December 3, 2018

OIG Calls for Major Reforms to Medicare Wage Index System 

According to a report released by the HHS Office of Inspector General last week, investigators discovered significant vulnerabilities in the wage index system while conducting reviews of hospitals’ wage data from 2004 through 2017.  The wage index, which is based on a detailed calculation of labor and related costs, is used to adjust the actual Medicare payment rates for hospitals and other providers.  The OIG found that CMS may not be accurately factoring in local labor prices when calculating the wage index for hospitals. Due to these inaccuracies, the OIG recommended comprehensive reform of the system that would require legislative action. Click here for the report.


Trump Administration Pushing Medicare Advantage, Now at 37 Percent of Medicare

Older Americans have been flocking to Medicare’s private plans, which promise predictable costs and extra benefits.

But the private Medicare Advantage plans have also been getting an unpublicized boost from the Trump administration, which has in the last few weeks extolled the virtues of the private plans in emails sent to millions of beneficiaries, according to an update from the New York Times.  Medicare’s annual open enrollment period closes on Friday. Administration officials predict that almost 37 percent of the 60 million Medicare beneficiaries will be in Medicare Advantage plans next year, up from 28 percent five years ago.  Click here.


25% of Government Shuts Down Friday as Congress Works To Pass a Number of Bills

This week will see more lower level legislation and a few Committee hearings with the focal point of how to fund about 25-percent of the government that runs out of money on Friday.  The President is threatening to veto any funding bill that does not contain $5 billion for a border wall. Also on the docket for the week is S. 2248, Veterans Benefit and Transition Act of 2018 that makes updates to educational and vocational rehabilitation programs for veterans as well as housing and burial benefits. It is also possible that the negotiated Farm Bill (H.R. 2) could be under consideration.  Clickhere for the veterans legislation and here for the Farm bill.


CMS Proposes New Rule To Lower Drug Prices; Protected Drug Classes Could Be Harmed

Early last week, the CMS proposed a new rule that would further the President’s blueprint to lower drug costs and reduce out-of-pocket costs for patients. Under the proposed rule, Medicare Advantage and Part D plans have more leeway to limit coverage of drugs in protected classes when the price of a medicine rises more than inflation or only minor changes are made to older products, leading to push back from patient groups, physicians as well as the pharmaceutical manufacturers. Currently, Part D plans must cover all drugs in the six classes including all cancer medicines, antidepressants and HIV drugs making it hard for plans to negotiate for lower costs.  Also within the rule is a requirement for Medicare Part D insurance plans to provide real-time access to drug pricing data by 2020, which would integrate with doctors’ EHRs or e-prescribing software and allow them to determine the price for a given drug and various alternatives for a specific patient. Comments are due to CMS by January 25, 2019. Click here for the rule andhere for the CMS fact sheet.

  • Avalere study funded by patient groups shows Medicare Part D plans already have enough levers to control costs of drugs in the protected classes, click here.
  • Conservative groups warn the President’s plan to lower drug prices based on the prices of drugs internationally is similar to price controls, click here.
  • The Washington Post looks at why drug prices have “skyrocketed” and what the government should do to bring the cost down, click here.

HRSA Finalizes 340B Ceiling Price Rule

The Health Resources and Services Administration has released a final rule to change the effective date of the 340B Drug Pricing Program Ceiling Price and Manufacturer Civil Monetary Penalties Regulation from July 1, 2019 to January 1, 2019. The final rule, initially published in January 2017, initially had an effective date of March 6, 2017, laid out how ceiling prices in the 340B drug discount program should be calculated, the so-called “penny-pricing policy” as part of the formula for calculating discounts, as well as civil monetary penalties for manufacturers who “knowingly and intentionally” overcharge providers. The effective date of the regulation, mandated in the Affordable Care Act, was subsequently delayed until July 1, 2019. Most published comments disagreed with the date change and declared it was unnecessary, HRSA responded that the rule has been delayed enough. To view the final rule, click here.

