April 16, 2018

Congress Moving Closer to Finalizing Comprehensive Opioid Package

The House Energy and Commerce Health Subcommittee held the third in a series of legislative hearings on a large number of opioid bills, these aimed at “Improving the Ability of Medicare and Medicaid to Provide Care for Patients.” The various bills would amend the Medicaid, Medicare Part B, and Medicare Part D programs to give them increased abilities to identify at-risk beneficiaries, provide treatment, and decrease overdose deaths. In the Senate, the Health Committee plans to vote on its draft legislation April 24th. However there are reservations, Democrats on the Committees have expressed concern that the legislation is moving too fast. Click here to view the Energy and Commerce hearing and legislation, and here for the Senate HELP Committee draft summary.

  • During the Energy and Commerce Committee hearing on Facebook, Rep. David McKinley (R-WV) grilled CEO Mark Zuckerberg on illegal opioid sales through the social media site, click here.
  • The House Ways and Means Committee released a white paper last week with details from the feedback of over 100 organizations on how to combat the opioid crisis, click here.
  • The National Safety Council urged Congress to pass legislation and offered a number of recommendations including improving data collection and requiring use of prescription drug monitoring programs, click here.
  • A trial date of March 18, 2019 has been set that could dictate settlement talks for hundreds of lawsuits filed against opioid manufacturers and distributors; the first includes two Ohio county lawsuits against Purdue Pharma and a City of Cleveland lawsuit against drug distributor AmerisourceBergen, click here.

FDA’s Gottlieb To Pharma: “End the Shenanigans”

Trump administration officials, seeking ways to lower drug costs, are targeting pharmaceutical companies that refuse to provide samples of their products to generic drug companies, making it impossible to create inexpensive generic copies of a brand-name medicine.  Dr. Scott Gottlieb, the commissioner of the Food and Drug Administration, said recently that drug makers must “end the shenanigans” that prevent competing products from reaching the market. Generic drug developers need samples of brand-name drugs to show that a generic copy is equivalent to the original. The maneuvers by brand-name drug firms, Dr. Gottlieb said, “frustrate the ability of generic firms to purchase the doses of a branded drug that they need to run their studies.” Click here for the NY Times story.


FDA Administrator Says Payers, PBMs Causing Cancer Drug Price Increases for Patients

In a speech to the Community Oncology Conference last week, the FDA Administrator Scott Gottlieb alleged that insurers and pharmacy benefit mangers are the cause for the increase costs of drugs to cancer patients, citing increasing co-payments and co-insurance practices as the chief causes. “Rising co-pays and co-insurance are pushing far too many patients into a financial no-man’s land where sometimes they must literally choose between exhausting their bank accounts, or going without access to potentially effective treatments,” Gottlieb said at the Conference. The statement follows Gottlieb’s March speech, when he accused drug companies and insurers of stunting the growth of cheaper versions of expensive medicines. Click here for the full speech.

Billions in Health Care Programs May Be Targeted in Rescission Effort

A month after Congress gave HHS a $10 billion bump in its annual budget, the Trump administration is telling the agency to find places to pare back.  Senior HHS officials are coordinating with OMB Health Programs Associate Director Joe Grogan to draw up a menu of cuts as part of a rescission package that could slash as much as $60 billion overall from the omnibus spending bill Republicans only just passed, according to press reports.  Such a package has little chance of passing both chambers of Congress, according to numerous lawmakers who spoke publicly.  Click herefor more.


Hospitals Leading Health Care Price Increases: Report

Health care prices are rising at the fastest rate in years, according to new data from Altarum, which found that prices have risen 2.2 percent since March of last year, the fastest annual growth rate since January 2012.  The big driver of price growth is hospitals. Altarum found that hospital prices have been annually growing at nearly 4 percent, the highest level in eight years. Pharmaceutical price growth has slowed down. Pharma prices grew just 1.9 percent over the previous 12 months, versus 4.7 percent price growth over the year before that. Click here for the Altarum report.


