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Weekly E-Bulletin

Senate Could Vote on Health Reform Bill This Week; CBO Analysis Will Be Released 

Five GOP Senators have announced their opposition to the health reform legislation released last week; 4 from the right wing, Paul (KY), Lee (UT), Cruz (TX), Johnson (WI) and one from the middle, Heller (NV).  All have said their positions are negotiable, to varying degrees.  The Congressional Budget Office will release its analysis “early this week.”  Experts are projecting the CBO to show the Senate bill costing 15-22 million Americans their coverage.  CBO said the House bill would cost 23 million Americans their coverage.


Here’s the politics:

  • To see the needle that GOP Leader McConnell (R-KY) has to thread to pass the bill, click here.
  • Here’s a look at where all 100 senators stand as of Friday.
  • Sen. Heller is not the only GOP centrist with concerns about Medicaid.  Click here.
  • Take a closer look at Sen. Heller’s predicament.  Click here.
  • Sen. Lee put the reasons for his opposition in writing.  Click here.

Here’s the policy:

  • Click here for the 26-page Senate leadership summary of the legislation. Click here for the 142-page bill.
  • For an excellent detailed summary of the Senate legislation from Health Affairs, click here.
  • Compare the House and Senate bills’ impact through a side-by-side of U.S. maps.  Click here.
  • State Medicaid directors oppose the Senate bill. Take a deeper dive into the Medicaid impact here.
  • Cuts to Medicaid in both bills may have a big impact on long-term care.  Click here for a review.
  • Some health policy experts believes the Senate plan falls short of lowering insurance costs.  Click here and here.
  • Accounting firm Oliver Wyman says it is the current uncertainty driving up insurance costs.  Click here.
  • The Commonwealth Fund is out with an analysis of how the House bill would impact hospitals in every state. Click here for their report.


CMS’ Proposes MACRA Updates Exempting More MIPS Clinicians

CMS has released its proposed MACRA regulations for Year 2. The rule would amend some existing requirements and also contains new policies for clinicians participating in either the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs). The proposal would exempt more doctors from MIPS through expanded low volume thresholds, delay measuring performance on cost, allow solo practitioners and doctors in small practices to form “virtual groups,” and delay a required upgrade to physicians’ electronic health record systems. CMS estimates about 94 percent of doctors will avoid penalties from the MIPS during the program’s second year. For the CMS fact sheet, click here, and the 1,000-page rule, click here.  You have 60 days to submit formal comments.


Trump Executive Order Attacks 340B Rx Program
President Trump is preparing to sign an executive order regarding Pharma that is not only pharma-friendly but directs HHS to reform 340B. A draft of the executive order became public late last week. Click 
here to read it. The 340B directive is Number 4.

  • Click here for an Atlanta Journal Constitution report on how hospitals are “chasing” 340B.

762 Rural Hospitals Received No Stars in CMS’ Rating Program
In April 2017, CMS released its fourth Hospital Quality Star Rating list. According to a new analysis, more than one third of rural hospitals did not receive a star rating, compared with 12% of urban hospitals. Among rural hospitals, CAHs and very small hospitals (lowest net patient revenue) were least likely to receive a star rating. Rural hospitals without a star rating were clustered across the West, Midwest, and South Census Regions. Click 
here for the report.


Hospitals Slammed with Opioid Emergencies

The coast-to-coast opioid epidemic is swamping hospitals, with government data published last week showing 1.27 million emergency room visits or inpatient stays for opioid-related issues in a single year. Click here.

  • Only 1 in 4 young Americans with opioid use disorder aged 13 to 25, and who have private insurance, are receiving treatment medication, according to a JAMA study. Researchers also found that younger individuals, females, and black and Hispanic youth were less likely to receive a medication. Click here for the study.
  • New AHRQ Study shows that the number of women being admitted to a hospital because of opioid or heroin abuse grew by 75 percent between 2005 and 2014 and hospitalizations for men increased by 55 percent over the same period. Women were hit hardest in West Virginia, Maryland and Massachusetts, while the highest hospitalization rates for men were in Washington, New York and Maryland. For the full report, click here.

