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Daily Archives: January 5, 2018

Running On Empty: CHIP Funding Could Run Out Jan. 19 For Some States

Some states are facing a mid-January loss of funding for their Children’s Health Insurance Program (CHIP) despite spending approved by Congress in late December that was expected to keep the program running for three months, federal health officials said Friday.

The $2.85 billion was supposed to fund states’ CHIP programs through March 31. But some states will start running out of money after Jan. 19, according to the Centers for Medicare & Medicaid Services. CMS did not say which states are likely to be affected first.

The latest estimates for when federal funding runs out could cause states to soon freeze enrollment and alert parents that the program could soon shut down.

The CHIP program provides health coverage to 9 million children from lower-income households that make too much money to qualify for Medicaid. Its federal authorization ended Oct. 1, and states were then forced to use unspent funds to carry them over while the House and Senate try to agree on a way to continue funding.

Congress extended funding on Dec. ǵ and touted that states would have money to last while Congress worked on a long-term funding solution. But CMS said Friday it could only guarantee that the appropriation will be enough to fund all states through Jan. 19.

CMS said the agency is in discussions with states to help deal with the funding shortfall.

€œThe funding … should carry all the states through January 19th based upon best estimates of state expenditures to date,” said CMS spokesman Johnathan Monroe. “However, due to a number of variables relating to state expenditure rates and reporting, we are unable to say with certainty whether there is enough funding for every state to continue its CHIP program through March 31, 2018.”

“States need to know whether they will need to find additional funding for children covered under the Medicaid CHIP program at a much lower federal matching rate, send letters to families, and re-program their eligibility systems,” said Lisa Dubay, a senior fellow at the Urban Institute. “Of course, the implications for families with CHIP-eligible children cannot be understated: Parents are worried that their children will lose coverage. And they should be.”

Although the program enjoys bipartisan support on Capitol Hill, the Republican-controlled House and Senate have for months been unable to agree on how to continue funding CHIP, which began in 1997.

The House plan includes a controversial funding provision — opposed by Democrats — that takes millions of dollars from the Affordable Care Act’s Prevention and Public Health Fund and increases Medicare premiums for some higher-earning beneficiaries.

The Senate Finance Committee reached an agreement to extend the program for five years but did not unite around a plan on funding.

Before the CHIP funding extension on Dec. 21, Alabama said it would freeze enrollment Jan. 1 and shut down the program Jan. 31. Colorado, Connecticut and Virginia sent letters to CHIP families warning that the program could soon end.

After the funding extension, Alabama put a hold on shutting down CHIP.

“Some states will begin exhausting all available funding earlier than others,” a CMS official said Friday. “But the exact timing of when states will exhaust their funding is a moving target.”

Bruce Lesley, president of First Focus, a child advocacy group, said Congress should have known its short-term funding plan was not enough.

“The math never worked on the patch, as it only bought a few weeks,” he said. âCongress must get this finalized before Jan. 19.”

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Grassley Calls For ‘Corrective Action’ On Abuses In Herpes Vaccine Research

WASHINGTON — A Republican senator is demanding that the Trump administration and a university scrutinize how a researcher was able to inject an experimental herpes vaccine into human subjects without routine safety oversight.

In letters sent out Thursday, Iowa Sen. Chuck Grassley also told the administration and Southern Illinois University that he wanted to be reassured that “corrective action” was being taken to prevent similar research abuses.

Southern Illinois University professor William Halford tested his experimental herpes vaccine on participants in the Caribbean and in U.S. hotel rooms without Food and Drug Administration or institutional review board oversight. After Halford died in June and Kaiser Health News raised questions about the research, the university concluded he was in “serious noncompliance with regulatory requirements and institutional policies and procedures.”

“[T]his entire episode illustrates a failure in necessary governmental oversight of vaccine research as well as a failure by SIU to properly oversee its research staff,” Grassley wrote in the letters that cited KHN’s ongoing reporting.

Grassley, the chair of the Judiciary Committee, is well-known for pushing U.S. agencies to account for what he describes as breakdowns or lapses in the federal bureaucracy — even when the GOP is in charge.

In this case, his letter to the Department of Health and Human Services and the Food and Drug Administration could put pressure on the Trump administration to take a more aggressive role in any investigation of Halford’s research. Grassley’s letter to SIU could also lead to the university implementing tougher reforms in the wake of the unauthorized research, which participants say occurred as early as 2013 and continued into 2017.

“The type of research conducted, apparently all under-the-radar to the Obama administration and the very university that employed [Halford], has put individuals at extreme health risk,” Grassley wrote.

Grassley also sent his letter to the federal Office for Human Research Protections (OHRP), which monitors how human subjects are treated in trials.

OHRP could have jurisdiction in launching an independent investigation because the university had pledged to follow human-subject safety protocols for all research, even if it was funded privately.

But experts say that the federal government has become less aggressive about pursuing human-subject research violations over the years.

The agency’s public assessments of research misconduct peaked in 2002, when it issued more than 100 “determination letters.” That number has steadily declined. In 2017, it issued one.

Further politicizing the matter, Halford’s company, Rational Vaccines, received millions of dollars for future research on the experimental vaccine from billionaire Peter Thiel, a President Donald Trump supporter and high-profile critic of the FDA.

