March 19, 2018

March 19, 2018

(NOTE: The federal government shuts down Friday, March 23, unless Congress reaches a final 2018 spending deal.  House legislation for an Omnibus spending bill is expected to be released for public review on Monday, March 19.  Click here for a news summary explaining the issue.)

Battle Over 340B Heats Up

HHS Secretary Alex Azar boasted last week in a speech to community health centers that Medicare’s regulation to cut reimbursement for 340B drugs is an example of transparency and fairness in drug pricing. He said, “The program was intended to offer affordable medicines to providers focused on low-income Americans, but has now expanded far beyond the original set of providers identified.” He said the program is an “immensely valuable tool” for community health centers, which serve low-income patients and HHS is “committed to ensuring the benefits of the program flow to its intended recipients — and that means the patients that you serve.” Click here for the full speech.

Senate Health Committee members peppered representatives from hospitals, pharmaceuticals and other providers about the 340B drug discount program during a hearing last week.  Combative Democrats pressured the witness representing the pharmaceutical manufacturers on drug prices, and the Republicans, specifically Sen. Bill Cassidy (R-LA), stressed the lack of transparency on the part of participating 340B programs.

  • Click here for the testimony from America’s Essential Hospitals.
  • Click here for Pharma’s testimony.
  • Click here for Community Health Centers’ testimony.
  • Click here for hospital systems pharmacists’ testimony.
  • Click here to view the entire hearing.

A PhRMA-commissioned Milliman report released last week just before the hearing found that hospitals participating in the 340B program prescribed more or pricier medications to commercially insured patients, click here. While a hospital-led report by L&M Policy Research shows that the 340B program helps safety-net treat more low-income patients, click here.

Senior GOP House Members Tackles Accreditors, CMS Over Hospital Safety Issues

Top Republicans have asked CMS and four hospital accreditation companies and CMS for several pieces of information related to accreditation programs and deficiencies or complaints. The letters came in response to a September Wall Street Journal story about accrediting from the The Joint Commission, which the Journal reported rarely withdraws approval even in light of hospital patient safety problems. The accreditation companies who each received letters are: the Bureau of Healthcare Facilities Accreditation, the Center for Improvement in Healthcare Quality, DNV GL Healthcare and The Joint Commission. Click here to see all the letters.

Report: Medicare Advantage Plans “Gaming System” and Making Millions More

A Wall Street Journal report last week says that Medicare Advantage plans are gaming the systems and reaping millions of additional dollars in bonus payments from the government.  The two-year budget deal signed into law last month included a provision expected to significantly reduce the practice. Yet industry experts say that even after the change, which won’t affect payments until 2020, insurers will still be able to achieve some gains on quality scores and bonuses. Click here for the WSJ report.

House Moves Forward on Opioid Crisis with 20+ Bills

The House Energy & Commerce Health Subcommittee released the list of 21 bills it intends to discuss during its two-day hearing on legislation entitled “Combating the Opioid Crisis: Prevention and Public Health Solutions” beginning on March 21. Six of the bills enhance and clarify FDA’s ability to, among other things mandate post-market studies, and use accelerated approval programs to expedite new pain therapies and addiction treatments as well as consider misuse and abuse as part of the drug review and approval process. Witnesses have not yet been announced. Chairman of the full Committee has stated that he hopes to have the legislation passed by Memorial Day. To see the full list of bills, click here.

  • Energy and Commerce Oversight Subcommittee to hold a hearing on the DEA’s role in the opioid epidemic on March 20th, click here.
  • The Agency for Healthcare Research and Quality has developed an interactive map with county-specific data on opioid-related hospital rates, click here.

