February 26, 2018

February 26, 2018


Hospitals Inflate Outpatient Oncology Treatment Costs: New Report

A new report published in the American Journal of Managed Care shows that large-scale medical centers inflated outpatient oncology treatment costs substantially above what Medicare typically pays, and their markups vary anywhere from three to six times as much. The recent analysis of 3,000 hospitals investigated the widespread practice by prestigious medical institutions of the mark up of oncology treatment prices to the financial disadvantage of patients paying out-of-pocket or with private health insurance. The study reviewed billing records at non-profit hospitals in 2014 to calculate a markup ratio compared to the Medicare allowable amount and found that pathology had the highest ratio at 4.1:1, or a markup of $310, followed by radiology and radiation oncology at 3.7:1 and 3.6:1, respectively. These markup prices and specialty services led to estimates for cancer treatment costs can vary from $50,000 to $500,000. To read the study, click here.  For the Johns Hopkins press release, click here.

New CDC Data Says Overdose Deaths Declined in 14 States

New provisional data released by the CDC shows that drug overdose deaths declined in 14 states during the 12-month period that ended July 2017, a potentially hopeful sign that policies aimed at curbing the death toll may be working.

The reported drop in overdose deaths occurred in Wyoming, Utah, Washington, Alaska, Montana, Mississippi, Kansas, Rhode Island, Oregon, California, Tennessee, Massachusetts, Arizona and Hawaii. Several states saw death spikes of more than 30 percent, most likely due to the increasing presence of the deadly synthetic drug fentanyl. Those are Delaware, Florida, New Jersey, Ohio and Pennsylvania, along with the District of Columbia. Click here for more, including state-by-state numbers.

House Tackles Opioid Use This Week; Opioid Solutions Sought Nationwide

The House Energy and Commerce Committee last week announced plans to take a broad approach in crafting a package of opioid legislation starting with a legislative hearing on Wednesday. In the first of three hearings to examine the opioid crisis and possible legislative solutions, the Health Subcommittee will review eight bills pertaining to the Controlled Substances Act. Beyond this first hearing, the full legislative package is expected to include bills addressing funding for new opioid alternatives, expanding access to addiction treatment options and ensuring resources are fairly allocated to states. The Committee also plans to look at ways to increase NIH capacity to research non-addictive medications, including through partnerships with private industry. Click here to view all the bills for Wednesday’s hearing.

  • According to a new study, in the Mid-Atlantic and Midwest states there’s a shortage of providers certified to prescribe buprenorphine, one of the most effective treatments for people with opioid addiction, click here.
  • The American Medical Association is pushing for medication-assisted treatment to be the seventh protected class of drugs under Medicare Part D among other suggestions, click here.
  • A six-month pilot project involving ten Colorado hospitals efforts to decrease opioid use in emergency departments. The hospitals sought to reduce opioid use by 15% but surpassed that goal and reduced usage by 36% during that same period in 2016, click here.

State, Regional Hospital Associations Seek Court Action on 340B; AAMC Opposes Cassidy’s 340B Bill

35 state and regional hospital associations last week urged the U.S. Court of Appeals for the District of Columbia Circuit to reverse a district court decision and grant a preliminary injunction to stop a nearly 30% Medicare payment reduction for many hospitals in the 340B Drug Pricing Program.  Click here for their friend of the court brief.

  • The legislation from Rep. David McKinley (R-WV), H.R. 4392, to roll back the 340B payment cut and impose a regulatory moratorium now has 187 House cosponsors.  Click here to see the updated list.
  • The AAMC sent a letter to Sen. Bill Cassidy (R-LA) opposing his 340B reform legislation.  Click here to read the letter.  the AAMC is also out with new 340B explanatory information.  Click here for their info-graphic.  Click here for their 3-pager on why the 340B program is important and why some congressional legislation makes it worse.

