WEEKLY E-BULLETIN


FTC Continues Hospital Merger Fight, Says Consumers Pay More

The chair of the Federal Trade Commission is not letting up on her fight against hospital consolidation, saying that the lack of hospital competition is costing patients more.  Edith Ramirez told a group last week that in areas where there is a hospital monopoly, prices are 15 percent higher than those in areas with four or more competitors, and the average in-patient stay in those places is almost $2,000 higher.  Click here for the Washington Post story.

  • A federal judge declined last week to temporarily block a union between Penn State Hershey Medical Center and PinnacleHealth System.  It is considered a rare loss for the Federal Trade Commission in a hospital merger case, which has usually prevailed in a series of cases against hospital mergers in recent years.  Click here for the judge’s opinion.

 

New MACRA Paper Details Help for Small Doc Practices; AHA Says It Has Big Impact on Hospitals

Facing growing criticism about the newly proposed MACRA physician payment formula hurts small physician practices, CMS last week released a six-page document outlining the flexibility the new system provides small and rural practices. Those flexibilities center on measurements under the Merit-based Incentive Payment System, participation in advanced alternative payment models and general education, training and technical assistance.  Click here for the CMS document.

  • CMS’ Acting Administrator Andy Slavitt again outlined the Quality Payment Program (the name of the new physician payment program under MACRA) to members of Congress last week in testimony before the Ways and Means Health Subcommittee.  Click here for his testimony.

 

  • The American Hospital Association said the new physician payment program will have a big impact on hospitals, as well as physicians and outlined numerous recommended changes.  Click here.

Rural Telemedicine on the Rise for Medicare Patients

More Medicare beneficiaries are using telemedicine to seek medical care and advice, though the practice is still only covered for patients living in rural areas where health care can be hard to reach, according to a new JAMA study. In 2013, there were 107,000 telemedicine visits made by Medicare beneficiaries, a 28 percent increase since 2003.  Only 1 percent of Medicare beneficiaries living in rural areas used a telemedicine visit in 2013. Half of US states have passed laws mandating telemedicine visits be reimbursed by commercial insurers at the same rate as conventional doctor’s office visits. Click here for the JAMA report.

Hospitals with Strong HCAHPS Scores Have Higher Margins: Study

A patient-centric model of care may increase income for hospitals, according to new research. The Accenture report examined six years of hospital margin data from CMS and compared it with patient experiences recorded in the Hospital Consumer Assessment of Healthcare Providers and Systems. The study found that hospitals that performed the best on HCAHPS achieved net margins that were an average of 50 percent higher than those with average ratings. Click here for the report.

Hospital VBP Program Did Not Improve 30-Mortality Rate: Study

CMS’s Hospital Value-Based Purchasing program did not lead to improved 30-day mortality for acute myocardial infarction, heart failure and pneumonia, according to Harvard T.H. Chan School of Public Health researchers in a report released last week.  “Taken together, these findings call into question the effectiveness of the national hospital pay for performance program and whether it is having the desired effect on patient outcomes,” the researchers write in BMJ.  Click here for their report.

Survey:  Patient Engagement a “Must” But Providers Divided on Best Strategies

Most healthcare providers believe that improved patient engagement leads to better outcomes, but were divided on the best strategies to accomplish this, according to survey results published by the New England Journal of Medicine.  42 percent of the 340 hospital or healthcare executives, clinicians and clinical leaders said less than a quarter of their patients were highly engaged in their care decisions. More than 70 percent said less than half of their patients are highly engaged. Only 9 percent of respondents reported high levels of engagement among their patients.  Click here for the survey results.

Are We Making Progress on Obesity? Apparently Not

Only 2 states have obesity rates below 20%, according to the Gallup-Healthways Well-Being Index released last week.  Only Colorado (19.8%) and Hawaii (18.5%) have less than a fifth of the population in ranges below obese, which is defined by CDC as having a body mass index of 30. Meanwhile, at least 1 in 3 adults are obese in 5 states, led by West Virginia with an obesity rate of 37%. The other states are Mississippi (35.5%), Delaware (33.8%), Arkansas (33.5%), and Oklahoma (33.5%). And the national obesity rate reached a new high of 28% in 2015, up from the rate of 25.5% in 2008.  Click here for the survey.

