August 26, 2019

CMS Decides To Revise Hospital Star Rating System 
CMS has announced it will update its hospital star ratings in early 2020 using the current methodology as the agency works on refining a new one. With the last update to the ratings system implemented in February 2019, CMS is already taking public comments to refine methodology for 2021 for the most up to date and accurate reflections of hospitals in its ranking system. CMS has a goal of proposed rule making in 2020 with implementation in 2021. Hospital associations were quick to voice their displeasure of the decision stating, “Republishing the flawed ratings in 2020 will not advance the goal of providing the public with accurate, purposeful information about quality.” For the CMS press release click here. (You will also be able to read the public comments and a summary of those comments.)

HHS Proposes Changes To Privacy Regulations Governing Substance Abuse Records
HHS has released a proposed rule to make changes to 42 CFR Part 2, the regulation that governs the privacy protections for substance use records. The proposed changes would, upon patient consent, allow doctors to incorporate notations of a patient’s substance use treatment history directly into an EHR and allow records of medication dispensing that are subject to Part 2 to be disclosed to a prescription drug monitoring program. Providers have been urging for a major overhaul to the provisions in light of the widespread opioid addiction crisis to allow doctors to share medical histories when appropriate and align the section with HIPAA. HHS contends that further changes to the section in the law, to include what providers are pushing for, will require Congressional action. Click here for the proposed rule, and here for the HHS fact sheet.
Medicare Advantage Prior Authorization Legislation Gaining Steam
Sponsors of the Improving Seniors’ Timely Access to Care Act of 2019 (HR 3107) are contacting stakeholders seeking support for their legislation they contend will improve delivery of care by streamlining and standardizing prior authorization in Medicare Advantage. The legislation will  also provide oversight and transparency of health insurance for America’s seniors. Over 300 organizations have already signed on, including various physician and health advocacy groups. For the full text of the bill click here. To sign up your organization and organizations already supporting the bill, click here.
Health Insurers Plan to Expand ACA Offerings
Insurers, including Oscar Insurance Corp., Cigna Corp., Bright Health Inc., Molina Healthcare Inc.,  Centene Corp. and Anthem Inc., are set to expand their Affordable Care Act coverages into 2020. As the ACA marketplace stabilizes, competition among insurers increases. To read more about the new offerings, click here.
Physicians Bracing for CMS’ New Appropriate Use Criteria Requirements
It’s being referred to as a ‘soft launch.’ The implementation in January 2020 of a CMS policy, aimed at reducing unnecessary testing, mandating that all advanced diagnostic imaging orders go through an algorithm that provides key confirmation codes required when Medicare is billed later on for the service. Dubbed a “clinical decision support mechanism” (CDSM), this software processes each CT, MRI, nuclear medicine, and PET order before spitting out its verdict to the ordering professional: “appropriate,” “maybe appropriate,” or “rarely appropriate,” according to a certain set of appropriate use criteria (AUC).  The new requirements were mandated in the Protecting Access to Medicare Act of 2014, but has been postponed several times. Click here for the report.  Click here for more on PAMA from CMS.
Report: Ambulance Transport Time Increases Significantly When a Rural Hospital Closes
A rural hospital closure in Kansas causing the lack of access to emergency care has had some devastating impacts on the patients in the community, especially when the emergency department that remained open was closed for renovations. During the two-week period, patients had to be driven long distances, or airlifted, for the care that they needed.  In one instance, a patient had to wait for a dispatcher to check with four separate air ambulance bases to find a pilot to take her to a nearby hospital. On average, a new report found that average ambulance transport time for a rural patient rose from 14.2 minutes to 25.1 minutes after a hospital closed, leading to horrible consequences for patients in rural areas. Click here to read the full report.
  • For a rural hospital on the brink of insolvency in Missouri, where 3 other hospitals have shut down in the past few years, every penny of collection counts. Poplar Bluff Regional is the last hospital standing in 5 counties in SE Missouri, and its patient population faces the same financial issues that the hospital does, so with a cash-poor hospital and even poorer patients, the hospital turns to the courts to sue for outstanding balances. Click here for details.
Drug Price Increases Slowing; HHS Appeals Price Advertising Rule
The Associated Press is out with a new report that brand-name drug prices are rising at a slower pace and at lower amounts when they do rise. In the first seven months of 2019, drugmakers raised list prices for brand-name prescription medicines by a median of 5%. That’s down from about 9% or 10% over those months the prior four years. From January through July this year, there were 4,483 price hikes, down 36% from that stretch in 2015. For the full report click here.
