         HHS plans to release additional information in the coming weeks on reportingrequirements for providers who have received funds. As a reminder, the Terms andConditions for all Provider Relief Fund payments require recipients to submit anyreports requested by the Secretary that are necessary to allow HHS to ensurecompliance with payment Terms and Conditions.

 See Premier’s updated summary of COVID-19 funding opportunities for healthcare providershere. Third, Premier is focused on the success of our members in reopening and restoring thehealth of their communities.  Here are initiatives and opportunities for consideration:

 ·         Premier data found that outpatient volume in the 2nd half of March declined >65%,

underscoring the importance of getting neglected patients in for care and practices backonline.  We discuss a variety of strategies to help you adjust to this new normal, includingpatient access and scheduling, practice operations, staffing, clinical services and ancillarycoordination, virtual technologies and financial management in an on-demand webinar –Medical Group Leaders' Guide to Navigating Post COVID-19. Visit the PhysicianEnterprise Solutions website for additional resources as well.

 ·         Register here to join our upcoming webinar on 7/16 at 1:00pm ET for a deep dive into

implementing an Integrated Specialty Care model. The newly launched model will helporganizations re-engineer cross specialty care practices to improve patient outcomes andincrease ROI. See more details of the network here or email Chris Murphy.

 ·                 Please join us for a webinar on Tuesday, 7/14 at 2 p.m. ET   “2020 MIPS Reporting –

Which Registry is Right for You?” 1 CE credit is available for this webinar. Register here. Fourth, Joe Biden and Bernie Sanders released their “Unity Task Force’s” policies that willfeed into the Party’s upcoming platform at its Milwaukee Convention scheduled for the week of

8/17. Healthcare plays a big role in party uniting Task Force’s plan underscoring the issue’spolitical prominence in the campaign and possible Biden presidency, including: 

·         A public option vs. “Medicare for All”, which Biden has articulated in presidentialdebates, but with new details including achieving cost savings by negotiatingprices with doctors and hospitals. Other coverage/insurance elements include:

·         Automatic enrollment in the public option, with the choice to opt out forAmericans who do not qualify for Medicaid but still fall below a certain income.

·         Required coverage of select drugs without out-of-pocket spending.

·         No co-pays or deductibles for primary care, and

·         Premium-free coverage to low-income individuals in states that haven’texpanded Medicaid.

 

·         Medicare coverage starting at age 60 and a choice for older Americans of olderemployer-provided coverage, Medicare, or a public option, as well as potentialexpansion of Medicare to cover treatment for dental care, vision and hearing loss.

 

·         A range of policies to achieve healthcare equity.

 

·         Actions in response to the pandemic, such as:

·         Enhanced funding for states and localities;

·         Special insurance options and coverage for people during the pandemic,including free COVID-testing, full coverage of COBRA by the federalgovernment for individuals who lost their jobs and the option of purchasing anew plan with no deductible, at a price determined by their income, or anexisting ACA plan; and 

·         Establishing a comprehensive, national public health surveillanceprogram.

 Other proposals that hospitals in particular should be aware of are: ·         Lowering costs through vigorously pursuing antitrust lawsuits against hospital,

insurance and pharmaceutical companies “to fight against mega-mergers…..that wouldraise prices for patients by undermining market competition.”

 

·         Outlawing the “predatory practice" of balance billing.

 

·         Increasing federal funds for Medicaid and subsidies for laid-off workers, tying thesepayments to unemployment rates.

 

·         Requiring healthcare workers pay of ≥$15 per hour.

 

·         Expanding mental health and substance use treatment access by requiring adequateinsurance coverage, investing in training and hiring more mental health providers.

 

On drugs, the plan would:

 

·         Allow Medicare to negotiate drug prices based on international prices, and make thoserates available to all payers, not just Medicare.

 

·         Cap out-of-pocket drug costs for Medicare beneficiaries and require manufacturers toreimburse Medicare for price increases above inflation.

