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11/16/2016

Weekly E-Bulletin


What Will Donald Trump’s Election Mean to Healthcare?

With Donald Trump’s upset victory, the Washington establishment is stunned. There are few places in federal policy that will be impacted as much, potentially, as health care. President-elect Trump said last week his top 3 priorities are immigration, health care and jobs. Click here for Strategic Health Care’s 3-page analysis, including links to key documents. An update to the Trump Transition website now includes “modernize Medicare” as a key goal (click here.) Speaker of the House, Paul Ryan (R-WI), said last week that his agenda includes an overhaul of Medicare and Medicaid. Click here.

More Health Care Developments:

• Trump says he is willing to keep some key parts of Obamacare, i.e. pre-existing conditions, kids stay on parents’ plans until age 26. Click here for the WSJ story. Trump said something similar on 60 Minutes. Click here for the video clip.

• Supporters of Obamacare are not going to roll over. They are already plotting to thwart GOP efforts. Click here. And the LA Times reports that repeal will not be that easy. Click here.

• Current CMS Administrator Andy Slavitt tweeted his top 4 priorities in the transition to the new Administration and saving CMMI is listed as #2. Click here.

• Perhaps in reaction to Trump’s win, enrollment in the Obamacare exchanges is surging. Wednesday saw more than 100,000 persons sign up. Click here.

• What do physicians want from a President Trump for health care? Read the letter several wrote to him here.

Policy is impacted as much by WHO is in charge as anything else. So, who will run HHS? Trump adviser and former GOP presidential candidate Dr. Ben Carson may top the list. Even Trump said he wanted to see Carson active on health care issues, should he win. Also on the HHS Secretary speculation list: Former Arkansas governor Mike Huckabee, Former Louisiana governor Bobby Jindal and Florida Governor and former HCA chief Rick Scott. As important, who will run CMS? No names have yet surfaced, but speculation will run rampant about both posts starting now.

Joint Commission: America’s Hospitals Show Continued Improvement

America’s hospitals continue to make strides towards improving patient safety and quality for common conditions for which people enter the hospital, according to The Joint Commission’s 2016 Annual Report: “America’s Hospitals: Improving Quality and Safety.” The report released last week presents information on how well more than 3,300 Joint Commission-accredited hospitals performed on individual measures of patient care during 2015. Measures covered in the report relate to children’s asthma, inpatient psychiatric services, venous thromboembolism (VTE) care, stroke care, perinatal care, immunization, tobacco use treatment, and substance use care. The number of accountability measures included in this year’s report is 29, down from 49 in 2014. Click here for the report. Click here to see how your hospital fared.

Medicare Part A and Part B Premium Increases Start in 2017

Some Medicare Part B beneficiaries will see a increase in their 2017 Part B premiums due to a small Social Security Cost-of-Living Adjustment. This increase is smaller, however, than the premium increase those same beneficiaries faced between 2015 and 2016 after lawmakers stepped in. Medicare Part B beneficiaries will see their monthly premium rise more than 12 percent in 2017, according to CMS. The agency established the upcoming standard monthly Part B premium at $137, up from this year’s rate of $121.80. The 2017 deductible for Part B beneficiaries is $183, up from $166. CMS also published its 2017 premium for Medicare Part A, which covers hospital services. To read the announcement from CMS click here. Click here for the Part B notice, and here for the Part A notice.

• Average out-of-pocket expenses for health care services in 2014 ranged from $288 for children younger than 18 to $1,253 for people age 65 and older, according to a new report from the Agency for Healthcare Research and Quality. Click here.

The Court Stops CMS Rule on Nursing Home Arbitration Rules

A federal district court issued an injunction last week to halt the implementation of a CMS rule that blocks nursing homes from using binding arbitration agreements that require patients and their families to agree to arbitration in case a future dispute arises. This is a win for the American Health Care Association (HCA) and the nursing home industry as they have relied on the arbitration agreements in admission contracts with new residents for some time. This injunction will stop implementation of that provision of the rule that bans providers from including those clauses in admission contracts. Click here for the injunction notice.

