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09/26/2016

Weekly E-Bulletin


CMS Wants Home Health Agencies to Report Major Falls

To satisfy another requirement of the IMPACT Act, CMS announced last week a new measure for Home Health Agencies to determine the percentage of patients who experience a fall with major injury. CMS justifies this measure as there are no existing measures that assess the incidence of falls with a major injury for home health. This quality measure will report the percentage of patients who experience one of more falls with the following major injuries during a home health stay: bone fractures, joint dislocations and closed-head injuries with altered consciousness, or subdural hematoma. Click here for a summary from our policy team. To view the call for public comment, click here.

House Passes Group of Health Bills

With the October recess fast approaching, the House of Representatives passed several health care bills last week. The bills go to the Senate where their fate is uncertain. Three of the bills came out of the House Ways & Means Committee, two of which are backed by hospitals and one of which is backed by dialysis patients and providers. The final originated in the House Energy and Commerce Committee and would extend the Medicaid special needs trust exception for people with disabilities. Click here for our 1-page summary of the following bills:

  • Sustaining Health Care Integrity and Fair Treatment (SHIFT) Act of 2016 (H.R. 5713)
  • Expanding Seniors Receiving Dialysis (ESRD) Choice Act of 2016 (H.R. 5659)
  • Continuing Access to Hospitals Act of 2016 (H.R. 5613)
  • Special Needs Trust Fairness and Medicaid Improvement Act (H.R. 670)

 CMS: Bundled Payments are Saving Money

Some of CMS bundled payment pilots have led to cost savings, with orthopedic surgery bundles showing the most significant savings and quality improvements, according to a report released last week.. In its second annual evaluation report for Models 2, 3 and 4 of its voluntary bundled payment project, CMS found that 11 out of the 15 clinical episode groups analyzed showed potential savings to Medicare. After these signs of success, CMS said it plans to continue to move forward with alternative payment models. Click here for the report and here for the CMS blog post.

  • Hospitals and health systems can accelerate their review of MIPS, APMs and Medicare bundles with the help of a newly launched advisory group, APM Plus. Comprised of physician, actuarial, legal, data, health plan, policy and operations experts, APM Plus can analyze hospitals’ current plans to move from volume to value, make data-centered recommendations and propose and implement the most financially and clinically beneficial alternatives. Click here for for more information.

MACRA Technical Advisory Committee Requests Comment on Proposal

The Physician-Focused Technical Advisory Committee (PTAC), created by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, has put out a call for public comment on draft guidance as to the kinds of payment models that it will consider and the kinds of payment models that will be more likely to receive favorable recommendations from PTAC. In the document, PTAC declares that they will only consider models that require clinicians to take accountability for (1) reducing spending without reducing the quality of care, (2) improving the quality of care without increasing spending, or (3) improving the quality of care and reducing spending. To read the draft document, click here. To provide comments send an email message to PTAC at PTAC@hhs.gov.

Regulatory Burdens Pushing Physicians Out of the Profession: Survey

According to a new nationwide survey of 17,236 physicians, nearly 50 percent of doctors intend to retire, reduce their hours or number of patients, or take on non-clinical roles in the coming years.  The survey was taking by the Physician’s Foundation at Merritt Hawkins. Regulatory burdens are driving much of physicians’ behavior.  Doctors are spending more than 20 percent of their time on non-clinical paperwork. And this is a source of frustration because only 14 percent of these same doctors report having the time they need to provide the highest standards of care.  Click here for the complete report.

1 in 4 Americans Enrolled in Medicaid

Since 2013, the number of Medicaid enrollees has grown from 58 million to 75 million, and the program now provides coverage to roughly one-quarter of all Americans, according to a new PwC analysis. By contrast, fewer than 5 percent of Americans are insured through the Affordable Care Act’s exchanges. The huge growth in Medicaid slowed to just 3 percent this year, with 2.3 million new enrollees. New Mexico has the highest percentage of residents enrolled in Medicaid at 36.3 percent and Utah has the lowest percentage with just 9.2 percent. Click here for the report.

  • One company continues to make money in Medicaid managed care: Molina.  Click here for that report.

Average Medicare Advantage Premiums to Decrease Next Year

The average monthly premium for Medicare Advantage beneficiaries will slightly decrease to $32.59 in 2017. That’s $1.19 less than the average premium this year.  The average premium for private Medicare enrollees has decreased by 13 percent since passage of the Affordable Care Act, CMS said. Medicare Advantage enrollment is projected to hit 18.5 million next year, accounting for roughly one third of all beneficiaries. CMS also announced there will be a modest increase in average monthly premiums for 2017 Medicare Part D prescription drug plans – $34 per month on average, up from $32.56 this year – a 4.4 percent increase. For more from CMS, click here.