Is TB Making A Comeback?

After two decades of steady decline, the number of active tuberculosis cases in the U.S. inched up last year. Hall’s was one of 9,563 TB cases reported last year, up from 9,406 cases the year before. The CDC is still trying to determine the reason for the uptick.   Click here for the news report.  Click here for the CDC data.

House Passes Numerous Opioid-Abuse Deterrent Bills; Conference with Senate Next

The House passed bills aimed at curbing the opioid abuse epidemic after three days of bipartisan support and overwhelming votes on more than 15 bills involved and about two dozen amendments. The main elements would set up a new federal task force to update best practices for pain management and establish a program at the Department of Justice to fund substance abuse programs in the states. However, HHS Secretary Burwell said the legislation lacks the “significant investment” needed to fight the epidemic.  The bills are as follows:
H.R. 4978 – NAS Healthy Babies Act – click here
H.R. 3680 – Co-Prescribing to Reduce Overdoses Act of 2016 – click
here
H.R. 3691 – Improving Treatment for Pregnant and Postpartum Women Act of 2016 – click
here
H.R. 1818 – Veteran Emergency Medical Technician Support Act of 2016 – click
here
H.R. 4969 – John Thomas Decker Act of 2016 – click
here
H.R. 4586 – Lali’s Law – click
here
H.R. 4599 – Reducing Unused Medications Act of 2016 – click
here
H.R. 4976 – Opioid Review Modernization Act of 2016 – click
here
H.R. 4982 – Examining Opioid Treatment Infrastructure Act of 2016 – click
here
H.R. 4981 – Opioid Use Disorder Treatment Expansion and Modernization Act – click
here
H.R. 5046 – The Comprehensive Opioid Abuse Reduction Act – click
here
H.R. 5052 – The Opioid Program Evaluation Act – click
here
H.R. 5048 – The Good Samaritan Assessment Act of 2016 – click
here
H.R. 4985 – The Kingpin Designation Improvement Act of 2016 – click
here
S. 32 – Drug Trafficking Act of 2015 – click
here

  • A handful of states are insisting that health professionals do a little research before they write another prescription for highly addictive drugs like Percocet, Vicodin and OxyContin.  Click here.

 

  • Here’s an unintended side effect of more transparency in health care:  drug addicts used ProPublica’s Prescriber Checkup site to find doctors who prescribe a high volume of painkillers.  “(I)t seems probable that some of the readers who visit Prescriber Checkup are looking for doctors who will prescribe narcotics and other powerful stimulants with few or no questions asked. ” Click here for the report.

 

  • A clinic in West Virginia has hired an anesthesiologist to manage the pain issues of patients – particularly the prescribing of pain killer opioids.  So far, a great success story.  Click here for the NY Times story.

 More Insurers Push Rx Companies for Pricing Based on Outcomes

Health insurers are pushing drug companies to offer more pricing strategies based on outcomes, according to the Wall Street Journal.  Such “value-based” deals are becoming more common as rising costs spur customers to demand assurances they are getting what they pay for. U.S. prescription spending rose 12% to nearly $425 billion in 2015, following a 13% increase in 2014, according to research firm IMS Health.  Click here for the story.

Surgeons in Physician-Owned Distributorships Perform More Surgeries

According to a newly released Senate Finance Committee report, surgeons who participate in physician-owned distributorships (PODs) may be motivated by profit to perform more surgeries. PODs serve as intermediaries between device-makers and providers, and owners receive commissions on additional sales. The report offers several recommendations to increase transparency and scrutiny of PODs. Click here for the report.

