February 24, 2020

CMS Targets 340B Prices 
CMS has quietly released a notice of proposed collection of information that will directly impact 340B drugs, as CMS prepares for the possibility that it may not win its currently pending appeal of the 340B court case. The court has already ruled that CMS could not impose its 28.5% 340B payment cut, as it did a few years ago. Now the agency is working to obtain acquisition costs for specified covered outpatient drugs. This data would be to justify future payment cuts for outpatient drugs. CMS wants, “to ensure that the Medicare program pays for specified covered outpatient drugs purchased under the 340B program at amounts that approximate what hospitals actually pay to acquire the drugs.” Comments are due March 7th, click here for the CMS proposal.

Specialty Drugs Are Half the Spending on Drugs in Commercial Plans
Pharmacy benefit manager giant Express Scripts analyzed the costs associated with the 33.6 million people enrolled in their plans and found that almost half of the spending was on specialty drugs. The annual Drug Trend Report, a comprehensive analysis of usage and costs for the medications, showed that while only about 2 percent of the population use specialty drugs they accounted for 47.7 percent of all spending on prescription drugs citing new therapies entering the market with few or no competing drugs to drive down prices. To read the report, click here.

  • The Wall Street Journal looks at how the drug lobby is losing its power as drug costs continue to rise, click here.
  • Trump keeps pushing to get legislation to lower drug prices, click here.
  • The FDA approved three drugs for nonprescription use through a process allowing for easier access and lower cost, click here.
  • The FDA has approved a new cholesterol drug.  Click here.

Flu Nearing Epidemic Status
With over 14,000 deaths from the flu since October, and a mortality rate of 6.8 percent, the 2019-2020 flu is only 0.5 percent away from the epidemic threshold of 7.3 percent. The last time the flu reached epidemic proportions was in 2009. Some good news is a CDC report that the flu vaccine prevents flu-related outpatient visits by about 45 percent. To view the latest from the CDC, click here. To view the report on the vaccine, click here.

U.S. Hospital at the Center of the Coronavirus
Eleven Americans who were recently evacuated from a quarantined Japanese cruise ship and brought to the University of Nebraska Medical Center have tested positive for coronavirus (click here). This brings the total of confirmed coronavirus cases in the United States to 34. The Omaha facility and its biocontainment unit were originally built in 2005, when SARS was at its height. Click here for a great NY Times story on why UNMC created its infectious disease center. Both the state health department and the CDC supported the idea and the location was favored due to the presence of the Offutt Air Force Base, given that the military typically would be part of the response to large-scale disease outbreaks. The Coronavirus quarantine is the second time the facility has come into use, after the UNMC previously treated three patients with Ebola in 2014.

  • To read the latest on the virus from the CDC, click here.
  • Italy has now become the largest outbreak outside of asia.  Click here.

CMS Proposes to Extend the Joint Replacement Model for 3 Years Only in the 34 Mandatory MSAs
CMS proposed last week to extend the Comprehensive Care for Joint Replacement or CJR Model for an additional three years, as well as add outpatient joint replacement procedures and include the target price calculation, the reconciliation process, the beneficiary notice requirements, gainsharing caps, and the appeals process to the model for the 34 mandatory MSAs. The proposal would also end the model in the 33 voluntary MSAs and the rural and low-volume hospitals. Click here for the proposed rule, and here for the CMS fact sheet.

Nonprofit Hospitals with Highest Incomes Provide Lowest Amount of Charity Care: Study
Nonprofit hospitals with the largest net earnings in 2017 provided less charity care relative to their revenue than nonprofit hospitals with lower earnings, according a new study published in JAMA.  Data came from Medicare cost reports on 2,563 nonprofit short-term general hospitals.  Researchers looked at financial assistance given to patients and found a disparity in the amount of charity care nonprofit hospitals provided when comparing the high-income with lower-income hospitals. The study showed that hospitals in the top quartile provided $11.50 of charity care for uninsured patients and $5.10 of charity care for insured patients for every $100 of overall net income earned, while those in the third quartile provided $72.30 in charity for uninsured patients and $40.90 of charity care for insured patients for every $100 of overall net income earned. The study looked at financial assistance only. Other community benefit services were not included in the calculations. To read the study, click here, and for an overview from the New York Times, click here.

  • “Why Are Nonprofit Hospitals So Highly Profitable?” A physician takes on hospitals in this New York Times op-ed, click here.
  • So, what is that study often cited by Sen. Bernie Sanders, that shows how a single payer health care system would save more than 68,000 lives and $450 billion a year? Click here.
  • Click here for the latest on the lawsuit that may end Obamacare.

More Americans Funding Healthcare Through CrowdFunding
One in five Americans reported that they or someone in their household have contributed to a crowdfunding campaign to pay for medical bills or treatments, according to a new survey. Crowdfunding is the process by which individuals may raise funds from a large amount of people, often through sites such as GoFundMe. Click here for details.