NY Times Exposes Growing Industry that Coaxes Women into Surgery, Sometimes Unnecessary

There’s a growing industry that makes money by coaxing women into having surgery — sometimes unnecessarily — so that they are more lucrative plaintiffs in lawsuits against medical device manufacturers, according to a new NY Times report.  Lawyers building such cases sometimes turn to marketing firms to drum up clients. The marketers turn to finance companies to provide high-interest loans to the clients that have to be repaid only if the clients receive money from the case. Those loans are then used to pay for surgery performed by doctors who are often lined up by the marketers.  Click here to report the story.

Ways and Means Committee Drafting New Telemedicine Bill

A bill that is expected to be drafted in the House Ways and Means Committee seeks to widen telemedicine coverage under Medicare to help reduce unnecessary hospital visits by Medicare patients, including those at nursing homes. The legislation would expand the coverage of telehealth services under Medicare with the goal of reducing expensive, unnecessary hospital visits. A broad coalition of health care stakeholders who are lobbying for the measure says it could save the government a lot of money while improving care for many Medicare beneficiaries. Click here for details.

  • Medicare paid a total of $17.6 million in telehealth payments in 2015, compared with $61,302 in 2001. Medicare telehealth payments include a professional fee, paid to the practitioner performing the service at a distant site, and an originating-site fee, paid to the facility where the beneficiary receives the service.  Click herefor the OIG report.

UnitedHealth Group Close To Employing 30,000 Physicians

Since its acquisition of 250 Las Vegas-area physicians in 2008, UnitedHealth Group has steadily expanded its physician workforce to shield itself from competitors and hospitals, according to news reports. To date, the health insurance giant’s physician arm, OptumCare, employs or is affiliated with about 30,000 physicians. If OptumCare completes its acquisition of Davita Medical Group, the insurer will tack on another 17,000 physicians to its ranks — making it one of the largest physician employers in America.  Hospitals are also moving swiftly to employ physicians.  By mid-2016 hospitals employed 42 percent of U.S. physicians. Nashville, Tenn.-based HCA Healthcare has roughly 37,000 physicians. Still, Optum outpaces Oakland, Calif.-based Kaiser Permanente’s roughly 22,000 physicians by 8,000. Click here for the Bloomberg report.

CMS Can’t Track ACA Coverage Terminations: GAO

Federal health officials are not able to reliably track ACA Marketplace enrollees whose coverage is canceled after they fail to pay premiums, which could lead to people subsequently signing up when they are ineligible to do so. The GAO report released last week found that while CMS and marketplace insurers share information on plan terminations, the agency doesn’t require health plans to consistently report the cause. GAO states that because the information isn’t tracked systematically, CMS is is not able to enforce certain rules for special enrollment periods that prohibits individuals from enrolling in plans during a special enrollment period if their prior coverage was canceled for nonpayment. Click here for the report.


Bipartisan Group of House Members Urge Administration To Keep ACOs

A group of bipartisan lawmakers want the Trump administration to continue a program that seeks to cut healthcare costs but is actually costing the government money. The lawmakers sent a letter to the Trump administration on accountable care organizations, which are groups of physicians, hospitals and other providers. ACOs were created by Obamacare to entice healthcare providers to cut healthcare costs. An ACO that cut its Medicare costs under a certain threshold can get a cut of the savings, providing a financial incentive. However, an ACO could have to pay Medicare if it doesn’t meet savings targets. But the ACOs are actually costing the federal government money.  Click here for the letter.

New CMS Exchange Rules Allow States To Select Essential Health Benefits

CMS last week issued a final rule that allows states to select essential health benefits that must be covered by individual insurance plans sold under former President Barack Obama’s healthcare law. The 2010 Affordable Care Act requires coverage of 10 benefits, including maternity and newborn care and prescription drugs. Under the new rule, states can select from a much larger list which benefits insurers must cover. That could lead to less generous coverage in some states. Click here for the Reuters report.  Click here for the CMS summary and rule.