Health Plans File Suit Over Risk Corridors

Minuteman Health of Massachusetts and New Hampshire has joined several other co-ops and payers in filing suit against the administration for failing to provide funding for the risk corridor program. Minuteman is seeking $5.5 million from the government to cover the amount for 2014 and the estimated amount for 2015. The suit charges that the federal government is violating the Fifth Amendment by illegally taking the company’s property in the form of “forced risk adjustment payments without just compensation.” For more on the suit from the Boston Globe, click here.

ONC Wants More Power To Stop Information Blocking

The agency that regulates and promotes health IT within the government, the Office of the National Coordinator, published its annual report to Congress last week, mostly highlighting its work to realize health IT’s potential. It outlines how ONC is promoting interoperability standards, promoting privacy and security, changing the business case for information sharing, and encouraging patient access and provider sharing of data. The ONC also asked Congress for more power to pursue cases of information blocking. The office notes the president’s 2017 budget included requests to explicitly prohibit information blocking and for the HHS Inspector General to investigate and penalize it. Click here for the complete report.

HHS Inspector General Releases 2017 Workplan

There are 24 new initiatives the OIG will pursue in 2017, ranging from provider reimbursement for hyperbaric oxygen therapy services, inpatient psych outlier payments, SNF reimbursement, Medicare payments for CCM and TCM and Medicare payments for service dates after individuals’ dates of death. Click here for the complete workplan.

Tobacco Linked to 40% of All Cancers in U.S.: CDC

Tobacco use contributes to 4 in every 10 cancers diagnosed in the United States, according to a new CDC report. That amounts to about 660,000 people who were diagnosed between 2009 and 2013 with various types of cancer, including lung cancer and cancers of the mouth and throat. Read the full study here.

CMS Issues Draft 2018 Operations Guidance to Insurers in the Federal Exchanges

CMS released its draft 2018 Letter to Issuers in the Federally-facilitated Marketplaces in an effort to influence exchange operations before President Obama leaves office. Comments on the draft are due on December 1st. The marketplace rules apply to individual, group, and dental plans. CMS stressed flexibility and proposed the 2018 enrollment season will run between Nov. 1 and Jan. 31 – the same as the current sign-up window. Click here for the CMS memo on the draft letter.

Medicaid Directors Say Payment Reform Is Their Top Concern

A majority of the country’s Medicaid directors say their biggest challenges are related to staffing and technology infrastructure. More Medicaid directors then in previous years said their first priority is so-called payment reform, an industry-wide focus on transitioning health care away from fee-for-service payments. Directors also highlighted a new focus on IT systems and on behavioral health. To read the results of the survey, click here.

Opioid Treatment Centers Still Lacking Across U.S.

Despite the nation’s decade long surge in opioid addiction, large swaths of the U.S. still lack specialized opioid treatment centers that can dispense methadone, one of three medications available to treat addiction to heroin and prescription pain pills. The other two medications, buprenorphine (approved by the FDA in 2002) and Vivitrol (approved in 2010), can be prescribed by doctors. But for some patients, particularly those who have built up a high tolerance for opioids through prolonged use or high doses, methadone can be the only addiction medication that works. Click here for the story.

• The Drug Enforcement Administration today will ban a synthetic opioid called U-47700, often dubbed “pink.” There have been 46 deaths in the US in the past two years in which the drug is a confirmed cause. Click here for more.

Testing Begins on Experimental Zika Vaccine

Scientists at the National Institutes of Health have begun the first of five early stage clinical trials to test the effectiveness of a new Zika vaccine in humans. The Zika vaccine contains whole virus particles that have been inactivated so the virus cannot cause disease in humans. However, the protein shell of the inactivated virus remains intact so it can be recognized by the immune system and evoke an immune response. For more from NIH, click here.

Supreme Court Will Not Hear Case on Anti-Competitive Generic Drug Agreements

The Supreme Court says it will not review an appeals court decision that took a broader view of what may qualify as an anti-competitive “pay-for-delay” agreement between brand and generic drug companies. The court’s refusal to hear the case leaves in place a 3rd Circuit Court of Appeals ruling from June 2015 that found that drug patent settlements involving a non-cash transfer of value are subject to antitrust scrutiny. “Pay-for-delay” is typically when brand drug makers pay generic companies to delay introduction of cheaper generic drugs. The decision is a win for the FTC. Click here for the Supreme Court order, and here for the lower court decision.

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