 

The Biden campaign also released a more detailed proposal to improve the healthcaresupply chain, which aligns with several key elements of Premier’s recommendations. SeePremier’s response to the plan here. Fifth, while the election is months away, we will periodically update you on how the race istrending.  This is a challenging environment for an incumbent due to public worry anddissatisfaction with the direction of the country and economy during this pandemic.Consequently, this election will likely be decided more so than usual by the way votersfeel about the state of the country in October and early November.  At this time, however,polling is trending strongly for the Democrats.  One prominent prognosticator is forecasting279 lean to solid electoral college votes for Biden to 188 lean to solid votes for Trump (270electoral votes are needed for to win).  Here is the state breakout: 

 Sixth, CMS released the 2018 Quality Payment Program (QPP) Experience Report, whichincludes data on participation and performance in the Merit-based Incentive Payment(MIPS) and Advanced Alternative Payment Model (APMs) tracks. Clinicians who participate in a qualifying Advanced APM that meets a certain level ofparticipation (either through payment or patient count) are considered a Qualifying APMParticipant (QP) and, therefore, receive the 5% APM Incentive Payment. Almost allAdvanced APMs had average scores above the payment and patient thresholds for the 2018performance period.  Other key findings from the QPP Experience Report include: ·         The number of clinicians who achieved QP status in 2018 (183,306 clinicians) nearly

doubled from 2017 (99,076 clinicians). 

·         98% of MIPS eligible clinicians participated in the program in 2018 and avoided anegative payment adjustment. (By contrast, only 95% of MIPS eligible clinicians avoidedthe negative payment adjustment in 2019.) 

·         >84% of MIPS eligible clinicians earned “exceptional performance” with paymentadjustments ranging from 0.2% to 1.68%. 

·         More than 98% of MIPS eligible clinicians in rural practices participated in the program,and 97% of rural practices earned a positive payment adjustment in 2018, an increase from93% 2017. 

Seventh, we’re expecting President Trump to sign 3 Executive Orders in the near future.We’re expecting these to address high drug costs, an issue the President vowed to tackle buthas failed to date, and “Buy America” program targeting healthcare goods needed during thisand future public health emergences.   There is a > 50% chance that Congress will take some action in the aforementioned COVIDlegislative package to facilitate the onshoring of U.S. medication and PPE productionfollowing supply shortages associated with COVID-19. The President will seek to jump start thiswith a “Buy American” Executive Order that will, among other things, target federal programsthat engage in more direct purchases of pharmaceuticals, e.g., Strategic National Stockpile

(SNS), Veterans Administration (VA), Department of Defense (DOD), Bureau of Prisons(BOP).  The drug pricing Executive Order is harder to determine given the administration’s setbacks tothis point in time.  We understand, however, there may be a drug importation or reimportationproposal.   Eighth, here are the therapeutic, vaccine and other clinical developments related toCOVID: ·         The administration announced new developments related to COVID-19 vaccines:

 o   The NIH launched a new clinical trials network that aims to enroll thousands of

volunteers in at least 5 large-scale trials at more than 100 clinical sites across theU.S. and internationally to test a variety of investigational COVID-19 vaccines andmonoclonal antibodies. The networks are based in Seattle, Durham, Atlanta and LosAngeles.

 o   The government is investing $1.6B to expedite the development of Novavax’s

coronavirus vaccine, with the goal of 100M doses by Q1 2021 if found effective.Novavax is planning to start Phase 3 efficacy trials this fall. The administration hasspent ~$4B for 6 companies, including AstraZeneca, Johnson & Johnson,Merck, and Moderna, and Pfizer.

 ·         HHS announced a deal with Gilead and AmeriSource Bergen to secure 500,000 additional

treatment courses of Remdesivir that will be distributed during the months of July (94,200courses), August (174,900) and September (232,800) at the negotiated price of ~$3,200 peraverage treatment course or $520 per vial. Hospitals should input into TeleTracking webportal their confirmed/suspected COVID-positive patients. Reach out to Wayne Russell formore information.

 ·         Gilead announced that remdesivir showed a 62% reduction in the risk of mortality

compared to standard of care (7.6% of patients treated with remdesivir died vs. 12.5% ofpatients who did not receive the drug therapy). The analysis is based on observationaldata from 312 patients in its phase 3 trial, not on a randomized controlled trial. 

·         HHS released states’ May-June testing plans that were submitted by governors ineach state.

