WEEKLY E-BULLETIN


Go to the Wrong Hospital and You’re 3 Times More Likely to Die: Study

In the first comprehensive study comparing how well individual hospitals treated a variety of medical conditions, researchers found that patients at the worst American hospitals were three times more likely to die and 13 times more likely to have medical complications than if they visited one of the best hospitals. The study’s authors looked at 22 million hospital admissions, including information from both the federal Medicare program and private insurance companies, and analyzed them using two dozen measures of medical outcomes. Adjusting the results for how sick the patients were and other factors, like age and income, the researchers discovered widespread differences among hospitals. Even a hospital that had excellent outcomes for heart care might have poor outcomes in treating diabetes. Click here for the study. Click here for the NYTimes story.

Hospital-Acquired Conditions Down Significantly Since 2010: HHS

Hospital-acquired conditions fell 21 percent between 2010 and 2015, according to new data released by HHS. Thanks to patient safety improvements, partly through initiatives launched as part of the Affordable Care ACA, HHS says about 125,000 fewer patients died due to hospital-acquired conditions and more than $28 billion in health care costs were saved. The data represents demonstrable progress over a five-year period to improve patient safety in hospitals. Click here to read the report.

CMS Posts IRF and LTCH Compare Websites

CMS announced last week that Inpatient Rehabilitation Facility (IRF) and Long-term Care Hospital (LTCH) Quality Reporting Program (QRP) Provider Preview Reports are now available.? Those providers have until the end of the 30-day preview period (January 10, 2017) to review their data. CMS also released the IRF Compare and LTCH Compare sites that takes reported data and puts it into a format that can be used more readily by the public to get a snapshot of the quality of care each facility provides. Click here for the IRF site, and here for the LTCH site. For the CMS fact on the LTCH Compare click here, and for the fact sheet on the IRF Compare click here. Click here for the CMS leaders’ blog for more on this initiative.

New ACO Targets Dual-Eligibles in Six States

Late last week, CMS announced new enrollment opportunities for two alternative payment models (APMs) that potentially would let physicians qualify for bonuses under the Quality Payment Program. Starting in January, CMS will once again accept applications from clinicians for the Comprehensive Primary Care Plus model and the Next Generation Accountable Care Organization model for 2018. The new ACO model will target individuals who are eligible for both Medicare and Medicaid and be built on the Medicare Shared Savings program. All states will be eligible, but preference will be given to states with low Medicare ACO penetration and only six states will be chosen. Click here for the CMS fact sheet on the Medicare-Medicaid ACO Model, and here for the fact sheet re-opened CPC+ model.

CMS Drops Proposed Medicare Part B Model

The Obama administration dropped its plan for a test of alternative Medicare payment for drugs given in doctors’ offices. The pharmaceutical industry mounted significant opposition to this proposal, which CMS designed partly to address concerns about rising drug costs. For more on this from the Washington Post, click here.

Final VA Rule Expands Scope of Practice for APRNs

The Department of Veterans Affairs’ final decision to expand the scope of practice of most advanced practice registered nurses who work for the federal agency has divided doctors and nurses. The VA has published a final rule that will amend its regulations to permit full practice authority for three types of APRNs. Specifically, the VA will allow three categories of APRNs—certified nurse practitioners, clinical nurse specialists and certified nurse-midwives—to practice independently. A fourth category—that of certified registered nurse anesthetists (CRNAs)—is not included under the final rule, but the federal agency is asking for comments indicating it could include this group in future rulemaking. Click here to read the new rule.

Key Advisory Panel Recommends 5-Year CHIP Extension

The panel charged with advising Congress on Medicaid and CHIP issues (MACPAC) says lawmakers should pass a five-year CHIP funding extension and maintain current “maintenance of effort” requirements through 2022. In its recommendation, the Medicaid and CHIP Payment and Access Commission said a stable source of coverage for children should be kept as Congress considers broader changes related to the ACA and entitlements. Federal funding for CHIP is slated to expire on Sept. 30 unless Congress extends it. The full list of MACPAC’s recommendations can be found here.

80 Rural Hospitals Closed Since 2010

Of the 25 states that have seen at least one rural hospital close since 2010, those with the most closures are located in the South, according to research from the North Carolina Rural Health Research Program. Thirteen hospitals in Texas have closed since 2010, the most of any state. Tennessee has seen the second-most closures, with eight hospitals closing since 2010. In third place is Georgia with six closures followed by Alabama and Mississippi, which have each seen five hospitals close over the past six years. Click here for the updated list.

• The state of Georgia has identified 49 rural hospitals it will help with a new tax credit program. Click here.

