Hospitals that would receive the biggest 340B remedy payments under a new proposal to correct unlawful reimbursement cuts tended to provide proportionally less uncompensated care than other 340B-eligible hospitals.
Healthcare economists and policy experts said Modern Healthcare's analysis of estimated uncompensated care costs relative to the size of the Centers for Medicare and Medicaid Services’ proposed 340B remedy payments shows that the drug discount program may have strayed from its mission to support hospitals that carry the heaviest burden of care for low-income patients.
The 340B drug discount program, which gives hospitals that treat low-income and uninsured patients drug discounts as steep as 50%, has faced a series of legal and regulatory challenges in recent years. One of the most recent developments stems from a six-year legal battle as hospital associations successfully sued to block the federal government’s Medicare 340B payment cuts of roughly 30% for most outpatient drugs from 2018 through Sept. 27, 2022. The Supreme Court in June 2022 invalidated the reimbursement reduction.
The litigation and CMS' proposed remedy underscores the ongoing battle between hospitals, which rely on the drug discounts to increase access to care and subsidize other services, and industry overseers that argue the program has grown too large, benefiting hospitals that provide relatively limited care for underserved communities. Some safety-net providers that offer disproportionately higher uncompensated care argue the program's benefit is limited because program dollars are spread across too many hospitals, clinics and pharmacies.
In the proposed rule issued this month, CMS would pay more than 1,600 hospitals roughly $9 billion via lump-sum payments to offset reimbursement cuts. While those payments are not based on uncompensated care levels, a Modern Healthcare analysis examined the impact of 340B-eligible hospitals.
The uncompensated care metric used in the analysis excludes hospitals’ Medicaid shortfall, which is the difference between hospitals’ care expenses for Medicaid beneficiaries and reimbursement levels, but includes charity care and bad debt costs, which represent the amount of free and discounted care hospitals provide for low-income patients plus patients’ outstanding bills for care.
The analysis compared hospitals' uncompensated care costs from 2018 to 2022 to hospitals’ operating expenses over that period to calculate the median uncompensated care cost as a percent of operating expenses. Modern Healthcare organized the results into five tiers of hospitals, separated by the amount of proposed remedy payments. The analysis excluded any hospitals that would not receive remedy payments, hospitals that filed fewer than four years of cost reports from 2018 to 2022 and those that did not report uncompensated care costs over that period. Nearly 100 hospitals were excluded from the 1,661 hospitals CMS listed in its appendix with proposed remedy payments.
Under the CMS proposal, hospitals that would receive the lowest remedy payments provided relatively more uncompensated care as a percentage of operating expenses than their peers, the Modern Healthcare analysis found.