Bipartisan Group of Governors Propose New Health Care Blueprint

A bipartisan group of governors last week released a health care blueprint they hope could help break the political stalemate over reforming the health care system. The seven-page report, released before the National Governor’s Association meeting in Washington this past weekend, suggests policies for improving affordability, increasing value-based care, and promoting state innovation. The plan was released by Govs. John Hickenlooper (D-CO), John Kasich (R-OH), Bill Walker (I-AK), Tom Wolf (D-PA) and Brian Sandoval (R-NV). Focusing on the move away from fee-for-service to paying for value and realigning consumer incentives are key component.  To read the report, click here. Click here for the Washington Post report.

Government Proposes to Expand Short-Term Insurance Plans

The Departments of Health and Human Services, Labor, and Treasury issued proposed rules last week that would expand access to short-term health insurance plans to keep short-term health insurance coverage for up to almost one year, a reversal of the Obama Administration’s decision to shorten that duration to three months. These proposed ACA alternatives are cheaper than traditional insurance, but in some cases they deny coverage for pre-existing conditions and some medical services. Additionally, they may also limit coverage for consumers with catastrophic illnesses, potentially leaving them responsible for large medical bills. While many Republican lawmakers voiced support, Democrats and patient groups voiced opposition. Seventeen patient groups released a joint statement opposing the proposal, saying it would lead to higher premiums, higher deductibles and stricter limits on benefits. Click here for the rule and here for the fact sheet.  Click here for the joint release. Click here for the op-ed from HHS Secretary Azar.

  • All of the new provider-sponsored health plans formed or announced between 2015 and 2017 were joint ventures of provider systems and health insurance companies.  Click here for the Health Affairs analysis.
  • White House Council on Economic Advisers states that government health insurance requirements are dampening drug price competition, leading to artificially inflated medication costs, click here for report, health findings begin on page 279.
  • HHS revised its budget last week to eliminate $12.3 billion for risk corridor payments, click here.
  • CDC report shows 29 million Americans, or nine percent, were uninsured in first nine months of 2017. Among those ages 18 to 64, 12.7% lacked coverage, 69.3% with coverage had a private plan, and 43.2% had a high-deductible plan, up from 39.4% in 2016, click here for details.
  • The UnitedHealth Group last week announced that it will collaborate with individual doctors, health systems and government to expand the use of bundled payment models in traditional fee-for-service Medicare, click here.

GAO Says Government Officials Don’t Know If Medicaid Demos Are Working

According to a recent GAO report, states and the federal government don’t fully know if Medicaid demonstrations are saving money or improving care. About one-third of Medicaid’s spending goes toward demonstrations, which allow states to test new approaches to delivering Medicaid services; however, the GAO found that the federal government did not require complete and timely evaluations from the states, so conclusive results were not available. Additionally, CMS was not making results that they did receive publicly available. GAO made three recommendations that mainly address public availability of evaluations. Click here for the report.

  • Medicaid was the primary payer for 54 percent of hospitalizations for patients younger than 18 (excluding hospitalizations for pregnancies and newborns) in 2015. That represented a sizeable increase from 2000, when Medicaid paid for 39 percent of hospitalizations in that category. Click here for details fro AHRQ.

Moody’s: Insurers’ Growth Strategies Threaten Not-for-Profit Hospitals’ Margins

US not-for-profit hospitals will face greater competition, risk of volume declines and margin erosion as the nation’s largest commercial health insurers aggressively pursue growth strategies, Moody’s Investors Service says in a new report. As insurers pursue vertical integration strategies, such as acquiring physician groups and non-acute care services, they enter into direct competition with hospitals and hospital services. Click here for more.

EHRs Driving Up the Cost of Claims Processing

Electronic health records aren’t able to reduce administrative costs, in fact they may increase costs, according to a new report published in JAMA. The study looked at the amount of time it took to complete billing and insurance activities in the EHR and the cost of personnel and overhead at an academic healthcare system with an EHR. Using the cost data to determine what percentage of professional revenue the costs represent, both the estimated cost and the percentage of professional revenue represented by the cost varied greatly. The estimated costs of billing and insurance-related activities ranged from $20 for a primary care visit to $215 for an inpatient surgical procedure, representing 3% to 25% of professional revenue. Click here for the study.