Thiel has not commented on the matter, despite investing in Rational Vaccines after Halford’s offshore trial.

SIU, meanwhile, has previously said it had no role or responsibility for Halford’s work, which it said it didn’t know about until after it was completed.

Following a KHN report that Halford completed the 2016 trial in St. Kitts and Nevis with no independent safety oversight, HHS demanded the university account for the research. The FDA and OHRP, however, have not commented on their roles in the matter.

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Half Of Hospitals In Conn., Del. Hit By Medicare’s Safety Penalties

As the federal government penalizes 751 hospitals for having too many infections and patient injuries, some states are feeling the cuts in Medicare payments more than others.

This year’s punishments landed the hardest in Connecticut and Delaware, where Medicare penalized half of the evaluated hospitals, federal records show. In New York and Nevada, four in 10 hospitals were penalized. A third were punished in Rhode Island and Georgia. (These figures do not include specialty hospitals automatically exempted from penalties: those serving veterans, children and psychiatric patients, and “critical access” hospitals that are the only institutions in their area.)

While every state except Maryland — which is excluded because it has a different Medicare payment system — had at least one hospital punished, some got off comparatively lightly. Sixteen percent of hospitals or fewer in Alabama, Kansas, Massachusetts, Missouri, Ohio, Texas and nine other states were punished. (State summaries are below; a searchable list of individual hospitals penalized is here.)

The penalties — now in their fourth year — were created by the Affordable Care Act to drive hospitals to improve the quality of their care. Each year, hundreds of hospitals lose 1 percent of their Medicare payments through the Hospital-Acquired Conditions (HAC) Reduction Program.

The program’s design is stern: Out of the roughly 3,300 general hospitals that are evaluated each year, Medicare must punish the worst-performing quarter of them — even if they have reduced their number of potentially avoidable mishaps from the previous evaluation period.

“I have seen with my own eyes the improvement, said Dr. Amy Boutwell, a quality-improvement consultant in Massachusetts. “I hear hospitals say straight up, ‘We donât want to be in the lowest quartile, we want to get out of the penalty zone.’”

The conditions Medicare considers include rates of infections from colon surgeries, hysterectomies, urinary tract catheters and central line tubes inserted into veins. Medicare also examines rates of methicillin-resistant Staphylococcus aureus, or MRSA, and Clostridium difficile, known as C-diff. The frequency of 10 types of in-hospital injuries, including bedsores, hip fractures, blood clots, sepsis and post-surgical wound ruptures, are also assessed. All these types of potentially avoidable events are known as hospital-acquired conditions, or HACs.

A mix of factors contribute to why more hospitals are punished in certain states. The penalties fall more frequently on teaching hospitals and hospitals with large portions of low-income patients. There are more of those in some states than in others. Some penalty recipients say Medicare isn’t adequately taking into account differences in patients, since those who are frailer are more susceptible to HACs.

There is also some element of statistical chance, since the number of reported conditions in one hospital on the edge of the bottom quartile might just have one or two more incidents than a hospital that narrowly escapes that designation.

Some repeatedly penalized hospitals, such as Northwestern Memorial Hospital in Chicago, say the program is flawed by what researchers call surveillance bias: The hospitals that are most diligent in testing and treating infections and injuries are going to appear to have more than comparatively lackadaisical institutions. The hospitals are responsible for reporting incidents to the federal government.

Medicare says it performs spot-checks, but Dr. Karl Bilimoria, director of the Surgical Outcomes and Quality Improvement Center at the Northwestern University Feinberg School of Medicine, said more policing is needed for the rates to be credible.

“In no other industry would this pass, where a program without an audit and voluntary data reporting would be considered valid,” Bilimoria said. “We know guys are gaming.

Still, many hospitals that have large numbers of sicker and low-income patients, or that handle more complex cases, have avoided the penalties. Medicare issued no punishments this year to Cedars-Sinai Medical Center in Los Angeles; the Cleveland Clinic; Intermountain Medical Center in Murray, Utah; Massachusetts General Hospital in Boston; or New York-Presbyterian Hospital in Manhattan. While safety-net and teaching hospitals were penalized at a higher rate than other hospitals, two-thirds of each group escaped penalties this year.

Dr. Kevin Kavanagh, board chairman of Health Watch USA, a patient advocacy group, said that most hospitals are reducing their HACs each year, in part because of the penalties.

“That’s really the bottom line that everyone should support, he said. “No system is perfect.”

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Viewpoints: Decline In Life Expectancy An ‘Indictment’ Of U.S. Health System; The Toll Alzheimer’s Takes

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Parsing The Policies: Trump And Association Health Plans; What About Out-Of-Pocket Health Care Costs?

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Research Roundup: Opioid Use; Medicaid Work Requirements; And Individual Marketplace Performance

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State Highlights: Flu Activity Takes Toll In Calif., Fla.; Breaking Down Infant And Maternal Death Rates In Texas, Conn.

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While Cancer Deaths Are Decreasing, U.S.’s No. 2 Killer Still Remains Formidable Foe

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Risky Behavior Decreased ‘Markedly’ Among Younger Students

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Less Than One In Three Americans Think Opioid Crisis Is A National Emergency

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