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CMS Releases Final Physician Payment System Rule; Agency Makes Major Changes

CMS released its final physician payment system rule on Friday.  It is the most comprehensive reform of Medicare since the creation of the Affordable Care Act in 2010 and takes effect January 1, 2017.  The Quality Payment Program regulation, that includes the Merit-based Incentive Payment System MIPS) and the Alternative Payment Model incentive, is 2,398 pages.  New flexibility has been built into the final rule that now allows clinicians to delay their full participation without being penalized until 2020.  CMS created a two-year transition period allowing for a longer ramp up period.  Click here for CMS’ executive summary.  Click here for the rule.  Strategic Health Care clients will receive further detailed updates as our policy team continues their review.

  • CMS is launching a new program that would reduce medical review for physicians participating in selected Advanced Alternative Payment Models.  CMS says two-sided risk models motivate care delivery in an efficient manner and greatly reduce improper billing while continually improving quality.  Click here for more information.
  • A Harvard researcher says Medicare’s Shared Savings Program is off to a promising start, especially when considering its trickle-down effects. While recent estimates suggest that Medicare’s program saved $287 million in 2014 – or 0.7 percent of total spending for ACO patients – the researcher says the total is closer to $685 million, or 1.6 percent of spending for ACO patients, when considering indirect savings.  The findings are published in the Annals of Internal Medicine.  Click here.

New Regs Give Government Power to Penalize EHR Companies

The Office of the National Coordinator for Health IT has finalized a 300-page rule that will give it more oversight over certifying electronic health records and other technologies that store, share and analyze health information for consumers. The rule also gives the ONC the authority to ask developers to pull noncompliant products from the market. The ONC would now have the power to decertify health IT products that don’t comply with regulations or are found to pose a risk to public health or safety.  Click here for the rules.  Click here for an ONC summary.

Hospital Spending on Rx Skyrocketing

Hospital spending on drugs for inpatients jumped by more than 23 percent from 2013 to 2015, and more than 90 percent of hospitals said price increases are straining their budgets, according to a new hospital association study. The report found that hospitals’ drug spending far exceeded the 9.9 percent growth in retail pharmacy spending over the same time. The study drew on responses from more than 700 hospitals. Click here for the report.

  • Insulin prices are soaring and it appears the profits are going to pharmacy benefit managers, according to a WSJ report. Click here.

More Rx Solutions to Fix the Opioid Abuse Epidemic?

Opioid prescriptions have skyrocketed from 112 million in 1992 to nearly 249 million in 2015, the latest year for which numbers are available, and America’s dependence on the drugs has reached crisis levels. Millions are addicted to or abusing prescription painkillers such as OxyContin, Vicodin and Percocet. Statistics from the CDC show that, from 1999 to 2014, more than 165,000 people died in the United States from prescription-opioid overdoses, which have contributed to a startling increase in early mortality among whites, particularly women — a devastating toll that has hit hardest in small towns and rural areas. The pharmaceutical industry’s response has been more drugs.  Click here for that story from the Washington Post.

Majority of MA Customers Will be in Four-Star Plans in 2017

More than half of Medicare Advantage enrollees will be in plans that receive at least four stars for quality in 2017, according to CMS. Nationally, the number of beneficiaries in four- and five-star Medicare Advantage plans with drug coverage had been increasing about 10 percent annually since at least 2014. In 2014, 52 percent of beneficiaries were enrolled in plans with the high ratings. The figure jumped to 60 percent in 2015 and by 2016 it was 71 percent. Enrollment in 2017 dropped slightly to 68 percent. There are expected to be 18.5 million individuals enrolled in private Medicare plans next year, representing about one-third of all beneficiaries. For the CMS fact sheet, click here.

  • Click here for an independent analysis of the growth of Medicare Advantage.

 Open-Heart Surgery Patients at Risk From Contaminated Devices

The CDC has issued a warning to healthcare providers and patients that there is a potential risk of infection from certain devices used during open heart (open-chest) surgery. This comes as new information has been released indicating that some LivaNova PLC (formerly Sorin Group Deutschland GmbH) Stöckert 3T heater-cooler devices, used during many of these surgeries, might have been contaminated during manufacturing. More than 250,000 heart bypass procedures using heater-cooler devices are performed in the United States every year. For more on this from the CDC, click here.  Click here for the Washington Post story.

Breast Cancer Death Rates Continue to Decrease

Breast cancer death rates among women decreased during 2010-2014, but racial differences persisted, according to a new CDC study.  The findings show changes for death rates from breast cancer by age group for black and white women, the groups with the highest death rates in the United States.  Among other findings: there was a faster decrease in breast cancer death rates for white women ( 1.9% per year) than black women (1.5% per year) between 2010 and 2014; among women under age 50, breast cancer death rates decreased at the same pace for black and white women; and the largest difference by race was among women ages 60–69 years. Click here for the report.

