23 Dec December 23, 2019

(NOTE: This Weekly Report Will Next Publish Monday, January 6.  Happy Holidays!)

Congress Gives Health Care Many Holiday Gifts
— A delay in the $4 billion Medicaid Disproportionate Share payment cuts
— No surprise billing legislation
— Repeal the Health Insurance Tax in 2021
These are just three of many health care ‘goodies’ Congress passed last week.  Click here for a Washington Post story. The $1.4 trillion spending package funds most government programs through September 30, 2020; however, some items were funded only through May 22nd including the $4 billion delay in DSH cuts, community health centers, and training for health care providers in underserved areas. Congress will have to pass another health funding bill prior to Memorial Day to get these programs through the calendar year. The Cadillac tax and medical device tax were also repealed. Other additions to the bill include increasing the age to purchase tobacco to 21, $25 million for gun violence research, legislation to allow generic drugs to come to market faster, and $8.9 billion towards an expanded Veterans Choice program. For all the bills and summaries, click here.

• Senate Health Committee Chairman Lamar Alexander (R-TN) vowed last week that he “will continue to do everything I can to keep surprise medical bills at the top of the congressional priority list until it’s done,” click here.
• If surprise billing were not allowed out-of-network, physician payments for privately insured patients would drop 13.4 percent and total healthcare spending for people with employer-sponsored insurance would fall by 3.4 percent – about $40 billion annually – according to a new study, click here.
• House Energy and Commerce and the Senate HELP Committees sent letters to companies that hire physicians for hospitals to use, as well as insurers requesting information on out-of-network billing practices and why they are occurring, click here.

New Regs Allow Importation of Prescription Drugs from Canada
The Food and Drug Administration has released a proposal that would allow the importation of certain prescription drugs from Canada, a key part of the Trump Administration’s overall proposal to lower drug prices. The rule would allow states, wholesalers and pharmacies to import certain medicines from Canada. Additional guidance issued by HHS would also enable the importation of certain medications made and sold outside the United States. The draft rule has an extended comment period of 75 days after publication and then states would have to draft their own plans on how to comply with the new federal rule, which will likely to take years before it is actually implemented. The import plan excludes controlled substances, IV drugs, and pricey biologics such as insulin and Humira. Click here for the FDA fact sheet, here for the proposed rule, and here for the guidance document.

• The Pew Charitable Trust looks at the history of drugs from Canada and how the new rule could impact prices, patients and manufacturers, click here.

Court Strikes Down Individual Mandate, Finds it Unconstitutional
The US Court of Appeals for the Fifth Circuit struck down a central provision of the Affordable Care Act, ruling that the individual mandate is unconstitutional. Click here to read the decision. The appeals court did not invalidate the rest of the law as the lower court did, instead sending the case back to the lower court to conduct a further inquiry into which of the law’s parts could survive without the mandate. The Democratic attorneys general who led the states that intervened in the case and argued to preserve the law will petition the US Supreme Court to hear the case before the lower court reconsiders its decision. In its landmark decision in 2012, the US Supreme Court upheld the mandate based on the Congress’s power to impose taxes. This new case arose after Congress reduced the penalty for not having insurance to zero dollars, thereby reducing the tax to zero. A final decision by the Courts is not likely until after the 2020 elections, making health care coverage even more prominent in the 2020 elections. For now, the ACA remains in place.

Obamacare Enrollment is Stable for Third Year
Enrollment through Healthcare.gov was about the same as the previous two years, with more than 8.3 million people signing up for plans through the federal exchange. That is even with a few glitches that led to CMS extending the open enrollment through Dec. 18th at 3:00 am eastern time over an “abundance of caution” by the agency. The final numbers show that the ACA marketplace has stabilized as over 4.4 million people signed up in the final week of enrollment alone. Click here for the snapshot from CMS.

CMS May Try To Recover Over $90 Million in Incorrect Meaningful Use Payments
According to a new report released by the HHS Office of Inspector General, CMS made an estimated $93.6 million in incorrect meaningful use payments over a four year audit period. The number represents less than 1 percent of the total $10.8 billion in payments made during the period and were due to CMS contractors not reviewing the supporting documentation for all hospitals to identify errors in the cost report numbers used to calculate the incentive payments. The OIG recommended that CMS try to recoup some of that money and notify hospitals so they can investigate. To read the full report, click here.