CDC To Award $85M for States to Combat Zika

CDC has announced that they will disperse $85 million in grants to U.S. states and territories can to help them prepare for Zika and the associated health outcomes like microcephaly. $25 million will go to 53 states, cities and territories at risk for outbreaks. Funds will be distributed based on the geographic location of the two mosquitoes known to transmit the Zika virus, history of mosquitoes-borne disease outbreaks, and the size of the population. Applications are due to CDC by June 13th and will be disbursed this summer. Click here for more from the CDC.

  • Puerto Rico announces it first Zika-related microcephaly case, click here for the story.

 Criminal Attacks Account for About Half of Health Care Data Breaches

About 90 percent of health care covered entities and 60 percent of business associates admitted to having had a breach of patient data in the last two years, a new Ponemon Institute survey says. Those numbers are about the same as last year. Fifty-three percent were confident or very confident they were able to protect all information, a bit higher than last year’s numbers. Criminal attacks were the leading cause of breaches, accounting for nearly half, a 5 percent increase from last year’s study.  Click here for the study.

HHS Announces “A Bill You Can Understand Challenge”

HHS has announced a challenge to encourage health care organizations and other innovators to design a medical bill that’s simpler and easier for patients to understand. The design challenge, “A Bill You Can Understand,” is sponsored by AARP. Two awards will be issued: one for the innovator that designs the bill that is easiest to understand and a second for the innovator that designs the best transformational approach to improve the medical billing system. Winners will be announced in September. Click here for more on the challenge.

GAO: Health Plans Continue Medicare Advantage Overbilling
Fundamental improvements are necessary to better regulate the private health plans that participate in the growing Medicare Advantage market, according to a new GAO audit. The report states the CMS audits intended to curb overbilling often dragged on for years without imposing significant financial penalties. GAO found that CMS has spent $117 million on Medicare Advantage audits and recouped $14 million. For the full report, click here.

  • The seven largest health insurers in the United States continued their enrollment growth last year.  Click here for details.

 Judge Rules ACA is Improperly Funded by Subsidy Program

A federal judge ruled the Obama Administration has been improperly funding an Affordable Care Act subsidy program. The judge said that the program can continue, pending the Administration’s promised appeal. The Justice Department has declared that the subsidies were funded appropriately. Health plans would likely feel the financial hit if the ruling stands because those payments go directly to insurers to make up for lower payments from their poorest customers. Click here for the Judge’s opinion. Click here for the Washington Post report.

Obamacare Nondiscrimination Policies Released by HHS

HHS released the final rule on the Affordable Care Act’s nondiscrimination policies that prohibits discrimination in health care on the basis of race, color, national origin, age, disability and sex, including pregnancy and gender stereotyping. According to the agency, it also “enhances” language help for those with minimal English proficiency. Click here for HHS summary of the rules and here for the final rules.

Kids Have Better Access to Health Care

A new National Center for Health Statistics report finds that just 2.3 percent of adolescents between the ages of 10 and 17 lacked a place for preventive care in 2014, down from 4.5 percent in 2008. Older teenagers (16-17) had higher percentages of not having a usual place for preventive care, not receiving a well-child checkup, and not having a dental visit compared with those in younger age groups. Click here for the report.

FDA Clarifies Stance on Medical Foods Marketing

The FDA finalized guidance that distinguishes what products qualify as “medical foods” to address confusion about how they can be labeled and sold in the market. The guidance states that medical food should not be labeled and marketed for diabetes, pregnancy or nutrient deficiency diseases like scurvy. But medical foods can be sold to address metabolic problems. For the guidance from FDA, click here.

CMS: Innovation Awards Result in Benefits to Patients

CMS’ Innovation Center last week released its second annual independent evaluation reports on its Health Care Innovation Awards.  CMS says the latest analyses show a wide range of experiences that have resulted in tangible benefits for patients and helped inform CMS in the development of new payment and service delivery models. Where data are available, these reports describe preliminary impact estimates on key outcome measures such as hospitalizations and readmissions. A number of awardees showed favorable results on one or more measures of cost, hospitalizations, readmissions, and emergency room visits.  Click here to review those reports from CMS.