August 27, 2018

Senate-Passed $857 Billion Appropriations Package Boosts Health Spending

The Senate last week passed a fiscal 2019 spending package, 85-7, that includes funding for the Departments of Defense, Labor, Education and HHS.  More than 300 amendments were filed, with more than 50 adopted by unanimous consent into the final bill.  (An amendment from Sen. Charles Grassley (R-IA) to allow Critical Access Hospitals to convert to freestanding outpatient and emergency departments was not included) Under the legislation, which now heads to the House, HHS would see a $2.3 billion boost, including a 5.4 percent increase for the National Institutes of Health, under the bill. Also included was a provision that gives $1 million to HHS to implement regulations requiring drug companies to list their prices in TV ads. Additional provisions include –

  • An amendment by Sen. Heidi Heitkamp (D-ND) to improve obstetric care for pregnant women living in rural areas;
  • An amendment by Sen. Richard Durbin (D-IL) to provide for the use of funds HHS to issue regulations on direct-to-consumer advertising of prescription drugs and biological products; and
  • An amendment by Sen. John Cornyn (R-TX) to promote school safety in rural areas.

To view all the 300+ amendments offered, click here. To read a breakdown of the bill and the process, click here.


Trump Administration, States Push Against Drug Prices with Transparency, Negotiations

In addition to the Senate Appropriations package, the White House is currently reviewing a proposed rule that would require drug ads to disclose prices. Last week, the White House Office of Management and Budget posted a listing of a proposed rule under review with the headline: “Medicare and Medicaid Programs; Regulation to Require Drug Pricing Transparency.” The OMB listing indicates that the proposed rule is not economically significant, meaning it has an economic impact of less than $100 million annually which is in line with most assessments that price-transparency policies alone will not control drug prices. Click here to view the listing.

  • Oklahoma Medicaid gets okay to negotiate drug prices, click here
  • Report finds that Medicare plans could be overspending by $1 billion on brand-name combination drugs when generic elements of those combinations are available, click here

Many More Hospitals Expected To Close: Morgan Stanley Analyst 

Morgan Stanley analysts led by Vikram Malhotra looked at data from roughly 6,000 U.S. private and public hospitals and concluded eight percent are at risk of closing; another 10 percent are considered “weak.” The firm defined weak hospitals based on criteria for margins for earnings before interest and other items, occupancy and revenue. The “at risk” group was defined by capital expenditures and efficiency, among others. The next year to 18 months should see an increase in shut downs.  Click here for details.


Senate Poised to Take up Opioid Legislation After Labor Day

Senate Majority Leader McConnell said last week that the Senate opioid package will be a top priority for the Senate to consider after Labor Day. However, floor time has not yet been scheduled and HELP Committee Chairman Lamar Alexander (R-TN) has not yet finalized the package, which will include bills reported out of four Senate Committees. The current draft of the package authorizes $500 million per year through 2021 for state opioid grants created under the 21st Century Cures Act as well as a provision to require the U.S. Postal Service to crack down on shipments of fentanyl and other illicit drugs through the mail. The House passed its package earlier in the summer, which will lead to a conference committee to reconcile the two bills. Click here for the Senate draft, and here for the House passed bill.

  • AHIP and eight health care organizations urge Senate Leaders to oppose a provision in the House bill that would require private plans and insurers to pay more for kidney disease treatments before Medicare kicks in, click here.
  • Research from the Ohio Department of Medicaid has found the Medicaid expansion championed by Republican Gov. John Kasich reduced the number of uninsured Ohioans by 50 percent over the last four years, bringing coverage to an additional 655,000 residents and getting treatment to 96 percent of people in the program with opioid addiction.  Click here.

CMS, Stakeholders Disagree on Impact of Proposed Physician Fee Schedule

During a CMS conference call last week entitled “Physician Fee Schedule Proposed Rule: Understanding 3 Key Topics Listening Session,” officials defended the proposal to change payment for office/outpatient based evaluation and management (E/M) visits, stating that most specialties will only see an increase or decrease in payments by 1-2 percent. They also claim that by decreasing the time needed to code the visits will dramatically save money for practices.  Additionally, officials pointed to the new add-on codes for complexities to account for the additional resources needed to care for patients needing more time. During questions on this topic, a caller pointed out that clinicians are already trying to see more patients in order to cover costs and that this would decrease funds even further, plus the add-on payments will not cover the decrease in payments. Officials urged listeners to fully review the impact of the proposal and comment on the rule.  Comments are due by September 10. To view the presentation, click here. CMS will post the audio and written transcript by the end of this week on the event page, click here.