Senate Bill Would Remove “Gag Clause” on Drug Prices

A bi-partisan group of Senators introduced legislation that would forbid health insurers and pharmacy benefit managers from using “pharmacy gag clauses” that prohibit pharmacists from informing consumers if their medicine would cost less if they paid out of pocket rather than using their insurance. The Patient Right to Know Drug Prices Act [S. 2554], introduced By Sen. Susan Collins (R-ME), would prohibit an insurer or pharmacy benefit manager from restricting a pharmacy’s ability to provide drug price information to a plan enrollee when there is a difference between the cost of the drug under the plan and the cost of the drug when purchased without insurance. To read the bill click here.

  • The President’s Cancer Panel has concluded that addressing the dramatic rise of cancer drug prices must be made a national priority. Doing so will require a concerted, immediate, bipartisan, and multilateral effort. The panel’s report proposes a variety of solutions. Click here for the report.

MedPAC Says Eliminate MIPS in Annual Report to Congress

In it annual report on payment policies released last week, the Medicare Payment Advisory Committee advised Congress to eliminate the Merit-based Incentive Payment System (MIPS) created in MACRA and establish a new voluntary value program in fee-for-service Medicare. Stating that MIPS will fail to deliver the desired improvements in quality of care because of flaws in its design, such as a lack of comprehensive measures to assess low-value care. The report also once again urges Congress to move forward with a unified post-acute care payment system. Click here for the summary and here for the full report.

  • House Ways and Means Health Subcommittee will have a hearing on MACRA’s implementation on March 21, they will discuss both MIPS and APMs, click here.
  • CMS says it plans to make further changes to MIPS this year. CMS’ Chief Medical Officer Kate Goodrich, M.D., explained in a meeting this week, according to the Healthcare Financial Management Association. Click here.

MACPAC Tells Congress To Allow More Telehealth in Medicaid

The Commission that advises Congress on Medicaid, MACPAC, has recommended that the federal government allow states more flexibility and give guidance not only on the use but in the implementation of telehealth. MACPAC also gave its analysis of the government’s two-year delay in cutting disproportionate share hospital funds, saying it found little correlation between DSH payments and the amount of uncompensated care. Managed care in Medicaid is now dominant over fee-for-service, with over 80 percent of beneficiaries receiving their healthcare through some type of managed care program. Click here for the MACPAC report.

Top Democrat Raises Concerns with Health Care “Mega-Mergers”

House Energy and Commerce Ranking Member Frank Pallone (D-NJ) sent a letter to Chairman Greg Walden (R-OR) to request a hearing on Cigna’s proposed plan to acquire Express Scripts for $67 billion, as well as the proposed $69 billion tie-up of CVS and Aetna. Pallone stated that he has concerns about the “ongoing trend of consolidation” in the health care system. The request comes after a recent hearing where witnesses emphasized a concern that the continued consolidation could have on a negative impact on consumers, including “mega-mergers” such as those proposed by Cigna-Express and CVS-Aetna. To read the letter, click here.

  • Click here for a Bloomberg report on how smaller pharmacies are being squeezed in the battle between PBMs,  major pharmacy companies and insurers.

Latest County Health Rankings Report Released

The latest County Health Rankings are out from the Robert Wood Johnson Foundation.  Among its many findings:

  • After nearly a decade of improvement, there are early signs that the percentage of babies born at low birthweight may be on the rise (8.2% in 2016, a 2% increase from 2014).  •  More than 1 out of every 5 youth in the bottom performing counties do not graduate from high school in four years.  •  In smaller metro and large urban counties, Black residents face greater barriers to health and opportunity. Black residents have higher rates of child poverty, low birthweight, and infant mortality, and lower high school graduation rates than White residents.  •  Child poverty rates remain at levels higher than those of the pre-recession era despite declines in recent years.
  • Teen birth rates have been declining across community types and racial groups for more than a decade. Hispanic teens have seen the most improvement with rates falling from 77.7 to 31.9 per 1,000 females, ages 15-19.

Click here to see the health condition of your county and others.