Small and Rural Physician Practices Face Significant Reform Challenges: GAO

A report by the Government Accountability Office found small and rural physician practices face significant challenges when they transition to value-based payment models in Medicare, including barriers related to health IT and data, financial resources and risk management, and population health management delivery of care. Interoperability issues and insufficient resources for training staff about EHRs, data analysis and data entry are barriers related to health IT and data, the report stated. Click here for the report.

25% of Adults Have Pre-Existing Conditions: Study

According to a new analysis from the Kaiser Family Foundation, about 1 in 4 American adults under the age of 65, or 52 million people, have pre-existing conditions that would make getting health coverage more difficult without the Affordable Care Act. “While a large share of this group has coverage through an employer or public coverage where they do not face medical underwriting, these estimates quantify how many people could be ineligible for individual market insurance under pre-ACA practices if they were to ever lose this coverage,” the analysis says. To read the study, click here.

Opioid Deaths Increasing at a Rapid Rate: CDC

Opioid deaths in the United States are still increasing, particularly among synthetic drug users, a new CDC report shows. The report indicates that deaths from synthetic opioids are increasing at a rapid rate, raising 72.2 percent in between 2014 to 2015. New York, Connecticut and Illinois saw the largest increases. Heroin deaths increased by 20.6 percent in between 2014 to 2015, with major increases in South Carolina, North Carolina and Tennessee. Click here for more from the CDC.

Obamacare Exchange Enrollment Booming

About 670,000 people signed up for Obamacare plans through HealthCare.gov last Thursday, according to HHS. President Obama said it was the biggest day ever on the federal enrollment website. HHS officials earlier this week said sign-ups were increasing ahead of the original Dec. 15 enrollment deadline to have coverage at the start of 2017. The Obama administration has delayed the deadline to Dec. 19 for the 39 states using HealthCare.gov, citing the growing demand.More than 4 million people had enrolled through HealthCare.gov as of last week, HHS said. The three-month enrollment window closes on Jan. 31, less than two weeks after President-elect Donald Trump takes office. Click here for a great state-by-state summary. Click here for the USA Today story.

Express Scripts Expands Value-Based Drug Oncology Program

The country’s largest pharmacy benefits manager, Express Scripts, states it will add additional drugs to its Oncology Care Value Program, which reimburses for cancer medications based on how well the drugs treat various types of cancer. The program, which pays for drugs treating multiple myeloma, non-small cell lung cancer, prostate cancer and renal cell carcinoma, also provides refunds to payers if patients discontinue a treatment early. With this the new expansion, the program in 2017 will address nearly one-quarter of oncology spent on pharmaceuticals, up from 5 percent in 2016. Click here to read the statement from Express Scripts.

Another Insulin Maker to Vows to Keep Prices Lower

Eli Lilly will offer up to 40 percent discounts on its insulin starting Jan. 1 for patients who are paying the full list price of the drug, the company announced last week. Lilly’s announcement follows Novo Nordisk’s pledge to limit any future list price increases on its diabetes medicines to less than 10 percent annually. The discounts will be available to patients without insurance or those in the deductible phase of their high-deductible insurance plan. They will be provided through a partnership with Express Scripts and Blink Health, an internet-based company that offers consumers discounts on medications. Click here for more from Eli Lilly.

Former Pharmaceutical Execs Charged with Price Fixing

The Department of Justice has charged two former senior executives with Heritage Pharmaceuticals for their roles in alleged conspiracies to fix prices for certain generic drugs. Former company CEO Jeffrey Glaze and Jason Malek, the company’s former president, were also accused of rigging bids and allocating customers for an antibiotic and a diabetes drug. The company ran its antibiotic scheme from as early as April 2013 until at least December 2015 and fixed prices for the diabetes drug between April 2014 and December 2015, DOJ said. Click here for more from the DOJ.

Biosimilar Case Declined By the Supreme Court

The Supreme Court declined to hear a challenge to an appeals court ruling that would have essentially given brand drug makers an additional six months of marketing protection from cheaper biosimilars. Aptoex had asked the high court to reverse the Federal Circuit’s July ruling that the company had to wait until it received FDA approval of its biosimilar to Amgen’s Neulasta before it could give Amgen the required 180 days notice of its intent to launch the copycat drug. Click here to view the decision on Aptoex from the Supreme Court.

Stress Is Literally Killing Us

The stresses of poverty in the United States have grown so intense that they are harming the health of lower-income Americans — even prematurely leading to their death. A report published by the Hamilton Project at the Brookings Institution finds that stress levels have greatly increased for Americans at all income levels since the 1970s, but especially for low-income groups. Click here for the story and report.