GOP Senators Introduce Pre-Existing Conditions Legislation  

10 Republican Senators, led by Sen. Thom Tillis (R-NC), introduced legislation last week that would force health insurers to cover all individuals regardless of health status. The Ensuring Coverage for Patients with Pre-Existing Conditions Act is designed to protect patients from the possible fallout from the lawsuit, Texas v. United States, that could roll back the ACA’s protections for pre-existing conditions and other popular provisions. The bill would amend the Health Insurance Portability and Accountability Act (HIPAA) to guarantee the availability of coverage for people in the individual or group health insurance market, including those with pre-existing conditions, regardless of the outcome of the lawsuit. The suit, scheduled for oral arguments Sept. 5, maintains that the ACA is now invalid since the vote to zero out the law’s individual mandate was part of last year’s tax reform. To view the legislation, click here.


280 Hospitals, 17 Health Systems, to Work Collectively to Improve Medicaid Care

Seventeen of the nation’s leading health systems, comprising 280 hospitals in total, announced last week that they will share best practices and work together to improve care for Medicaid patients. The collaboration – Medicaid Transformation Project – will see the hospitals collectively implement new Medicaid care models and digital solutions to identify, develop, and scale financially sustainable solutions that improve the health of underserved individuals and families. The project is jointly led by AVIA, a hospital innovation network, and former CMS Acting Administrator Andy Slavitt, who now runs Town Hall Ventures. Click here for more from AVIA. Click here for more from Forbes.


Justice Department Attacks Anthem Over MA Fraud Investigation

The Justice Department has requested the U.S. District Court for the Southern District of New York to force Anthem to turn over information related to an ongoing Medicare Advantage fraud investigation involving the insurer’s plans that brought in nearly $215 million using retrospective chart reviews over a two-year period. Anthem has declined to hand over the documentation stating that investigators are overstepping their authority by asking for information that is protected by attorney-client privilege and falls outside the scope of the ongoing probe. DOJ prosecutors contend that the investigation is focused on whether Anthem violated the False Claims Act by failing to ensure diagnosis codes were valid while taking hundreds of millions of dollars in federal reimbursement. For more on the investigation and court battle, click here.

CMS’ New Program Tackles Opioid Epidemic Impact on Kids

CMS’  Innovation Center announced last week a new effort to combat the nation’s opioid crisis called the Integrated Care for Kids (InCK) Model that has the aim of reducing expenditures and improve the quality of care for children under 21 years of age covered by Medicaid and the Children’s Health Insurance Program (CHIP) through prevention, early identification, and treatment of behavioral and physical health needs. The InCK Model will help state Medicaid agencies and their local health and community-based partners to identify and address risk factors for behavioral health conditions in children and understand that the earliest signs of a problem may present outside of clinical settings, such as in schools or at home, and may be known not to clinicians but rather to teachers and to child welfare and foster care programs. Click here for more on the program.

  • CDC study shows that construction workers have the highest rate of opioid- and heroin-related overdose deaths when compared with other occupations, click here
  • FDA has awarded a contract to the National Academies of Sciences to create new opioid prescribing guidelines amid the opioid crisis, click here
  • Attorney General Jeff Sessions said the Department of Justice has served two Ohio doctors temporary restraining orders that prevent them from writing prescriptions, following allegations from the DOJ that the doctors unnecessarily dispensed opioids. The civil injunction against the doctors is the first of its kind, according to Sessions. Click here for more.

Six States Win Combined $389 Million in Lawsuit Over ACA Fees

Texas, Kansas, Louisiana, Nebraska, Kansas, and Wisconsin are set to receive a combined $389 million from the IRS as a Federal Judge ruled they are entitled to a refund of fees on their state Medicaid programs. The states sued over a part of the ACA that requires states to pay a portion of the Health Insurance Providers Fee to help fund the health insurance law. A U.S. District Judge ruled that language in the ACA actually statutorily exempts the states from having to pay the Health Insurance Providers Fee and that the states are entitled to receive a refund from the IRS of the money they paid. It’s unclear whether the government plans to appeal the ruling. Click here for the ruling.