Teen Marijuana Vaping Rates Increase
A new NIH survey shows that approximately 21 percent of 12th grade students in the US said they vaped marijuana during the previous year, a 7.7 percent gain from 2018 and the second largest increase in any substance use on record. University of Michigan research published in JAMA also found that 19 percent of 10th graders and 7 percent of 8th graders reported vaping marijuana in the last year. The increases in all three grades translate into at least 1 million additional THC vapers in 2019 versus 2018, this in spite of the increased information available about the dangers that are leading to lung diseases. The director of the National Institute on Drug Abuse said the “growing popularity threatens to undo years of progress protecting the health of adolescents in the U.S.” Click here for the study.

• The FDA and DEA have announced that they shut down 44 websites advertising illegal vaping cartridges with THC and other adulterated substances in them, click here.
• The latest CDC report on vaping shows that 2,506 people have been hospitalized with vaping-related lung injuries and the number of deaths has increased to a total of 54, click here.
• The Times reports on the increase of heroin use. Because it is not an opioid, federal addiction help funds cannot be used to stem the rising tide of modern heroin addiction, click here.

GAO Slams National Drug Office for Not Hitting Federal Opioid Law Goals
The report found that ONDCP addressed some but not all of the selected statutory requirements GAO reviewed. GAO made 4 recommendations, including that the Director of ONDCP should develop more plans to help the agency meet SUPPORT ACT requirements, some of which have an impending February deadline. The report further found that the Office of National Drug Control Policy hasn’t laid out a 5-year projection for budget priorities and doesn’t have required data on substance use disorder treatment in its latest drug control data dashboard. To read the GAO report, click here.

1,900 Deaths from Flu Already This Season
The flu is widespread in 30 states and has claimed almost 2,000 deaths this season, including 19 children, according to the Centers of Disease Control and Prevention. Nearly every state reports elevated activity, the CDC said in its weekly update Friday. The CDC estimated there have been at least 3.7 million flu cases so far this season, 32,000 requiring hospitalization. It reported 1,900 deaths, including 19 children. Most patients are infected with a strain called B/Victoria that normally doesn’t appear until the end of flu season. The virus tends to strike children and young adults more often, but that anyone can be affected, according to the CDC. The weekly reports finds widespread flu in Puerto Rico and 30 states: Alabama, Alaska, Arizona, California, Connecticut, Delaware, Florida, Georgia, Idaho, Indiana, Kentucky, Louisiana, Maryland, Massachusetts, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington. Click here for the CDC update.

A Win and a Worry for Suicide Prevention
With the recent approval from the FCC to use 9-8-8 as the new suicide prevention hotline, utilization of the suicide prevention service is anticipated to go up – a good thing by all accounts. However, the director for the National Suicide Prevention Lifeline worries that the program is underfunded and will not be able to handle the influx of calls effectively. To read more on the potential effects before the new number goes live, click here.

New JAMA Study Shows Americans Moving Away from PCPs
Tracking patients with primary care providers over the last decade, the study found that Americans with a PCP declined over the last decade by 2 percent. Patients who are male, Latino, black or Asian without insurance and lived in the South were much less likely to have a primary care doctor, the study found. Having a primary care provider decreased across the board for Americans in their 30s, 40s, and 50s. Among 30-year-olds, the number dropped from 71 percent to 64 percent from 2002 to 2015. For the JAMA study, click here.

• The average salary increased last year for both physicians (to $363, 924) and advanced practitioners (to $122,973) according to a study by LocumTenens, click here.

Unplanned Hospital Visits Can Lead to Higher Rate of Death in Older Adults
A new study published in the Canadian Medical Association Journal found that for older adults an unexpected hospital admission had a high likelihood of increasing the risk of death within five years after that visit. Based on more than 922,000 Canadians aged 66 or older between 2007-2017, researchers found that 51 percent of those who died during the study had experienced an unplanned hospital admission. Contrary to that, only 13 percent died within five years of a planned hospital visit and only 3 percent of those who had neither a hospital admission nor a trip to the ED died. Click here for the study.