WEEKLY E-BULLETIN


261 House Members Urge CMS to Change HOPD Rule

261 House members signed onto a letter last week urging CMS to make changes to the proposed rule dealing with hospital outpatient departments (HOPDs) to allow for more flexibility. The letter voices concerns over the strict regulations dealing with relocations, new ownership, and additional services. CMS is expected to release the final rule any day. The letter is attached.

While MA Grows, Traditional Medicare Spending Declines

A growing number of Medicare beneficiaries are leaving traditional Medicare for Medicare Advantage.  Nearly simultaneously, traditional Medicare spending growth is slowing beyond expectations.  Apparently, there is no clear reasons for both developments, as reported last week in the NY Times.  Click here.

ACO’s Should Move to Two-Sided Risk Models: MedPAC

It’s no surprise that government agencies are suggesting that Medicare ACOs should be moved to two-sided risk models, allowing lower performing ACOs to lose money. The Medicare Payment Advisory Commission last week said that Accountable Care Organizations should move towards two-sided risk models. MedPAC suggested that such a move would harmonize the models with Advanced Alternative Payment Models and create more savings for the government. Click here for MedPAC’s ACO analysis and potential recommendations to Congress.

DEA Announces Limitation on Opioid Production in 2017

The Drug Enforcement Administration published a regulation last week that will reduce the amount of Schedule II opiate and opioid medication that may be manufactured in the United States in 2017 by 25 percent or more. A handful of medicines were reduced by more, such as hydrocodone, which will be 66 percent of last year’s level.? Demand for these opioid medicines has decreased leading to the reduction in production limits. Click here to read the regulations and here to read more on the reduction from DEA.

Senator Says Government Payments, More than Consumer Buying, Grew EpiPen Revenue

The maker of the EpiPen made an increasing share of its money from taxpayers rather than other consumers in recent years, according to an analysis by Sen. Charles E. Grassley (R-IA).  The analysis found that from 2011 to 2015, government charges for EpiPen increased by 463 percent, while EpiPen sales in general only increased 51 percent during that time. Additionally, the share of EpiPen-maker Mylan’s revenue from taxpayers increased to 53.4 percent of revenues in 2015 from 23.3 percent in 2011. The EpiPen, which costs around $600 for a 2-pack, is used to reverse deadly allergic reactions. Click here for more.

It Will Cost $395 Million to Repeal Part B Demo: CBO

For Congress to block a proposed demonstration project to reform how Medicare pays for physician administered drugs, the Congressional Budget Office (CBO) estimates that it would cost the government $395 million over 10 years. That’s a dramatically lower cost than CBO’s first analysis that said legislation to stop the demo would cost about $18 billion in 2017. CMS is refining its proposed rule after receiving pushback from lawmakers, hospitals, physician, and the pharmaceutical industry. The proposed demo would first change the payment formula to incentivize the use of lower cost drugs, then introduce a variety of value-based payment models. CMS is expected to release a revised final rule later this year. Click here to review the CBO estimate.

  • MedPAC is weighing in on controlling Part B drug costs, which it says has increased an average of 8 percent a year over the past five years. Click here for MedPAC’s slide presentation last week that outlined the issue and possible recommendations to stop the growth in costs.

 CMS Moves Forward on New Part D Project

The federal government has named six Part D sponsors that are participating in its Enhanced Medication Therapy Management Model, which is set to begin next year. The six participants–Blue Cross and Blue Shield of Florida, Blue Cross and Blue Shield Northern Great Plains, CVS Health, Humana, UnitedHealthcare and WellCare Prescription Insurance–serve an estimated 1.6 million beneficiaries.  Click here for the CMS announcement.

Nearly 175,000 Comment on VA’s Proposed Nursing Rule

The American Nursing Association and the American Hospital Association have mobilized supporters to back a proposal that would allow highly skilled nurses in the Veterans Health Administration to manage patients’ care without a supervising physician, according to reports last week. The open comment period attracted a record-setting 174,411 responses. The American Society of Anesthesiologists and the American Academy of Family Physicians oppose the rule. Click here.