The Battle Continues Between Patients’ Control of Their Health Records and Ongoing Privacy Concerns
The tech industry’s push to require greater patient access to personal health records may allow unprecedented convenience for patients to move their health data from office to office or easily find clinical trials but it has also created major privacy concerns for policymakers. Access changes could lead to a loss in protection by HIPAA as soon as records leave the doctor or hospital. The developers of the apps for patients may have access to sensitive patient information. Officials in the HHS office that oversees health technology have said new rules will give consumers transparency about app-makers’ privacy practices, giving the FTC a role in keeping tech firms accountable. Lawmakers such as Sen Kirsten Gillibrand (D-N.Y.), have committed to increasing protections, with recently introduced legislation to create a new federal agency devoted to data privacy, in health and other sectors. To read the Data Protection Act, click here.

House Set to Vote on Anti-Vaping Legislation This Week
The House is scheduled to vote on a pair of bills (that may be merged into one) to curb vaping usage, specifically among the young. The bills (H.R. 2339 and H.R. 4742) would ban some popular flavored tobacco products, such as mint and menthol and assess an excdise tax on tobacco alternatives equivalent to the $1.01 federal levy per pack. The bills would also apply tobacco advertising rules on vaping products and require HHS to promulgate regulations on synthetic nicotine products. Click here for H.R. 2339, and here for H.R. 4742.

Many Caregivers Are in Poor Health Themselves
Almost 20 percent of people who identified themselves as caregivers for family members or friends reported that they are in fair or poor health, according to a survey by the CDC. The Behavioral Risk Factors Surveillance System survey found that 20 percent of respondents were classified as caregivers from 2015-2017. The CDC notes that unpaid caregiving can be physically, financially and emotionally draining.  As the Baby Boomer generation ages, more people will be associated with the practice that may compromise the health of the caregivers themselves. To read the study, click here.

UnitedHealth Group Ending Contracts with Mednax – Arkansas, Georgia, North and South Carolina Impacted
UnitedHealth Group has canceled its contracts with Mednax Health Solutions’ anesthesiologists, neonatologists, and obstetricians in four states. The contracts are set to end between March 1 and September 1. If a new deal is not created, Mednax doctors will be out-of-network for those with UnitedHealth insurance, regardless if the doctors work at in-network hospitals, putting patients at risk for high costs and ‘surprise’ medical bills. Mednax estimates the termination will affect $70 million of revenue this year. Click here for the Mednax announcement. Click here for more details.

120 Rural Hospitals Closed over the Last Decade
Since 2010, 120 rural hospitals have closed their doors, with 2019 breaking the record with 19 closures in a single year, according to a new report by the Chartis Center for Rural Health. The report looked at several factors indicating if and how much at-risk a rural hospital may be for closure. More than 450 rural hospitals are financially unstable. As operating margins decline, “a one percent increase in total revenue can decrease the likelihood of closure by three percent on average,” the study said. “Similarly, a one percentage increase in the proportion of outpatient revenue decreases the likelihood of closure by five percent on average.” The report also found that being in a state that expanded Medicaid decreases the likelihood of closure by about 62 percent. To read the full study, click here.

200,000 Tricare Beneficiaries To Lose Care at Military Health Facilities
More than 200,000 Tricare beneficiaries, including 80,000 active-duty family members, will no longer be seen at 37 military health clinics across the country in the coming years, according to a recent Department of Defense report. Affected facilities will maintain pharmacies for all beneficiaries, but will transition to offer outpatient and occupational health services to only active-duty patients. Former beneficiaries will be forced to find civilian doctors in their communities over the course of two to four years. The change comes after a review of military hospital operations and is predicted to save $36 million. While the change carries no significant costs to active duty personnel, retirees and families will have to pay cost shares under the Tricare Prime and Tricare Select programs through civilian providers. To see the list of affected facilities, click here.

New Report Finds U.S. Children’s Wellbeing Ranks Lower Than 38 Other Countries
The United States ranked 39th in a recent study, commissioned by the Lancet, the World Health Organization and the United Nations Children’s Fund. It examined 180 countries and ranked them based on the wellbeing of their young populations. Factors, such as health, education and nutrition were taken into consideration. Future predictions, such as carbon emissions, were added in as well. The WHO states that early investments in children’s health, education, and development have benefits that compound throughout the child’s lifetime. Click here for the study.
  • A new study from the Pew Trusts looks into children who are part of a growing health insurance coverage gap, click here.

Women Increasingly Having Heart Attacks without Chest Pain
Chest pain is the most common symptom of a heart attack in men and women. However, women are more likely to have unusual symptoms or no symptoms of chest pain at all. As a result, the incidence of women receiving delayed treatment and care is rising. Contrary to popular belief, women have a higher risk of dying from a cardiovascular condition than all forms of cancer combined. The American Heart Association is working to bring more awareness and funding to the issue through the Go Red for Women initiative. To read more, click here.

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