August 28, 2017

August 28, 2017 (NOTE: The Weekly Report will not be published next week.  Have a safe Labor Day weekend.)


Opposition Grows Against CMS’ Proposal To Cut 340B 

A CMS advisory panel last week recommended that the agency not finalize its proposal that would drastically cut Medicare payments for drugs acquired under the 340B Drug Pricing Program. In July, CMS proposed to pay separately-payable, non-pass-through drugs (other than vaccines) purchased through the 340B program at the average sales price minus 22.5%, rather than ASP plus 6%, starting in January. Instead the advisory panel recommended that the agency collect data about the proposal’s impact and how CMS should shift the savings if such a cut were implemented.  For more on the advisory panel and to read the testimony from the Association of Community Cancer Centers and the American Hospital Association, click here.


1,200+ MACRA Comment Letters Sent to CMS on Proposed Regs

CMS received more than 1,200 comment letters to its proposed MACRA (Quality Payment Program) regulations that are scheduled to take effect January 1, 2018.  Generally, comments were favorable toward the updated regulations, as providers think increasing the number of clinician exemptions from participation and lowering reporting requirements are good steps.  Final regulations are expected in the fall.  Among the major groups submitting comments:

American Medical Association: click here.

American Hospital Association: here.

American College of Physicians: here.

American College of Surgeons: here.

American Association of Nurse Practitioners: here.


CHIP, Dozens of Medicare Program Expire Before Year’s End

The Children’s Health Insurance Program (CHIP) and a few dozen other Medicare and Medicaid programs expire after September 30 or December 31 this year and there is no certainty that Congress will extend them.  There seems to be broad support for CHIP and for the past several years the other “extender” programs were tied to CHIP passage legislation.  The Medicare-Dependent Hospital program, extra payments for rural home health and ambulance providers and teaching health centers are just a few of the expiring provisions.  Click here for a complete summary and report.


Medicare’s New End-of-Life Consults Growing Rapidly

In 2016, the first year health care providers were allowed to bill for advance-care planning session, nearly 575,000 Medicare beneficiaries took part in an end-of-life consultation that’s now being paid for by Medicare, new federal data show. Nearly 23,000 providers submitted about $93 million in charges, including more than $43 million covered by the federal program for seniors and the disabled. Click here for details.


Pace of New Federal Regs Slows to Historic Low

The pace of regulatory activity has dipped to new lows in the first six months of the Trump administration. The Office of Information and Regulatory Affairs, which reviews all significant federal regulations, processed 67 regulatory actions in the first six months of this administration, including notices, proposals, and final rules, compared with 216 actions by the same point in the Obama administration, according to government data. Click here for more.


Non-Profit Hospitals Expenses Outpace Revenue Growth: Moody’s The ratings agency Moody’s is out with its annual review of financial performance for its 323 rated hospitals and found that annual expense growth rate outpaced annual revenue growth rate for nonprofit and public healthcare organizations. Moody’s said annual expenses grew 7.2%, which outpaced 6% annual revenue growth. That led to absolute operating cash flow contraction of -4.5%. Additionally, they found that 50.5 percent of net patient revenue in 2016 was from outpatients, up from 50 percent in 2015 and 47.9 percent in 2013. Click here for more on the assessment from Moody’s.

  • Major for-profit hospital operators were plagued by weak patient volumes in the quarter that ended June 30, and this trend is likely to continue through next year. Click here for details.

Fighting Opioid Epidemic, HHS Looking to Fill Positions on New Pain Management Task Force

HHS announced last week that it is seeking nominations for a new pain management task force to develop best practices for prescribing medication and managing chronic pain. The task force, which was authorized by the Comprehensive Addiction and Recovery Act (CARA) of 2014, S. 524, will investigate whether there are gaps or inconsistencies in pain management among federal agencies, propose recommendations to address gaps, and develop a strategy for disseminating pain management best practices to health professionals. The task force will have up to 30 people, nomination are due Sept. 27. Click here for the announcement in the Federal Register.


Investigative Report Targets Recover Centers of America

A marketing blitz and an infusion of private equity money have helped make Recovery Centers of America into the self-described fastest-growing addiction treatment provider in the country. But a STAT-Boston Globe investigation has found the company spends lavishly on five-star facilities and advertising while skimping on giving patients basic care. Click here for the report.