The Number of Pediatric ED Visits Grows

In 2015, there were 30 million ED visits for children aged 18 years or younger, with a rate of 382.9 per 1,000 population. The vast majority of these visits (96.7 percent) were treat and release. Infants and children aged <5 years, representing 25.5 percent of all children in the U.S. population, accounted for more than 40 percent of pediatric ED visits in 2015.  Click here for more details from The Healthcare Cost and Utilization Project (HCUP).


DME Competitive Bidding Is Working: GAO

An overhaul of Medicare payment rates for durable medical equipment such as wheelchairs and oxygen tanks led to a huge decrease in spending, but didn’t create significant access problems, according a new GAO report. The fee-for-service rates were adjusted based on a competitive bidding process implemented in 2011. The GAO found that payment rates for the five most expensive categories of equipment in 2016 had dropped by an average of 46 percent. Analysts found an 8 percent decrease in the number of vendors supplying these items, but determined that beneficiaries typically were still able to access the equipment they needed. Click here for the report.

  • Seniors in Anthem-affiliated Medicare Advantage Plans will be able to use their over-the-counter plan allowances to buy items — such as first aid supplies and support braces — at Walmart, the companies announced this morning.  Click here.

85.5 Million Americans Live in Health Professional Shortage Areas
Nearly 60% of the federally-recognized Health Professional Shortage Areas are in rural America. With the physician shortage impacting areas across the United States, rural America is continually hit hardest as loss of one physician can have a much larger impact on the community’s physical and financial well-being.  Click here for more.

  • The CAH Coalition is fighting for Critical Access Hospitals in Washington for better reimbursement, a roll back of onerous regulations and support from more government agencies.  Click here.

HPV Vaccination Rates Not Keeping Up with Rising HPV-Related Cancer Rates

Cancers linked to the human papillomavirus have increased significantly over the last 15 years in the United States with more than 43,000 people developing HPV-associated cancer in 2015, compared to about 30,000 in 1999, according to a new report from the CDC. HPV is the most common sexually transmitted infection, with almost 80 million Americans infected with the virus and throat cancer now recorded as the most common HPV-related malignancy. And while the cancer rates are rising, the rate of HPV vaccinations for the virus is also going up but, according to the CDC, not fast enough. Almost half of those between the ages of 13 to 17 in 2017 received all the recommended doses for HPV vaccination, and only two-thirds had received the first dose. Both of these groups did see a five-percentage-point increase from the previous year but are clearly not keeping pace. To read the full report on the HPV cancers, click here, and for the report on vaccinations, click here.

  • FDA recommends that researchers limit the use of placebos in certain clinical trials for cancer, click here

Progress Made on HIV

The share of U.S. patients with HIV whose viral levels were suppressed steadily grew from 32 percent in 1997 to 86 percent in 2015 thanks to improvements in antiretroviral therapies and in treatment access, according to a new study. But the researchers uncovered some disparities, including lower rates of viral suppression for younger patients and black patients. One limitation of the study: It looked at patients who were being treated at eight HIV clinics in the U.S., meaning it did not account for patients who remain outside of the health system. Click here.


RFI Issued Seeking Input on EHR Systems

HHS Office of the National Coordinator for Health IT (ONC) has released a request for information (RFI) seeking input on the Electronic Health Record (EHR) Reporting Program established as Section 4002 of the 21st Century Cures Act (Cures), and is a first step toward fulfilling the Cures’ requirement.  Cures requires HHS to convene stakeholders to develop a reporting system that collects information that would help providers select appropriate EHR products. The reporting criteria would include the evaluation of certain functionalities of EHR systems including: security, usability and user-centered design, interoperability, conformance to certification testing, and other factors necessary to measure the performance of EHR technology. Click here for the RFI.


There is No Safe Level of Alcohol: Study

According to a study funded by the Bill and Melinda Gates Foundation, there is no safe level of alcohol use and drinking is a leading risk factor for death and disability worldwide. The Global Burden of Disease study, published in The Lancet, analyzed 23 causes of alcohol-related impairment or death, including liver and heart disease, various cancers, as well as car crashes and other alcohol-related accidents, across 195 countries over almost 30 years. Researchers found that drinking is the leading risk factor for death and disability-adjusted life years among 15- to 49-year-olds and that any level of alcohol use is bad for health  as they estimate that dropping from two drinks a day to zero would reduce an individual’s risk of death by 7.1 percent. Click here for the study.

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