Costs at For-Profit SNFs Lower, Margins Higher:  GAO

For each fiscal year from 2011 through 2014, direct and indirect care costs were lower as a percentage of revenue, on average, at for-profit Skilled Nursing Facilities compared with nonprofit and government SNFs, according to a new report from the Government Accountability Office. Direct and indirect care costs were similarly lower at chain SNFs compared with independent SNFs. In addition, the median margin, which measures revenue relative to costs, was higher for for-profit and chain SNFs than for other SNFs in each of the 4 years. The GAO also found that data about skilled nursing facilities (SNFs) is difficult to access and self-reported data isn’t guaranteed to be accurate. Click here for the GAO report.

Physician and ER Visits Down Among Uninsured in Medicaid Expansion States

New findings show that ambulatory visits, including physician and emergency department visits, among adults ages 19 to 64 has declined in Medicaid expansion states, according to data published in Health Affairs. Physician office visits, measured based on insurance held during the month the visit occurred, went from 8.4 percent in 2011-13 to 5.6 percent in 2014. Additionally, emergency room visits by uninsured individuals declined from 19.8 percent in 2011-13 to 10.5 percent in 2014. To read the blog with the findings, click here.

Health Insurance Tax Credits Could Be Available for 2.5 Million People

2.5 million people who bought health insurance through health exchanges may be eligible for subsidies if they shop in the marketplaces, according to a new HHS report. This number includes more than 100,000 people in each of six states – California, Texas, Florida, North Carolina, Illinois, and Pennsylvania. The agency said 6.9 million people now buy insurance in the individual market outside of the exchanges and 5 million of them would be qualified to buy coverage in the Obamacare marketplaces. About half of those 5 million could get premium tax credits not available outside the exchanges, which are offered to those with incomes up to about $100,000 for a family of four. To read the report, click here.

White House using Video Games and Lyft to Enroll Millennials for Insurance

The White House has entered into a partnership with video-game streaming site Twitch and is offering cheap trips to enrollment events via ride-sharing app Lyft to get millennials signed up for health insurance through the exchanges. Originally, the Obama Administration set a goal that 40 percent of sign-ups would be 18 to 34 year olds. However, that age bracket makes up less than 30 percent of enrollees as the newly insured have been older, sicker and more expensive than expected. Click here for more on this initiative from the White House Blog.

More Middle-Aged Americans Commit Suicide than Any Other Group: CDC

Middle-aged Americans die by suicide more than any other demographic; however, federal policies and programs aimed at reducing the growing number of suicides in the U.S. – 40,000 deaths last year – have largely ignored this population. Nearly half of all suicides in the past two decades were among people between the ages of 40 and 64, according to government data. But, most federal prevention programs cater to at-risk teenagers and people in their early 20s.  Click here for the update from CDC.

  • An independent panel convened by the National Institutes of Health has developed a 10-year roadmap for advancing research to prevent youth suicide. The panel listed 29 recommendations. Click here for details.
  • Although men commit suicide at a much higher rate than women, among physicians the rate is about equal.  One physician’s story in the Washington Post last week detailed rampant sexism in medical school and its impact on women in the profession.  Click here.

CMS Releases Detailed Hospice Data Set

CMS last week released a privacy-protected public data set, the Hospice Utilization and Payment Public Use File, which provides information on services provided to Medicare beneficiaries by hospice providers. CMS also released an update to the Market Saturation and Utilization Data Tool, formerly called the Moratoria Provider Services and Utilization Data Tool. For the first time, this tool will include information on hospice services.  More more information and to access the data, click here.

Hospital Charges $39 for Holding Baby Following Birth

A hospital apparently charged for holding a baby after it was born, according to press reports last week.  The hospital was not identified by the family that posted the bill on-line.  Click here for details.

Study: GOP and Dem Docs Treat Patients Differently

It must be that time of year.  A new study shows that Republican and Democratic physicians treat patients differently.  The study is raising eyebrows and certainly has its detractors.  Click here.