 The Federal Communications Commission announced an additional $197.98 million in fundingwas available for its Rural Health Care Program, which assists rural providers in the purchasingof telecommunication services. Officials from the Federal Communications Commission (FCC)have expressed the agency’s commitment to aiding the expansion of telehealth access,especially during the COVID-19 pandemic. (Article here Number, Premier weighed in on 2 proposed regulations.  First, we strongly recommend that CMS not finalize requirements that hospitals submitpayer-negotiated median charges as part of their cost reports in the FY 2021 inpatientprospective payment system (IPPS) rule. We also submitted comments on the COVID-19 interim final rule, recommending additional

policies to mitigate the effects of the ongoing public health emergency, including:

 

·         Accelerating payment of ACO shared savings and Advanced APM bonuses.

 

·         Removing the cap on risk score increases, and

 

·         Converting all quality measures to pay for reporting.

 Finally, healthcare providers and companies around the country are innovating anddisrupting care during the pandemic. Here are this week’s: ·         A coalition of 11 providers, payers and other healthcare organizations launched an ad

campaign called "Keep Social Distancing, Stop Medical Distancing."  The campaign isaimed to encourage patients to get routine care and check on concerning symptoms duringthe COVID-19 pandemic.  The campaign will be on TV, in print and across social media.

 ·         In another move to invest in “retail health,” Walgreens Boots Alliance announced a $1

billion investment to bring primary care providers into at least 500 – 700 storesacross 30 US markets over the next 5 years.  Walgreens is partnering with primary careprovider VillageMD, buying 30% stake in the company.  The announcement comes on theheels of one of its competitors, CVS Health, announcing a similar primary care presencenamed the “HealthHub.” A major difference of the VillageMD model from the HealthHub isWalgreens’ emphasis on bringing physicians into the clinic, while CVS has stated thatphysicians are not needed onsite to create a full-service customer Hub.

 ·         Retail giant Walmart, which has also invested in primary care locations, continues to

expand its US health care presence by announcing the creation of a health insuranceplan called Walmart Insurance Service, LLC.  Separately, Walmart announced last weekthat it would partner with Humana and Quest Diagnostics to provide access to drive-throughCOVID-19 tests.

 ·         Oak Street Health, a Medicare-focused primary care company that operates more than 50

primary care centers in Illinois, Michigan and Indiana, filed an aggressive growth strategyin its registration statement to go public.

 

·         J.D. Powers released its annual Medicare Advantage (MA) customersatisfaction survey, finding overall satisfaction rose 5 points compared to 2019,reaching a score of 800 (on a 1,000-point scale). Here are the top 10 scores.

 Congressional Action

 Bipartisan Effort Underway to Ensure Continued 340B EligibilityBecause of patient case mix changes experienced by hospitals during the public healthemergency, a bipartisan group of senators has introduced legislation (S. 4160) to allowhospitals that were participating in or applied for the 340B drug discount program beforethe public health emergency (PHE) to temporarily maintain eligibility. Sens. John Thune(R-SD), Debbie Stabenow (D-MI), Rob Portman (R-OH), Tammy Baldwin (D-WI), ShelleyMoore Capito (R-WV) and Ben Cardin (D-MD) are leading on the bill. Under the bill, hospitalswould be eligible for any cost reporting period during the PHE, ensuring hospitals do not lose340B eligibility. Rep. Doris Matsui (D-CA) is building support for a similar provision in the House.  We urge our members to voice support for this provision to their lawmakers. 

Regulatory Changes and Guidances If you are encountering federal regulatory impediments, please email us so we canfollow up with federal officials. Here are the key contacts for this: ·         For Medicare & Medicaid Waivers, Payment and Coverage issues, email Melissa

Medeiros

 ·         For supply chain issues contact Soumi Saha 

 ·         For health IT, security and Privacy contact Meryl Bloomrosen  Premier’s Public Affairs team holds bimonthly weekly office hours. Please join us at noon (EST)on the 1st and the 15th of the month to receive updates and ask questions on CMS’ COVID-19response. The dial-in number for this call is 800-781-9807 and the access code 1107569#. Youcan send questions in advance of this weekly call to Premier_PublicAffairs@Premierinc.com. Below are the latest updates to federal guidances broken out by their objectives. We areupdating daily our comprehensive resource that you can use to find needed informationon these and other recent developments from HHS. Check back regularly for the latestupdates.

