WEEKLY E-BULLETIN


New Budget, Tax Deal Has Big Impact on Health Care

The President has signed a two-part $1.8 trillion omnibus spending and tax package after months of negotiations.  The package will fund the federal government through September 30, 2016.  Some of the top health provisions –

  • Does NOT include the provision that would have exempted hospitals building off-campus outpatient departments from lower Medicare reimbursement rates established in a budget deal in November.  This HOPD site neutral issue is expected to be addressed early next year.
  • It does suspend for two years the Affordable Care Act’s 2.3 percent sales tax on medical devices and the tax on high cost (Cadillac) insurance plans,
  • It delays for one year the Obamacare tax on all health insurance plans,
  • It mandates that any law that references the United States Preventative Task Force breast cancer and mammography screening guidelines refer to the version issued before 2009 – essentially rejecting more recent recommendations that called for less frequent screenings.
  • The NIH budget is getting a $2 billion increase, FDA is getting a $133 million increase and the National Cancer Institute is receiving a $264 million increase – the largest increase for cancer research in a decade.
  • Agency for Healthcare Research and Quality was cut from $364 million to $334 million; however, the program was saved from when the House appropriators voted to eliminate the agency entirely earlier this year.
  • The agreement provides an additional $91 million for programs to combat opioid abuse at the CDC and Substance Abuse and Mental Health Services Administration and funding for combating antibiotic-resistant bacteria was increased by roughly $300 million.

For an excellent complete executive summary of all the provisions, click here for our policy team’s review.

GAO Says Congress Should Equalize Payments Between Providers

The GAO is now weighing-in on the HOPD site neutral debate that will continue into next year in Congress.  The GAO is out with a new report that says, “In order to prevent the shift of services from lower paid settings to the higher paid HOPD setting from increasing costs for the Medicare program and beneficiaries, Congress should consider directing the Secretary of the Department of Health and Human Services (HHS) to equalize payment rates between settings for E/M office visits—and other services that the Secretary deems appropriate—and to return the associated savings to the Medicare program. HHS provided technical comments on a draft of this report, which GAO incorporated as appropriate.”  Click here for the GAO report.

Blanket Hardship Exemption for Meaningful Use Penalties Passes Congress

Another Medicare package of “policy tweaks” passed Congress Friday and is expected to be signed by the President this week. The reforms include a blanket hardship exemption from 2015 meaningful use penalties to all providers who ask for it. The penalties would have been assessed starting in 2017.  Doctors would have until March 15 to apply for the exemptions and hospitals until April 1. S. 2425 also changes how Medicare pays for power wheelchairs and radiation therapy as well as Medicaid program integrity.  The bill was crafted by Sens. Rob Portman (R-OH), John Casey (D-PA), Chuck Schumer (D-NY), Richard Burr (R-NC), Roy Blunt (R-MO), Ron Wyden (D-OR) and Michael Bennet (D-CO).  Click here to read the bill.

Tackling Chronic Conditions if Focus of New Senate Report

The Senate will be focusing on passing legislation next year that addresses chronic health conditions. The Senate Finance Committee has released the details more than 20 proposals it is considering as part of a long-term effort to improve health care and reduce Medicare cost for beneficiaries with chronic conditions.  The committee’s Chronic Care Working Group, which convened 80 meetings on the topic, released a 30-page report based on 530 comments that it received from interested parties.  The report emphasizes that the committee is not endorsing any of the ideas outlined in the report and that any eventual initiatives will need to be budget neutral or save money.  Click here for the report.

FTC Working To Block Three Hospital, System Mergers

Federal regulators want to block a planned merger between Advocate Health Care Network and NorthShore University HealthSystem, two leading hospitals in the North Shore area of Chicago. It’s the third hospital deal that the Federal Trade Commission has come out against in recent weeks. The agency has also taken action to stop Cabell Huntington Hospital’s acquisition of St. Mary’s Medical Center in the Huntington area of West Virginia, and Penn State Hershey Medical Center’s merger with PinnacleHealth System in the Harrisburg, Pa., area.  Click here for more from the FTC.

  • Researchers have found that even after controlling for other factors, areas with just one hospital had prices that were 15.3% higher than areas with four or more hospitals. Areas with two hospitals had prices that were 6.4% higher, and areas with three hospitals had prices that were 4.8% higher.  Click here for the report in Time.

 More Americans Are Choosing A Facility Over a Specific Physician

A new report that concludes one in five Americans has “no usual source of healthcare” and more are choosing a facility over a doctor. Personal relationships between physicians and patients have been declining over the past 15 years while choosing a clinic or hospital has risen. Physicians are concerned this may result in a less coordinated patient care experience.  Click here for the American Family Physician report.