  • The FDA last week granted accelerated approval to Vitrakvi (larotrectinib), a treatment for adult and pediatric patients whose cancers have a specific genetic feature, click here.


Medicare Buy-In Proposal, an Alternative to Medicare for All, Gains Traction

While Medicare for all was touted by many Democratic candidates during the recent mid-term elections, Democrats in the House of Representatives, the new majority, are looking at the proposal that is a bit more moderate: Medicare Buy-In. Under the proposal, championed by Rep. Brian Higgins (D-NY), anyone aged 50 to 64 who buys insurance through the health-care exchanges would be eligible to buy in to Medicare. Additionally, younger working Americans who wish to buy into the program would have the option to do so, and their employers could continue to contribute to their premiums pre-tax. Click here for more on the efforts and here for the bill introduced last year.


Amazon Software to Mine Health Data to Assist Providers 

In a blog post last week, the tech giant confirmed that it would start to sell software to mine patient medical records for information that doctors and hospitals could use to improve treatment and cut costs. According to Amazon, the software can read digitized patient records and other clinical notes, analyze them and pluck out key data points. This is yet the next move that the online retailer is using to get into the health space after last year it paid $1 billion for an online pharmacy called PillPack Inc. to acquire the capability to ship prescription drugs. Amazon aims to ultimately leverage the tool to allow patients to manage their own health, proactively schedule visits, and make informed decisions about their own care. In the blog post, Amazon confirmed it is already working closely with Seattle’s Fred Hutchinson Cancer Research Center to apply the service to cancer care. To read the full blog from Amazon, click here.


US Life Expectancy Lowers Again, Opioids Blamed

According to the Centers for Disease Control and Prevention, Americans who were born in 2017 are expected to live 78.6 years, a decrease of 0.1 from 2016. The CDC cites mortality from drug addiction and suicides among young adults is mostly to blame. In 2017 alone, more than 70,000 people died due to a drug overdose, nearly 10 percent more than in 2016. This is the highest amount of overdose deaths ever recorded. Click here for more from the CDC.

  • White House Office of National Drug Control Policy announced $2.9 million in grants to combat the opioid epidemic, click here.
  • The need to develop quality measures for opioids to prevent potential adverse outcomes such as overdoses is explored in a Health Affairs blog, click here.
  • New York Times investigates how Dayton, OH was able to decrease overdose deaths by 54-percent, click here.

According to the World Health Organization, the number of reported measles cases globally rose 30 percent last year amid a series of outbreaks across the world, click here.


Senate Committee Advances Health Bills to the Floor

The Senate Health Committee advanced four bills to the full Senate last week that included maternity care, pediatric services, and Alzheimer’s research as well as a number of Presidential nominations. The bills include –

  • S.2076, the Building Our Largest Dementia Infrastructure for Alzheimer’s Act;
  • H.R. 6615, the Traumatic Brain Injury Program Reauthorization Act of 2018;
  • H.R.315, the Improving Access to Maternity Care Act; and
  • S.3482, the Emergency Medical Services for Children Program Reauthorization Act of 2018.

Click here to view the markup and review the legislation that was voted on. Sign-Ups Still Lagging; AMA Says Commercial Markets Less Competitive

Yet another week of open enrollment for the ACA Marketplace Exchanges sees the enrollment pace significantly down from last year’s sign-ups.  Overall, enrollment is down by 9.2 percent on a daily basis, with an average of just over 100,000 signing up for 2019 coverage each day. At the same point in the open enrollment in 2019, 2.8 million individuals had signed-up for coverage, this year the number is 2.4 million. Why is it so slow? Experts suggest different things but most agree that the main issue is probably that the population is unaware that it is the open season.  According to a Kaiser Family Foundation poll, only one in four who buy their own insurance know that the open enrollment deadline is December 15th. Click here for the CMS weekly snapshot of the enrollment, and here for the KFF poll.

