WEEKLY E-BULLETIN


Medicare Drug Spending Skyrockets: CMS Report

Spending on prescription drugs in Medicare Part D increased 17 percent from 2013 to 2014, according to new data released by CMS. Drug costs in the program grew from $104 billion to $121 billion between 2013 and 2014. The data set is compiled from drugs paid for by Medicare Part D, including 38 million beneficiaries. Medicare spent more than $3.11 billion in 2014 on Gilead’s hepatitis C treatment Sovaldi alone. More than 33,000 Medicare patients were treated with the drug, which was priced at $84,000 for a 12-week course that offered the first reliable way to cure the deadly disease. The data files reveal the drugs that ran up the largest bills with Medicare Part D in 2014, as well as those that were prescribed at the highest volume. To review the files, click here. Click here for the CMS 2014 drug spending dashboard for the top drugs.

  • Pharmaceutical company payments to physicians were associated with greater regional prescribing of brand diabetes drugs and oral clotting drugs in Medicare Part D, a new study in the British Medical Journal found.  Click here.

Big Price Increases for Orphan Drugs Prescribed for Non-Orphan Uses: Study

A health insurance industry analysis of orphan drugs finds a correlation between orphan drug price increases and orphan drugs that are used to treat common conditions. The report, released last week, analyzed drugs that qualified for orphan status, which FDA gives to rare disorder treatments that drug companies would not develop were it not for the incentives that accompany the designation. Drug companies get 50 percent tax credits for research and development expenditures on orphan drugs, they don’t have to pay the drug application fee, and they get extra help from FDA during orphan drug development. Click here for the AHIP study.

CMS’ New Cardiac Bundle Could Cost Hospitals a Bundle: Analysis

About 85% of hospitals that may be required to participate in Medicare’s proposed new cardiac bundled payments can expect to see a modest impact that doesn’t exceed about $500,000 per year, according to a new Avalere analysis that based its conclusions on 2013-14 spending data. However, a smaller proportion of hospitals are likely to experience significant penalties because their current spending is significantly above the average for their region. Click here for the analysis.

Aetna Drops 11 States in Federal Health Exchange Pullback; Feds Double Down on Exchange Efforts

Aetna and subsidiary Coventry/?HealthAmerica are pulling out of the federal health exchange marketplace in 11 states beginning in 2017, citing unexpectedly high claims costs that led to a second quarter $200 million pretax loss and more than $430 million in losses since the marketplace plans launched in January 2014. Aetna will continue to participate in the Delaware, Iowa, Nebraska and Virginia marketplaces next year. UnitedHealth Group Inc. and Humana Inc., which Aetna has agreed to buy for $37 billion, are also pulling out of states after posting hundreds of millions of dollars of losses. Click here for the announcement from Aetna.

  • Aetna CEO Mark Bertolini expressly warned the Department of Justice in a letter on July 5 that if the Administration tried to stop Aetna’s merger with Humana, Aetna would be forced to scale back its exchange presence. Click here for the letter.
  • Click here for an interesting analysis on this issue in the Washington Post.
  • Despite the insurance industry pullback, the federal government is preparing a major push to get more Americans to sign up on the exchanges.  Click here for the NYTimes report.

UNOS Proposes Liver Transplant Policy Changes

The United Network for Organ Sharing (UNOS) has proposed changes to the geographic regions for liver transplants to better match organ supply with demand and make access more equitable. UNOS proposes establishing eight liver distribution districts nationwide, instead of the current 11 to create a better balance of organ availability with the number of patients waiting. Comment on the proposal is due October 15th. Click here for the UNOS Proposal.

Researcher Says Data on Medical Error Deaths is Overblown

The data on medical error deaths is overblown and misleading, according to a New York Times article published last week by Aaron Carroll, a health care researcher.  He says that the steadily rising number of hospital deaths linked to preventable medical errors is based on limited evidence and the true number is likely a tiny fraction of what’s reported.  A landmark 1999 study originally concluded that 98,000 deaths per year were linked to preventable errors; a recent BMJ study raised the tally to more than 250,000 deaths per year. Click here for his report.

Study: Medicaid Expansion Cut Hospital’s Uncompensated Care Costs

A new analysis estimates that in states where Medicaid has been expanded, hospitals’ uncompensated care costs have decreased from 4.1 percentage points to 3.1 percentage points of operating costs. The research, published this week in the journal Health Affairs, examines uncompensated-care costs at 1,249 U.S. hospitals between 2011 and 2014. “Our estimates suggest that uncompensated care costs would have decreased from 5.7 percentage points to 4.0 percentage points of operating costs in nonexpansion states if they had expanded Medicaid,” researches said.Click here for the abstract.

CMS To Crack Down on Steering Medicare/Medicaid Patients to Individual Market

CMS is seeking information from the public regarding reports that some health providers are steering Medicaid and Medicare eligible patients to individual market plans in order to receive higher payment rates. In it’s official request for information issued last week, CMS requests comments on the frequency of this reported practice, the impact it has on patients, and suggestions about how to prevent it. Click here for the notice from CMS.

CMS Wants Help on IMPACT Act Measures

CMS is soliciting public comment on a collection of standardized assessment-based data items developed under the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) to meet the domains of: cognitive function and mental status; special services, treatments, and interventions; medical conditions and co-morbidities; and impairments. CMS has already developed many of the measures for Long-Term Care Hospital, the Inpatient Rehabilitation Facility, the Skilled Nursing Facility, and the Home Health Agency settings as required by the IMPACT Act. Click here for the public comment page.

Women Physicians Reimbursed $19,000 Less Per Year by Medicare

Medicare reimburses female physicians significantly less than their male colleagues, even after adjusting for factors such as hours worked, years of experience, and productivity, according to a new study last week in the Postgraduate Medical Journal. After adjustment, the overall reimbursement differential against female providers was $18,677.23. The researchers compared the reimbursements made to female and male physicians in 13 medical specialties for more than 3 million claims. Click here for the study.

Low-Income and Latinos Most Likely to be Uninsured: Study

Latinos and people with incomes below the federal poverty level are among the populations most likely to lack health insurance coverage according to a new analysis. Of the 24 million adults who still lack coverage, about 40 percent are Latino and a similar share have incomes below the federal poverty level. About a third of the country’s remaining uninsured adults would qualify for Medicaid if their states had expanded it. To read the study, click here.

Half of U.S. Has OB/Gyn Shortage: Analysis

Nearly half the counties in the U.S. don’t have a single obstetrician/gynecologist and 56 percent are without a nurse midwife, according to the American College of Nurse-Midwives.  The workforce shortage can have dangerous consequences, and may help explain why a relatively high percentage of American women die as a result of pregnancy, says a community health researcher.  Click here for the story.

CMS Susceptible to Cyber Attacks

A new HHS OIG report released last week says that CMS’ wireless networks could be vulnerable to hackers. The office conducted tests to penetrate CMS’s wireless networks between August and December 2015, and found four weaknesses in the agency’s systems, despite some protections. The auditor said there was no evidence that the weaknesses had been exploited, but warned that if they were compromised it could result in “unauthorized access to personal information as well as disruption of critical operations.” Click here for the report.

Hospital Has a “Sticky” Situation

A British hospital discovered it had become home to more than 100,000 bees when patients noticed honey dripping down the walls. Beekeepers were summoned to Rockwood Hospital in Cardiff, Wales, after the discovery last month, and found a large colony of bees in the roof above a ward. The hive had gone unnoticed for up to five years. For more on this story from the BBC, click here.