Report: Where Docs Make the Most, Least

Doximity lat week released it’s second annual Physician Compensation Report which analyzed compensation in 50 U.S. metro areas to indicate how salary trends compare across regions. The report showed that Charlotte, N.C. ($402,273), Milwaukee ($398,431), and Jacksonville, Fla. ($379,820) with the highest salaries for their physicians and Durham, N.C. ($282,035), Ann Arbor, Mich. ($302,692), and Baltimore ($304,002) with the lowest. Additionally, while in 2017, for the first time, more women than men enrolled in U.S. medical schools, they continue to observe a significant disparity in compensation by gender. Click here for the report.

FDA’s Plan Would Reduce Nicotine Levels in Cigarettes In an advanced notice of proposed rulemaking, the FDA has announced it will release a plan to control nicotine levels in cigarettes. FDA plans on lowering nicotine levels to be minimally addictive or non addictive by issuing a series of foundational rules and guidance documents that will delineate key requirements of the regulatory process. In this framework, it seeks to control the role that flavors, such as menthol play in initiation, use and cessation of tobacco products. Also, it will solicit additional comments and data related to the regulation of premium cigars. The analysis of the framework predicted that slashing nicotine levels could push the smoking rate down to 1.4 percent from the current 15 percent of adults and result in 8 million fewer tobacco-caused deaths through the end of the century. Click here for the FDA press release, and here for the notice.

  • A CDC report published last week finds that almost four out of five middle and high school students was exposed to some type of e-cigarette advertisement helping the increase in usage among the age group, click here.

Unclear Whether Congress Will Fund ACA Insurance Subsidies

The Congressional Budget Office says legislation to fund cost-sharing reduction subsidies could lower premiums by 10 percent.  Click here for details.  Meantime, Families USA said it opposes a push in Congress to fund the Affordable Care Act’s cost-sharing reduction subsidies, arguing that the move would actually harm consumers. The stance from Families USA highlights conflicting pressures facing congressional Democrats as they enter the final days of negotiating an Obamacare stabilization package, which would including three years of funding for the CSRs.  Click here for details.

Medicaid Is Vital for Rural America’s Financial Health: Report

Medicaid covers nearly 24 percent of rural, nonelderly residents and offers financial stability to rural facilities by reducing uncompensated care costs. In some cases, it allows them to provide costly, but vital services such as high-risk maternity care. According to a new Kaiser Family Foundation report, Medicaid pays for close to 45 percent of all U.S. births annually, and about 51 percent of rural births. However, with over 80 rural hospitals closed since 2010, many hospitals need to make difficult cuts, and 1 in 10 rural counties have lost their obstetrics programs. Research suggests that Medicaid expansion and more generous coverage, increases the odds that rural areas have any kind of obstetrics program and better prenatal care, means better outcomes. Click here for the KFF report.

  • The University of Minnesota Rural Health Research Center found that families living in rural counties faced increased risk of out-of-hospital birth, birth in a hospital that does not provide obstetric care, and preterm birth, after losing hospital-based obstetric services, click here.
  • The CAH Coalition is actively working with Congress and federal agencies to best support the unique needs of Critical Access Hospitals. Click here to learn more about their work.

JAMA: U.S. Spends More for Health, But for Different Reasons

In 2016, the United States spent nearly twice as much as 10 high-income countries on medical care and performed less well on many population health outcomes, according to a new study published last week in JAMA. Contrary to some explanations for high spending, social spending and health care utilization in the United States did not differ substantially from other high-income nations. Prices of labor and goods, including pharmaceuticals and devices, and administrative costs appeared to be the main drivers of the differences in spending.  Click here for the report.  Click here for the news summary.

Food and Wine Magazine Looks at Hospital Food Around the World

Something that seems universal in the United States is that patients are not always keen on the food they are served while in the hospital, but is that case in other parts of the world? Food and Wine magazine recently reported on 10 meals from around the world where they found everything from simple pasta and sauce in Italy, to buckwheat pudding in Russia. Click here for the article.

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