WEEKLY E-BULLETIN


Medicare ACOs Save $466 Million in 2015

Over 400 Medicare accountable care organizations generated more than $466 million in total program savings in 2015, according to the latest data from CMS. However, Medicare spent $217 million more in bonuses than the ACO program saved.  The data is from the financial results of 392 organizations participating in the Medicare Shared Savings Program and 12 enrolled in the Pioneer ACO program. Among ACOs that started in 2012, 42 percent generated savings large enough to qualify for payments, compared to just 21 percent for those that joined the program in 2015. The 12 Pioneer ACOs achieved savings of $37 million last year, according to CMS. Half of them reduced spending enough to keep some of the savings. The administration has set a goal of having 50 percent of Medicare payments flowing through alternative payment models by 2018. To read the results from CMS, click here. For a good CMS 2-page summary of ACO stats, click here.

  • For all specific MSSP performance data, click here.
  • For 2015 specific Pioneer ACO performance data, click here.

Most Rural Hospital Closures in the South: Study

Of the 25 states that have seen at least one rural hospital close since 2010, states with the most closures are located in the South, according to research from the North Carolina Rural Health Research Program. Top of the list was Texas with ten hospitals closed since 2010, Tennessee saw the second-most closures, with eight hospitals closing since 2010 and in third place, Georgia with six closures. For more from the study, click here.

  • Rural and small independent physician practices are increasingly worried that the new CMS physician payment system (MACRA) will bring an end to their ways of doing business.  Click here for the story.

House Calls May Save Millions for Federal Health Programs

CMS says that one of its demonstration projects has shown that delivering comprehensive primary care services at home helped to keep Medicare recipients with multiple chronic illnesses or disabilities out of hospitals, emergency rooms and nursing homes.  Many of those patients are among the 37 percent of Medicare beneficiaries with more than three chronic health conditions who together consume almost three-quarters of spending for the federal health care plan for the elderly and disabled. Because they are sick, frail, and often isolated, they are prone to putting off visiting their primary care provider while their conditions worsen, leading to more expensive care down the road. Click here for the story.  Click here for specific program results from CMS.

Private Equity Acquiring Derm Practices Nationwide

Private equity firms are buying up dermatology practices across the country, according to a report by Business Insider. In the past two years, there have been more than 200 such purchases of physician practices by investors, with about 30 of them involving dermatology practices, with more deals likely to come in the future. Click here for the details.

NIH Launches Centers for Health Disparities for Chronic Diseases

In response to the need for more vigorous approaches to address chronic diseases among minority and other groups, NIH has launched the Transdisciplinary Collaborative Centers (TCC) for Health Disparities Research on Chronic Disease Prevention program. Two centers will focus their research efforts on community-based, multilevel interventions to combat chronic diseases such as heart disease, cancer and diabetes and will share approximately $20 million in funding over five years. Click here for more from NIH.

Health Exchange Enrollment Hits New Low

Enrollment in the insurance exchanges for President Obama’s signature health-care law is at less than half the initial forecast, pushing several major insurance companies to stop offering health plans in certain markets because of significant financial losses, according to numerous reports. As a result, next year, more than 1 in 4 counties are at risk of having a single insurer on its exchange. Click here for the New York Times report.

Higher Rates Won’t Impact Low Cost Plans

Affordable Care Act exchange customers will largely be shielded from large rate increases because, according to new HHS analysis, they’ll be eligible for larger subsidies. HHS researchers assumed a theoretical rate increase of 25 percent to examine how that would affect premiums for customers in the 38 states that use HealthCare.gov for enrollment. They concluded that 73 percent of customers could buy plans that cost $75 or less after subsidies. The overwhelming majority of Obamacare customers – 87 percent – are eligible for subsidies. To read the analysis, click here.