FDA Commissioner Continues Efforts to Lower Cigarette Nicotine Levels

FDA Commissioner Scott Gottlieb has further outlined how the agency will move forward with a regulatory framework to lower nicotine levels in combustible cigarettes. This will include the consideration of peer-reviewed studies to determine a maximum nicotine level, a look at how lowering nicotine will impact current smokers’ behavior, and investigate the potential for smokers to turn to alternative tobacco products. To read the article by Gottlieb, click here.

  • In a letter to FDA, Democrat Senators request a ban on menthol cigarettes, click here for the letter.
  • Smoking prevalence remains highest among those with behavioral health conditions.  Click here for a very good analysis of what can be done.

Senate Targets Exchange Market Stabilization Initiative

A key senate committee will hold two hearings September 6 and 7 that will focus on stabilizing the Affordable Care Act’s insurance. The sessions will feature testimony from state insurance commissioners and governors on how to keep premiums low and increase insurance options in the markets for 2018. Lamar Alexander, Chairman of the Committee, and Patty Murray, the Ranking Democrat Member, are working together to pass a narrow stabilization measure by the end of September before the next enrollment period begins. Click here for details on the Sept. 6th hearing, and here for the hearing on the 7th.

  • The House “Problem Solvers” Caucus has released its recommendations for bipartisan ACA reform.  Click herefor a very good analysis.

Report:  ACA Helped Reduce Racial and Ethnic Disparities

Between 2013 and 2015, disparities with whites narrowed for blacks and Hispanics on three key access indicators: the percentage of uninsured working-age adults, the percentage who skipped care because of costs, and the percentage who lacked a usual care provider. Disparities were narrower, and the average rate on each of the three indicators for whites, blacks, and Hispanics was lower in both 2013 and 2015 in states that expanded Medicaid under the ACA than in states that did not expand. Click here for the Commonwealth Fund report.


Overdoses in Women More Prevalent in Rural South and Midwest

The final report released by the Office of Women’s Health on Opioid Use, Misuse, and Overdoes in Women study found that death rates from drug overdose for women are more pronounced in the rural South and Midwest. The study looked at rates from 1999-2015 and found that the increase in deaths due to opiod overdoses in women far outpaced that of men. The report identified a possible explanation being that rural areas often lack access to treatment for substance use disorder. To read the full report, click here.


More Than 60 Drug-Price Transparency Bills are Drafted in 30 States

30 states have drafted more than 60 drug price transparency bills this year aimed at identifying drug maker expenses, and unveiling business practices of pharmacy benefit managers, according to a new analysis. Most of the action to hold-off prescription drug price increases is taking place in the states, which are dealing with strained budgets. The more ambitious legislation calls for making drug companies justify prices, particularly for new drugs or for large price increases for older drugs. Other plans will use long-standing laws on unfair business practices to reveal drug-pricing practices. Click here for the report.


Group Urges Investigation of Gwyneth Paltrow’s Wellness Company GOOP

Last week in a letter to a pair of district attorneys, Truth in Advertising asked for a review of a sampling of “inappropriate health claims” that GOOP has used to market dozens of products, like a crystal that the company claims can treat female infertility. “The company does not possess the competent and reliable scientific evidence required by law to make such claims,” the advocacy group wrote on Tuesday. To read the letter, click here.  For more on the history of criticism of GOOP’s practices before from BuzzFeed, click here.


CMS Seeks Help with QPP Website

CMS is looking for help to make the Quality Payment Program website meet the needs of the clinician community, to provide streamlined access to information and minimize undue burdens for program participation. CMS is inviting representatives from organizations of all sizes to assess current and future functionality of the website, as well as make recommendations for improvements. CMS is looking for:  Medicare clinicians; Practice managers; Administrative staff; and EHR and Registry vendors. For those interested, email [email protected] to participate in a one-on-one feedback session. For more on the project, click here.


State Legislators Think Differently About Health Care Priorities Depending on Party: Study

According to a new study published in the American Journal of Public Health, party membership, not location or legislative chamber, was the biggest predictor of legislators’ goals on health care priorities. Researchers based this on a survey of almost 400 responses from state legislators in various regions of the country that asked them to rank 13 different health care priorities. Republicans heavily prioritized “reduce government involvement,” while Democrats ranked “reduce disparities” in health care because of race, ethnicity or socioeconomic status as a high priority. However, reducing individual costs was a top priority for members of both parties, although legislators differed in the scope of how to address it. To read more about the survey, click here.

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