Telemedicine Serves Important Role in Rural Health Telemedicine’s role in rural health care continues to expand. At the Eastern Idaho Regional Medical Center (EIRMC) they use a Robotic Stroke Assessment machine that connects ER physicians with a stroke neurologist whenever a patient comes in. For strokes, time is of the essence, and with telemedicine, EIRMC has seen the standard of care for stroke patients improve. The Federal government has been exploring ways to better expand telemedicine in rural areas, including allowing Medicare Advantage to cover telehealth. For more on EIRMC’s efforts, click here.

  • The CAH Coalition is actively working with Congress and federal agencies to support the needs of Critical Access Hospitals, including payment for telemedicine, as they work across rural America, click here.

Amazon Introduces Line of Over-the-Counter Drug Health Products

Back in August, Amazon quietly started an exclusive line of over-the-counter health products produced by private-label manufacturer Perrigo. Business analysts state that this is seen as a possible challenge to pharmacy retail chains that could spark a price war and put pressure on store-brand profit margins. The e-commerce giant launched the Basic Care line over the summer which includes 60 products ranging from ibuprofen to hair regrowth treatment — adding yet another reason for customers to skip retail stores. Click here for more from CNBC.

Is the #MeToo in Medicine Coming?

A recent investigation by NBC News’ Elizabeth Chuck looks at sexual harassment in health care professions, particularly in hospitals and operating rooms. The article digs into the “male dominated culture of medicine” by interviewing female clinicians who have endured decades of overlooked intimidation. “Sexual harassment against women in medicine has been studied for decades: A 1995 study found 52 percent of all women in academic medicine said they had been sexually harassed. But unlike Hollywood and other industries where allegations against powerful men have recently shined a light on inappropriate behavior, medicine has yet to have its #MeToo moment. Nonetheless, women in the field are hopeful that that is about to change.” Click here for the NBC News article.

At Least 97 Kids Die From Flu This Season: CDC A total of 97 pediatric deaths have been attributed to the flu this season, according to the latest data from the CDC.  The incidence level appears to be waning a bit, but hospitalizations are still high.  Click here for the latest CDC update.  Click here for the national flu map.  Click here for a good Washington Post update.

  • The Advisory Committee on Immunization Practices (ACIP) of the CDC has voted in favor of a renewed recommendation for the use of AstraZeneca’s FluMist Quadrivalent, the only needle-free flu vaccine on the market. The nasal spray vaccine has been off the U.S. market for two years because it barely worked against one common strain of flu in kids.  For more from the manufacturer, click here.

Clinicians Who Treat Kids with Brain Injuries Should Coordinate, Need More Training: CDC

According to a report to Congress from the CDC, health care providers that treat children who experience traumatic brain injuries would benefit from more training and better coordination across the health care delivery system. The report states that TBIs in children is a “significant public health burden” in the U.S. and its effects can be “chronic and disabling,” but there is little information on its scope. The CDC is currently drafting evidence-based clinical guidelines on the diagnosis and management of TBIs including calls for more training in medical school and nursing programs as well as formal systems to monitor over time the health of a child who experiences a TBI. To read the CDC report, click here.

Cleaning Products’ Impact on Health ‘As Bad as Smoking’ in a Norwegian Study A study conducted by Norwegian researchers tracked 6,000 people, who used cleaning products regularly over two decades. Researchers measured the lung function by testing the amount of air breathed out by the participant and conducted a questionnaire on the frequency of cleaning products used. The results analyzed a decreased lung function and increased rates of asthma in women, especially those who worked as cleaners. The decreased air amount was equivalent over the period to those with a 20-cigarette daily smoking habit. Click here for full report

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