Eight States Using Reinsurance Pools to Calm Insurance Markets

Minnesota is one of four states trying to calm roiling health insurance markets by creating state reinsurance pools – even as actions by Congress and the Trump administration continue to create uncertainty in the health insurance industry. Maryland became the latest to do so and another six states are taking steps to launch their own reinsurance programs. Essentially, it entails insurance companies taking out their own insurance to protect themselves when they are hit by an unexpectedly high claim.  Click here for the report from Pew.


CBO Predicts Moderate Increases in Medicare and Medicaid Spending

The Congressional Budget Office last week released its annual Budget and Economic Outlook that is forecasting large amounts of overall deficit spending, however it foresees only moderate increases in health care spending this year. CBO anticipates that Medicare spending will have a 3 percent growth in 2018, lower than in previous years due to higher expected premium receipts. Medicare spending from 2019-2028 is expected to increase by an average of 7 percent per year. Medicaid spending is expected to have a minimal increase of 2 percent in 2018, due to a flattening growth in enrollment.  Slower per capita cost growth will hold the increase to its lowest level since 2012. After 2018, the program will grow at an average rate of 5.5 percent per year. To read the full report, click here.


House Farm Bill Makes Big Changes to SNAP

House Agriculture Committee Chairman, Mike Conaway (R-TX), released last week the long awaited farm bill that will cost about $860 billion over 10 years, about $100 billion less than the last farm bill’s initial cost estimate. As expected, the legislation adds work requirements for those receiving assistance from the Supplemental Nutrition Assistance Program. Between 5 million and 7 million SNAP recipients would see stricter work requirements. It would also more than triple money spent on education and work training for SNAP beneficiaries. To read the legislation, click here and for the section-by-section of the bill, click here.


Physician Shortage Projected to Reach 120,000 by 2030

According to a new report by the Association of American Medical Colleges, the demand for physicians continues to outpace new graduates, which results in a new physician shortage projection of up to 120,000 doctors by 2030. The analysis showed that the there will be a shortfall of between 42,600 and 121,300 physicians by 2030, with specialists seeing the biggest deficiency over the time period ranging anywhere from 33,800 to 72,700. A major factor in this shortcoming is that the population aged 65 years and older will grow by 50 percent and the population aged 75 years and older will grow 69 percent. Click here for the report by AAMC.

FDA Approves Artificial Intelligence Device for Patients with Diabetes-Related Eye Issues 
Good news for diabetics. The FDA permitted the marketing of the first medical device to use artificial intelligence to detect high levels of diabetic retinopathy in adults who have diabetes. The device, IDx-DR, is a software program that uses an artificial intelligence algorithm to analyze images of the eye taken with a retinal camera. It provides a screening decision without the need for a clinician to interpret the image or results, which makes it usable for health care providers who are not normally involved in eye care. The IDx-DR accurately identified patients with a higher diabetic retinopathy 87.4% of the time and patients who did not have a high level of diabetic retinopathy 89.5% of the time. Click here for the full report from the FDA.

Report Details Critical Access Hospital Swing-Bed Quality Measures
The University of Minnesota Rural Health Research Center released a report on the use of swing-beds in critical access hospitals following their interviews with CAH networks and hospitals. The report identifies recent swing-bed trends in CAHs and identifies the challenges in measuring CAH swing-bed quality of care. The CAH Coalition based in Washington, D.C. advocated to Congress and federal agencies to ensure proper support for swing-beds in Critical Access Hospitals and was able to stop proposed cuts to CAH swing-bed reimbursement rates during recent budget negotiations. To read the University of Minnesota report, click here, and here for more on the CAH Coalition effort to stop the swing bed cuts.

Government Report Lists Top 10 Foods with the Highest Pesticide Content
Does your diet heavily rely on fruits and vegetables? You may want to be careful of which fruits and vegetables you buy. The Pesticide Data Program Report issued by the Department of Agriculture and the FDA identified the foods with the highest amount of pesticide residue. The researchers tested more than 38,800 non-organic food samples and analyzed the average amount of pesticides found on each sample. The top 10 fruits and vegetables are strawberries, spinach, nectarines, apples, grapes, peaches, cherries, pears, tomatoes, celery, potatoes and sweet bell peppers. Click here for the full report.

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