A Third of C-Sections Were Performed on Low-Risk Deliveries in 2013

About 35 percent of cesarean sections, or C-sections, were performed for low-risk deliveries in 2013, according to new data from the Agency for Healthcare Research and Quality. Low-risk C-section rates varied tenfold (from 4.6 to 46.9 per 100 low-risk deliveries) among the largest hospitals that account for 80 percent of all births, and there was even wider variation among smaller hospitals.  Click here for the data.

Tax on Sugary Drinks Leads to Less Obesity, Diabetes and Tooth Decay: WHO

In a report issued last week, the World Health Organization said evidence shows a 20 percent tax on sugary drinks – including soda, sweet teas, and even some juices – can lead to a a similar drop in consumption, which would help reduce obesity, Type 2 diabetes and tooth decay. The report called on countries to create action plans that use taxation, consumer education and restrictions on marketing “sugary products” to children. The WHO also found that produce subsidies that reduce prices between 10 and 30 percent could prompt people to eat more fresh fruits and vegetables. Click here for the report.

  • Pepsi and Coca-Cola have sponsored at least 96 national health organizations since 2011, according to a new analysis published in the American Journal of Preventive Medicine. Two of the groups the soda companies sponsored? The American Diabetes Association and the Juvenile Diabetes Research Foundation. During the same time frame, the two companies lobbied against at least 28 public health bills that aimed to slash soda consumption or boost nutrition. Click here for the report.

Medicaid Spending Growth Slowing Down

Growth in Medicaid spending has slowed down in fiscal 2016 as fewer states entered into Obamacare’s optional expansion, according to new Kaiser Foundation data. The spending growth was just less than 6 percent, down from a 10.5 percent growth rate in fiscal 2015. State spending grew 2.9 percent this year and is projected to increase to 4.4 percent in 2017. Click here for the report.

Vent Use Increasing for Advanced Dementia Patients

The rate for mechanical ventilation for hospitalized nursing home patients with advanced dementia has risen as the number of ICU beds in hospitals increases, according to a new analysis.. Researchers found that from 2000-2013 use of mechanical ventilation increased from 39 per 1,000 hospitalizations in 2000 to 78 per 1,000 hospitalizations. They hypothesized that as the number of ICU beds in a hospital increased over time, patients with advanced dementia were more likely to receive mechanical ventilation. Click here for the research study in JAMA.

House GOP Continues Fight Against Risk-Corridor Payments for Insurers

House Republicans are asking a federal court to deny risk-corridor payments to an insurer that participated in a health care exchange. They filed an amicus brief to a lawsuit filed by an insurance company. House Republicans are supporting the Justice Department’s position in the case, which stems from a major funding shortfall in the risk-corridor program. The case, Health Republic Insurance Co. v. United States, was the first lawsuit filed by an insurance company to try to cover risk-corridor payments. Several other suits have been filed since. To read the amicus brief, click here.

Teen E-Cigarette Users Likely To Be Tobacco Users

A new study has found that that teenagers who use e-cigarettes are more likely to smoke or chew tobacco than those who do not use tobacco products. This is a surprise to researchers as most models had predicted the opposite. In a sample of 6,352 people who have tried e-cigarettes, their models predicted that 791 cigarette smokers had used e-cigarettes. The actual number was more than double: 1,814. Click here for the study.

Actions to Fight TB Falling Short

New data published by WHO in its 2016 Global Tuberculosis Report, show that countries need to move much faster to prevent, detect, and treat TB if they are to meet global targets. Governments have agreed on targets to end the TB epidemic that include a 90% reduction in TB deaths and an 80% reduction in TB cases by 2030 compared with 2015. The report also signals the need for bold political commitment and increased funding. Click here for the report.

Medical First: Paralyzed Man Senses Touch through Robotic Arm

For the first time, scientists have helped a paralyzed man experience the sense of touch in his mind-controlled robotic arm. For the cutting-edge experiment, a collaboration between the University of Pittsburgh and the University of Pittsburgh Medical Center, electrodes smaller than a grain of sand were implanted in the sensory cortex of the man’s brain. The electrodes received signals from a robot arm. When a researcher pressed the fingers of the prosthesis, the man felt the pressure in the fingers of his paralyzed right hand, effectively bypassing his damaged spinal cord.  Click here for the story.

Alternative Pain Treatments Common among Those with Musculoskeletal Pain

Patients with musculoskeletal pain use complementary health approaches nearly twice as much as those without this type of pain, according to a new report from the National Center for Health Statistics. Data shows that more than half of the adults in the United States had some type of musculoskeletal pain disorder in 2012, including lower back or neck pain, sciatica, and arthritic conditions. To read the report, click here.

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