Health Costs May Not Be as Reasonable in Your Area as You Thought

A new, compelling study of health care cost data, which for the first time includes a massive trove of data from commercial insurers, shows that areas of the country that appeared to have lower costs were actually higher because previous studies only looked at Medicare data.  This analysis could shake-up previously held beliefs about high and low cost areas.  Click here for the NY Times report. Click here for the 55-page study.

Prices for Top Generic Drugs Skyrocketing: OIG Report

A new HHS OIG report found that for the top 200 generic drugs, 22 percent of the quarterly average manufacturer prices (AMPs) exceeded their inflation-adjusted baseline.  In fact, one drug exceeded its inflation-adjusted AMP by an average of 2,363 percent for the 12 quarters it was a top 200 generic drug. The report comes after the passage of a federal bill mandating generic drug makers offer state Medicaid programs rebates tied to inflation.  Click here for the report.

Journal of Medical Ethics Takes On CME Accrediting Body

The United States Accreditation Council for Continuing Medical Education is disingenuous about the amount of funding and influence the drug industry has over its courses for physicians, a new Journal of Medical Ethics op-ed says. ACCME doesn’t count two major forms of industry funding as commercial support. Non-monetary resources such as equipment supplies and facility fees paid for by industry aren’t counted if the pharma company pays a third party, not the CME provider. It also doesn’t count advertising and exhibit income from industry as commercial support.  Click here for the op-ed.

No More Tanning Beds for Those Under 18: FDA Rule

The FDA has proposed a rule to prevent people under 18 years of age from using indoor tanning beds, as well as a requirement for adults who use the beds to sign a form acknowledging the health risks. The FDA also proposed a rule that the agency says would increase the safety of tanning beds, including more prominent health and safety warnings, requiring emergency shut-off switches and requiring improved protective eye-wear.  To read more about the proposed rule from the FDA, click here.

States Not Prepared for Infectious Disease Outbreaks

28 states are not as prepared as they should be for preventing, detecting, diagnosing, and responding to infectious disease outbreaks by scoring five or lower out of 10 key indicators, according to a new study from the Trust for America’s Health and the Robert Wood Johnson Foundation.  Delaware, Kentucky, Maine, New York, and Virginia scored the highest for preparedness.  Click here to see how your state scored.

Health Insurers Want To Know Your Car Model, What Magazines You Read and a Whole Lot More

Health insurers are scooping up huge quantities of personal information in a bid to figure out when you’re likely to get sick — and to design interventions to keep you healthy.  Insurance companies have always had access to your medical records, and in some cases your genetic data, too. Now, they’re paying data miners to sift through information on everything from what model car you drive to how many hours you sleep, from which magazines you read to where you shop and what you buy.  The goal: To decipher patterns that will allow them to steer you away from health emergencies. And to save themselves a whole lot of money in the process.  Click here for more.

Report Says CMS Not Aggressively Pursuing Health Plan Overpayments

Despite evidence as early as 2008 that some health plans were being overpaid for Medicare Advantage customers by tens of millions of dollars, CMS has reduced efforts to recoup those funds, according to the Center for Public Integrity. The department conducted 30 annual audits of insurers, despite having sufficient staff to conduct more than twice as many. Click here for the report.

CMS Releases Big Home Health Data Set

CMS has released a public data set that provides information on services provided to Medicare beneficiaries by home health agencies.  The Home Health Agency Utilization and Payment Public Use File contains information on utilization, payments, and submitted charges organized by provider, state and home health resource group.  Click here for details.

Most Popular Health Exchanges Plans Are Spiking in Price

The Robert Wood Johnson Foundation has released the only nationally comprehensive public data set that includes information on all plans offered in the health insurance marketplaces in 2015 and 2016.  The study found that the average premiums for ACA’s silver plans increased by 11.3 percent from 2015 to 2016, and the average individual deductible for silver plans spiked by 17.7 percent.  Silver plans are the most popular of the marketplace exchange products as 70 percent of consumers chose them.  Click here for a state-by-state list of average costs for each plan.

Drug Overdose Deaths See Sharp Increase: CDC


The CDC reported Friday that 47,055 people died of drug overdoses in 2014 – a 6.5 percent increase from the year before and a startling 137 percent jump since 2000.  Overdoses on prescription opioids in particular climbed by 9 percent, while overdoses involving heroin and synthetic opioids such as fentanyl grew by even more – 26 percent and 80 percent, respectively.  Overdose deaths were highest in five states: West Virginia, New Mexico, New Hampshire, Kentucky and Ohio. Click here for the report.