 Achieving Healthcare Sustainability in the COVID-19 Era Healthcare workforce. CDC released data on increases in health-related workplaceabsenteeism among workers in essential critical infrastructure occupations during the COVID-19 pandemic in the U.S. from March to April 2020. Whereas the overall impact of COVID-19 onhealth-related workplace absenteeism in March and April was minor, increases in absenteeismin personal care and service, healthcare support, and production occupations, groups thatcontain or define essential critical infrastructure workforce categories, highlight the risks andconcerns surrounding occupational transmission of COVID-19. Facilitating Care in the Home CMS telehealth guidance for 2020 and 2021 eCQM reporting by eligibleprofessionals/eligible clinicians: CMS released guidance for eligible professionals andclinicians on inclusion of telehealth encounters when reporting electronic clinical qualitymeasures (eCQMs) for certain CMS quality reporting programs in 2020 and 2021. The guidance, which specifies which eCQMs would be telehealth-eligible for each reportingperiod, is applicable for the following quality reporting programs: ·         Quality Payment Program: Merit-based Incentive Payment System (MIPS) and Advanced

Alternative Payment Models (Advanced APMs). 

·         Comprehensive Primary Care Plus (CPC+), 

·         Primary Care First (PCF), and 

·         Medicaid Promoting Interoperability Program for Eligible Professionals. Encounters that are identified by telehealth-eligible codes will be eligible for inclusion in thecalculation of the specified eCQMs, unless otherwise noted. Additional information is available at the following links:·         2020 Performance Period guidance·         2021 Performance Period guidance Telehealth funding. The FCC has added nearly $200 million to 2020 funding for its RuralHealth Care Program, which has helped providers in remote areas leverage broadbandnetworks for telemedicine during the COVID-19 pandemic. The total amount of supportavailable to eligible healthcare providers for funding year 2020 will be $802.74 million. ContactTony Malcoun at Tony_Malcoun@PremierInc.com to find out how Premier can help. Supply Chain and Clinical Preparedness Nursing homes. CMS announced that it will deploy additional resources through its QualityImprovement Organizations (QIOs) to nursing homes in COVID-19 hotspots, as identified bythe White House Coronavirus Task Force. QIOs are CMS contractors that work with healthcareproviders to improve quality of care for Medicare beneficiaries. CMS also released “Five ThingsAbout Nursing Homes During COVID-19” as part of an ongoing HHS series. 

Infection Prevention and Control Recommendations for Healthcare Personnel (HCP).CDC clarified that the recommendations for universal use of eye protection (in addition to afacemask) for HCP working in facilities located in communities with moderate to sustainedCOVID-19 transmission is intended to ensure HCP eyes, nose, and mouth are all protectedduring patient care encounters. Please visit the regulatory updated Novel Coronavirus page in the Disaster Preparednessand Response PremierConnect Community.  Email Disasterresponse@premierinc.com foradditional information. Premier has created a cybersecurity repository with cybersecurity-specific resources, news andrecommendations. State Medicaid & CHIP Waivers CMS has approved more than 200 requests for state relief in response to the COVID-19pandemic, including recent approvals for Alaska, Iowa, Hawaii, New Jersey, North Carolina,Pennsylvania, Rhode Island, Utah, and Virginia. State-by-state developments of Sec. 1115 waivers can be found here. 

ICYMI: Premier Coverage ·         A recent Premier survey illuminates why almost every U.S. hospital is building safety

stock of critical pandemic medications. Read about it in our recent blog. 

·         If your health system has not yet implemented an assistance program to help patientsafford their medications, now is the time to start. Here are five things providers shouldevaluate when setting up a medication assistance program.

 Have a wonderful week. Blair

Blair G. ChildsSenior Vice President444 North Capitol Street, NWSuite 625Washington, D.C. 20001-1511202-879-8009 (O)202-285-7101 (C); 202-879-8009 (F)Susan Ueberroth, Executive Coordinator: 202 879 8010, Susan_Ueberroth@Premierinc.com

Premier, 2006 Malcolm Baldrige National Quality Award Recipient13034 Ballantyne Corporate Place, Charlotte, NC 28277

http://www.premierinc.com/baldrige