VA CHOICE Program Nearly Out of Funds

Senate appropriators last week tore into Veterans Affairs Secretary David Shulkin when discussing a funding shortfall that threatens to cut off veterans from private health care providers. The debate opened up a particularly touchy issue for veterans that remains low on Congress’ radar. But lawmakers will need to appropriate billions into the VA Choice Program to keep it running past mid-August. The program allows veterans in certain circumstances to use doctors and hospitals outside the traditional VA medical system. Click here to view the hearing and read the VA’s prepared testimony.

House Reps Target High Cost of Insulin

Congressional Diabetes Caucus co-chairs Reps. Tom Reed (R-NY) and Diana DeGette (D-CO) sent letters to leaders of the pharmaceutical, insurance and pharmacy benefits manager lobbies last week requesting a meeting to discuss the increasing cost of insulin. “Both the underlying cost of insulin and the direct cost burden on patients with diabetes have risen in recent years,” the pair wrote. “People skip doses, fail to pay rent or buy groceries and even resort to an insulin ‘black market’ in order to afford their insulin.” The letter said. To read the letters, click here.


Committee Leaders Urge CMS to Act on Inspector General Recommendations

In a letter to the CMS Administrator, House Energy and Commerce Committee leaders urged CMS to follow through with a backlog of recommendations issued by the Office of Inspector General (OIG) that date back almost 30 years that include issues relating to Medicare Parts A and B, Medicare Part D, and Medicaid. The letter asks CMS to prioritize the top 25 unimplemented recommendations, stating, “These top unimplemented recommendations have been identified by OIG as ones that would most positively impact HHS programs in terms of cost savings and/or quality improvements.” Click here to read the letter.


House Tort Reform Bill Heads to Floor Vote; CBO Says Bill Would Cut Premiums at Least 25%

The House this week will vote on H.R. 1215, the Protecting Access to Care Act of 2017, a bill that aimed at curbing medical professional liability premiums. Modeled after California’s Medical Injury Compensation Reform Act (called MICRA), the bill includes a $250,000 cap on non-economic damages; limits on the contingency fees lawyers can charge to maximize patient recovery; and a rule, where damages are allocated in direct proportion to fault. According to the Congressional Budget Office, under the bill, premiums for medical malpractice insurance ultimately would be an average of 25% to 30% below what they would be under current law. To view the bill text and summary, click here.


ONC’s Database of Certified EHRs Updated, Sortable
The Certified Health IT Product List landing page has been updated by the ONC to keep it current and make it easier to navigate. Users may now access a full, sortable list of certified health IT products via a resource shortcut and a list of all the 2015 edition certified products through a shortcut for application programming interfaces. Click here.


Discrimination Widespread for Women Physicians: Study 

Nearly 80 percent of the almost 6,000 women physicians surveyed reported facing discrimination on pay, benefits, promotions, performance evaluation, decision-making role or disrespect, according to a new JAMA report. Almost 90 percent of those who said that they faced discrimination because they were mothers attributed the discrimination to pregnancy status or workplace policies on maternity leave. More than half of the same group responded they had been treated disrespectfully by nursing and other support staff, and reported they had been discriminated against based on breastfeeding. To read the study, click here.


Fewer American Teens Having Sex
According to a new CDC report reflecting data from 2011 to 2015, about 42 percent of girls and about 44 percent of boys ages 15-19 reported that they’d had sex. Both numbers continue a gradual decades-long decline: In 1988, 51 percent of girls and 60 percent of boys in the same age group answered affirmatively on the question of sexual activity. Click here for the CDC report.


Tired of that Tattoo?  FDA Offers Safe Options for Removal

One in eight Americans regret their tattoos leading to modifications and many times removal of the body art. Seeing a rise in removal, the FDA is offering tips on how best to get rid of tattoos, the side effects, and possible consequences. The consumer alert discusses creams, lasers, and dermabrasion among other methods.  To read the FDA alert , click here.

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