  • CMS Administrator Seema Verma shared her vision for innovations and reforms to strengthen health insurance markets under the ACA, click here.
  • CMS unveiled new guidance that would allow states to bypass many ACA requirements such as fixed-dollar amounts to individuals to cover medical expenses and granting them permission to set new rules on what types of coverage can qualify for subsidies, click here.
  • According to a report by Georgetown University, the number of uninsured children in the United States increased last year for the first time since data collection began, click here.
  • American Medical Association study shows commercial insurance markets were less competitive last year than in 2016 in half of the country, click here.

CVS/Aetna Deal Becomes Official, Plans New Model of Care

The CVS/Aetna closed their $69 billion merger combining CVS’ pharmacies with Aetna’s insurance business, stating their new model of care will lower costs and increase services. Early next year, CVS plans to start testing stores with added health services. These new locations will likely focus on managing common chronic conditions, adding more primary health services at CVS’ MinuteClinics, guiding discharged hospital patients through their at-home plans and managing complex conditions. Click here for more.

  • New report shows that insurers deny one in every 10 claims for medical testing or screening and say “Not Medically Necessary” is the Most Common Insurer Reason for Denying Coverage, click here.

Senate Committee Continues Series of Hearings on the Cost of Health

In its final hearing of a series, the Senate Health Committee discussed the reduction of health costs through innovative programs as well as the factors that influence costs. Committee Chairman Lamar Alexander (R-TN) described the hearing as a tactic to put the spotlight on these issues and what can be done about them. Lots of discussion from both sides of aisle centered around surprise billing and the need to further education for patients from their providers. Republicans focused on innovation and telehealth, while democrats expressed concerns over the lack of behavioral health programs. Click here to watch the hearing and view written statements.


HHS Releases Draft Strategy to Reduce Health IT Burden on Providers

HHS has released a draft strategy designed to help reduce administrative and regulatory burden on providers caused by the use of health information technology such as electronic health records. The draft policy paper was required in the 21st Century Cures Act. HHS received input and feedback from stakeholders, including clinicians, expressing concerns that EHR burden negatively affects the end user and ultimately the care delivery experience to create the strategy. The draft strategy outlines three overarching goals designed to reduce clinician burden –

  • Reduce the effort and time required to record health information in EHRs for clinicians;
  • Reduce the effort and time required to meet regulatory reporting requirements for clinicians, hospitals, and healthcare organizations; and
  • Improve the functionality and intuitiveness (ease of use) of EHRs.

Comments are due by January 28, 2019. To read the draft and submit comments, click here.


Study Shows One in 40 Children Have Autism

That is according to a new study released by HRSA last week. The study supports previous research suggesting autism diagnoses have increased in kids in the past 20 years as about 1.5 million children in the United States have been diagnosed with autism spectrum disorder. Researchers found that more than one quarter of kids with autism were taking medications and nearly two-thirds had received behavioral treatments to manage symptoms within the last year. The study was published in Pediatrics and includes data from more than 50,000 children from the 2016 HRSA National Survey of Children’s Health. Click here for the study.


Brain Stimulation May Help Relieve Depression
A study published in Current Biology provides evidence that mild pulses of electricity can help relieve depression. The study, performed on patients with epilepsy and depression who were admitted to hospitals for care, found that when they targeted the part of the brain right above the eyes patients almost automatically felt as if there had been improvements. Individuals in the control group did not report feeling the same improvements which provides evidence that this treatment could be beneficial. More research needs to be done to see if the treatment has long lasting effects. To read the study, click here.


Will Climate Change Affect Your Health?

The US Global Change Research Program, a team of 13 federal agencies, released its 4th annual National Climate Assessment last Friday with detailed information about the possible impact of climate change on each US region and the effects climate change will have on health, economy and infrastructure. Some key predictions include: A decline in crop production, specifically Midwest farms will only be able to produce about 75% of the corn they produce today. An increase in food and waterborne illness, which is expected to spread to seafood in northern seas and affect oysters grown in the Northeast. And an increase in premature death rate due to higher temperatures, which will cause the Midwest an additional 2,000 premature deaths per year by 2090. For the full report, click here.

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