Pharmaceutical Coupons Leading to Higher Part B Payments: GAO

The increasing use of drug coupons in the private sector means Medicare Part B may be paying higher prices, according to a new GAO report. In 2015, drug companies offered coupon programs for 29 of the 50 high-expenditure Medicare Part B drugs that GAO analyzed. GAO estimated that for the 18 drugs for which it had coupon data, the average sales price (ASP) exceeded the actual market price by 0.7 percent leading to about $69 million lower spending if the ASP equaled the effective market price. Click here for the report.

Mylan’s EpiPen Troubles Mounting

Mylan started to significantly raise the price of EpiPens when the company believed a generic version of the drug would enter the market in 2015, but that product was eventually rejected by the FDA, according to a New York Times report. Another non-generic version of the drug was pulled from the market last year, meaning Mylan will retain a monopoly over the treatment for at least another year. Click here for the story.

  • There are other reasons consumers are seeing more out-of-pocket drug costs. Increased cost-sharing, and high deductible plans in particular, have exposed more consumers to price hikes that once would have been borne by payers. As parents fill prescriptions for fresh back-to-school supplies, they are being hit with the most recent increases, and they are complaining. Click here for the report.
  • Mylan is under congressional fire for the rising price of EpiPens, but the drug company also raised prices for some of its other drugs even more earlier this year. Click here.

All Blood Products in US to be Tested for Zika

With growing evidence that Zika may be spreading across the continental U.S., the FDA is calling for all U.S.-donated blood and blood products to be tested for the virus in order to protect against Zika transmission through transfusions. FDA stated it is making the change due to the potentially dramatic consequences of Zika infection to children born to women exposed during pregnancy. Click here for the FDA announcement.

CDC Awards $6.8 Million for Zika Response

The CDC announced it is awarding $6.8 million to organizations around the country to assist with Zika response efforts. The funding will go toward mosquito surveillance and control, as well as communications and outreach to pregnant women about the risks of Zika. The American Public Health Association, the March of Dimes Foundation, and the Task Force for Global Health are among the organizations receiving money. For more from the CDC, click here.

HHS Awards $9 Million Towards MERS Vaccine

Regeneron will get up to $8.9 million to manufacture and study two antibody therapies to potentially prevent and treat the respiratory infection MERS. There are no medicines or vaccines to treat MERS, which first emerged in Saudi Arabia in 2012 and has been confirmed in other Middle Eastern countries, Africa, Europe and the United States. Click here for the announcement.

Better Care Coordination Driving Rate of Potentially Avoidable Hospitalizations: AHRQ

From 2005 to 2013, the rate of potentially avoidable hospitalizations for all conditions, excluding chronic obstructive pulmonary disease, fell about 23 percent, according to a new government report. Rates of potentially avoidable hospitalizations for all conditions in 2013 were highest among African-Americans and lowest among Asians and Pacific Islanders.  These are just a few of the facts in the 2015 AHRQ Chartbook on Care Coordination.  Click here for the 48-page fact-filled report.

Analysis Finds Conflict for Cancer Guidelines Authors

According to new JAMA Oncology analysis there is a high prevalence of large financial conflicts of interests among authors of the National Comprehensive Cancer Network (NCCN) guidelines. 86 percent of the 125 doctors who worked on National Comprehensive Cancer Network’s lung, colon, breast and prostate cancer guidelines had at least one conflict of interest averaging $10,000 in 2014, according to the analysis. Overall, about $30.3 million in payments were reported to the guideline authors. Click here to read the analysis.

Medicare Driving Federal Deficit Growth: CBO

In its updated Budget and Economic Outlook, the Congressional Budget Office estimated the current fiscal year will end with a deficit of $590 billion, $56 billion higher than it projected in March. Outlays for the Medicare program are expected to increase by $30 billion, or 6 percent, this year, with growth largely driven by increased spending per person on prescription drugs. Medicaid outlays are expected to increase by $15 billion, or 4 percent, this year. The CBO anticipates Medicaid enrollment will be roughly flat in 2016. The CBO estimates outlays for the Children’s Health Insurance Program will climb $5 billion this year, to $14 billion. To read the CBO estimate, click here.