  • HHS has appealed a July ruling that stated the Department does not have the authority to force drug manufacturers to disclose list prices for a 30-day supply of any prescription drug that is covered through Medicare and Medicaid and costs over $35 a month, click here.
House Panel Chair Launches Inquiry into Top E-Cigarette Manufactures as First Related Death Is Reported
The Energy and Commerce Chairman, Frank Pallone Jr. (D-NJ), wrote last week to the CEOs of Juul Labs, Fontem Ventures, Reynolds America, and Japan Tobacco International USA, requesting information on each companies’ research regarding their marketing actions, the public health impacts of their products, and their role in the promotion of adolescent use of their products. In his letters, Pallone discusses concerns of the lack of information on electronic nicotine delivery systems available to consumers. Pallone is requesting answers to his questions by September 20, 2019. To read more, click here.
  • U.S. health authorities said on Friday that they are investigating the cases of 193 people in 22 states who developed severe lung illnesses after using electronic cigarettes. That is 40 more cases than two days ago, when the CDC issued a statement about the illnesses. Most involve teenagers and young adults. Click here for details.
  • A new study from the FDA in the American Journal of Preventative Medicine details the impact of “The Real Cost” campaign, an anti-youth-smoking initiative. The study revealed success in the campaign and a financial benefit of 53 billion dollars saved in cost of smoking related care, click here.
Opioid and Heroin Use Declining
Released last week, SAMHSA’s 2018 National Survey on Drug Use and Health revealed that the number of people who misused opioids fell from 11.4 million to 10.3 million. However, illicit drug use overall increase by .4% from 2017 to 2018. For comments on the survey from Dr. Elinore F. McCance-Katz, assistant secretary of Health and Human Services for Mental Health and Substance Use, click here. For the full report click here.
  • Starting this week, a new federal rule that was finalized in February, will go into effect prohibiting healthcare organizations from flushing hazardous waste pharmaceuticals into the sewer system, for the final rule click here.
Need for More RNs Growing
The job market for Registered Nurses is projected to increase by 15% from 2016 to 2026. One of the reasons is an increased demand for healthcare services as the population ages. Another reason is because of financial pressure from hospitals to discharge patients as quickly as possible. This may result in a greater amount of people being admitted to outpatient care centers, long-term care facilities, and a larger need for care at home. Additionally, growth at outpatient care centers, where patients do not stay overnight, is estimated to be higher than average. To learn more, click here.
WHO Responds to Micro-Plastics in Drinking Water
In response to more communities discovering polluted drinking water, the World Health Organization has requested more research into micro-plastics and plastic pollution. As of now, very little is known about the exposure and impact of micro-plastics in drinking water on human health. The WHO has recommended that the removal of microbial pathogens that are a known risk be prioritized by drinking water suppliers. To review the complete WHO response, click here.
NIH Study to Offer Genetic Counseling
The National Institutes of Health has begun the 5-year, $4.6 million ‘All of Us’ project. The study will sequence approximately one million volunteers’ genomes. The NIH is focusing on recruiting diverse participants from ethnic and socio-economic groups that have been underrepresented in biomedical research in the past. To learn more from NIH, click here.
Ecstasy-Assisted Psychotherapy Has Potential for Success
MDMA, or ecstasy, shows potential to be a successful, new treatment for Post-Traumatic Stress Disorder (PTSD). Researchers are examining how taking pharmaceutical-grade MDMA, in combination with psychotherapy, can be used in patients with severe PTSD, through a series of clinical trials. Currently. MDMA is classified as a Schedule I controlled substance, having no acceptance for medical use and a high potential for abuse. Because of this, current studies are being privately funded by the Multidisciplinary Association for Psychedelic Studies (MAPS). To read more about the progressing effects of the new psychotherapy, click here. To view the study guidelines from MAPS click here.
A Patch that Can Analyze Your Sweat and Transmit To Your Cell Phone
Scientists from the University of California, Berkeley created a patch that can determine the sodium amount in sweat and the sweat rate directly from the skin. The device consists of a well with sensors, which collect sweat and measure potassium, glucose, and sodium. Additionally, the well connects to two spiraling tubules that measure the sweat rate. The new patch collects sweat at the surface of the skin and analyzes it directly from a custom-made circuit board. The circuit board collects data and transmits it to a cell phone. Click here to learn more about the new patch.
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