NCQA: Only 10 Percent of Health Plans Rated 4.5 or 5

The NCQA is out with a new report ranking 1,012 health plans according to consumer satisfaction; the extent to which they provide preventive services; and how well they perform in treating chronic and acute conditions. In each category, patient outcomes count extra in the score.  Overall, 10 percent of plans received a 4.5 or 5 out of 5, while just 3 percent landed in the lowest tier, earning ratings of 1.5 to 2.  The top-rated plans were split relatively evenly between private, Medicare and Medicaid plans, the NCQA says.  The 10 states with the highest percentage of plans with a 4.5 or higher were Massachusetts, Rhode Island, Wisconsin, Maine, New Hampshire, Minnesota, Vermont, New York, Hawaii and Iowa. Click here for the NCQA report.

AMA Report Says Major Health Insurer Mergers “Quash” Competition

New data released last week show the nation needs more competition in health insurance markets, and supports antitrust efforts to block unprecedented mergers among four of the nation’s biggest health insurance companies. Left unopposed, Anthem’s acquisition of Cigna and Aetna’s takeover of Humana would collectively quash competition in insurance markets across 24 states, according to newly updated market analyses released by the American Medical Association. Click here for details.

Hospitals Increasing Use of Broad-Spectrum Antibiotics: CDC

The CDC is out with a report saying hospitals are increasingly using broad-spectrum drugs that fight a range of disease-causing bacteria, which may signal increasing concern about infections caused by drug-resistant bacteria. The study, published in JAMA Internal Medicine, found that overall antibiotic use in hospitals changed little between 2006 and 2012. However, there was a substantial increase in use of broad-spectrum antibiotics, a trend that the authors called “worrisome in light of the rising challenge of antibiotic resistance.” Click here for the study.

UN Members Commit to Fight Superbugs

The 193 member countries of the United Nations last week adopted a declaration to fight antibiotic resistance, adopting a broad set of goals to reduce the use of the drugs in agriculture and human medicine. The declaration recognizes the serious threat posed globally, and calls on all countries to commit to a global plan including preventing the spread of microbes resistant to antimicrobial drugs, monitoring them and exploring new models to support innovation. Click here for the Washington Post report.

Malnutrition Adds Billions to the Cost of Health Care in the U.S.

Malnutrition among people with chronic diseases costs $15.5 billion in additional healthcare spending per year, according to a new study. Individual states face $25 million to $1.7 billion per year in healthcare spending as a result of malnutrition. More than one-third of patients admitted to the hospital are malnourished or become malnourished during their inpatient stay, the report notes. The condition is difficult to diagnose because it’s hard to recognize, especially among obese individuals. Click here for more details from the report in the journal Plos One.

MS Society Taking on Pharma, Calls for Limits on Rx Price Increases

The National Multiple Sclerosis Society is calling for limits on price increases for older drugs and several insurance reforms.  The group calls for limiting price hikes on drugs that have been on the market “for a considerable time.” They are also advocating for an out-of-pocket cap for prescription costs in Medicare and requirements that insurance companies not place all medicines for a disease on a specialty tier with co-insurance.  The group cited a 2015 study finding huge price increases for multiple sclerosis treatments in the past 20 years. The cost of first generation drugs averaged $60,000 annually in 2013, up from $8,000 to $11,000 in the 1990s.  Click here for all their recommendations.

Medicare Spending on EpiPen Skyrockets

Medicare spending on Mylan’s EpiPen jumped to nearly $88 million in 2014, up from just $7 million in 2007 when the company first acquired the product, according to a new Kaiser Family Foundation analysis. The figures represent a 1,150 percent increase in spending by the federal health program, mostly due to the price Medicare paid for the drug going from $71 in 2007 to $344 in 2014 – an increase of 385 percent – while number of prescriptions grew to 255,419, an increase of 160 percent. Click here for the report.

  • Mylan CEO Heather Bresch, facing bipartisan criticism over the pricing of EpiPen, told the House Oversight and Government Reform Committee last week the company only nets a profit of $100 per two-unit pack of EpiPen. Bresch said the EpiPen price increases were justified in part by the resources Mylan invested in increasing access to the drug, especially in schools. Click here to view the hearing and read the prepared testimony.

Kindred Fined $3 Million for Improper Billing

Kindred Healthcare, Inc., the nation’s largest provider of hospice and home medical services, paid a penalty of almost $3.1 million for continuing with improper billing despite having agreed with the federal government to suspend the inappropriate practices. The fine represents the largest to date for violations of a so-called corporate integrity agreement, according the Office of the Inspector General at HHS. Click here for the HHS comments.

RAND Analysis Compares Clinton, Trump Health Care Plans

The health care plans put forth by Hillary Clinton and Donald Trump would lead to dramatically different changes in access to coverage, according to a new analysis by RAND Corporation and Commonwealth Fund researchers. Clinton’s proposals would build on the coverage gains made under Obamacare, while Trump’s policies would roll back programs that have allowed roughly 20 million Americans to get insurance, according to the report.  Click here for the RAND analysis, which may require signing in.

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