February 4, 2019

Hospital-Acquired Conditions Down Significantly
Good news for hospitals and their patients, according to the latest Agency for Healthcare Research and Quality’s National Scorecard on Hospital-Acquired Conditions, HACs have dropped by about 13-percent over a three-year period. HACs include infections, adverse drug reactions, and similar unintended side effects. Of particular note in the study is the 28-percent reduction in drug-related adverse events.  The data shows that 86 out of every 1,000 hospitalzations in 2017 resulted in hospital-acquired conditions down from 99 out of 1,000 in 2014 and 145 out of 1,000 in 2010. AHRQ states that this reduction helped prevent more than 20,000 deaths and saved roughly $7.7 billion. To view the results, click here.

HHS Proposes Rule to Overhaul Drug Rebate Program
HHS and the Office of Inspector General jointly proposed ending federal protections for drug manufacturer rebates to pharmacy benefit managers and health plans in an effort to encourage upfront patient discounts and flat service fees for the companies. The proposed rule would alter the anti-kickback statute by ending the safe harbor protection for rebates on prescription drugs paid by manufacturers to PBMs, Part D plans, and Medicaid managed care organizations and create a new safe harbor protecting discounts offered to patients at the pharmacy counter. While HHS contends this will lower prices for consumers, some have voiced concerns that health plans would raise premiums in response to lost rebate profits. Click here for the fact sheet and here for the proposed rule. Click here for the Wall Street Journal report.

CMS Administrator Outlines Next Steps for Value-Based Care
In a speech at the CMS Quality Conference last week, CMS Administrator Seema Verma told the group that the agency will focus on empowering patients, better results, and increasing innovation through value-based care and to expect a lot out of CMMI. Verma stated that CMS is, “prioritizing a well-informed, empowered consumer rather than a government agency to make our health care decisions.” She also acknowledged the transition to value-based care “has been slow,” as just 14-percent of Medicare providers are in such arrangements however, CMS has spent the last year developing new models and ways to boost provider participation. To view the full speech, click here.

CMS Proposes Small MA Payment Increase for 2020 and New Non-Medical and Benefits
CMS proposes to increase payments to Medicare Advantage plans 1.59% in 2020, according to its Part II of the 2020 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part D Payment Policies, and Draft Call Letter. (CMS released Part I of the Advance Notice on December 20, 2018.)  Part of this proposal are changes from the Bipartisan Budget Act of 2018 to allow MA plans, beginning CY2020, to offer non-medical supplemental benefits to chronically ill enrollees. These include many benefits related to the social determinants of health such as transportation and food delivery.  Part II also includes additional policies to help plans prevent and combat prescription opioid overuse. CMS will accept comments on all proposals in Part I and Part II through Friday, March 1, 2019, before publishing the final Rate Announcement and Call Letter by April 1, 2019.  Click here for the CMS Fact Sheet, here for Part I proposal, and here for Part II proposal.  Click here for a brief Healthcare Finance news summary.

  • The Center for Medicare Advocacy and the Medicare Rights Center sent a letter late last year (click here) to CMS Administrator Seema Verma raising concerns that the agency was providing inaccurate and incomplete information to beneficiaries in order to steer them to MA plans.
  • From 2010 to 2015, the rate of opioid-related hospital stays increased between 27 and 39 percent among patients age 65 and older, depending on the age group. Non–opioid-related hospital stays decreased 17 percent for patients age 65 and older during the same period. Click here for details from AHRQ.
  • CMS says it is commited to helping seniors reduce poverty.  Click here for the agency’s review of this issue.

Emergency Docs Offer Plans to Combat Surprise Billing
Seeing most surprise bills as a result of an emergency room visit, the American College of Emergency Physicians last week offered suggestions to combat medical surprise billing. ACEP changes would occur mostly for the insurance industry, including undoing balance billing, when a provider bills the patient for out-of-network care; requiring insurers to be more clear about what is covered in a health plan; and creating a simpler process for patients to follow up on billing.  They also suggest creating Commission on Access to Quality and Affordable Emergency Care to report to Congress on offer long-term solutions. To read the proposal, click here.

House Panel Looking for Answers on Insulin Prices
House Energy and Commerce Chairman Frank Pallone (D-NJ) and Oversight Subcommittee Chairwoman Diana DeGette (D-CO) sent a letters to to Eli Lilly, Novo Nordisk, and Sanofi, insulin manufacturers, seeking information about their net profits from insulin products as well as explanations for the significant increases in the price of the diabetic drug. They would like the “company’s assistance in understanding the root cause of rising insulin prices and the obstacles to providing more affordable medication.” To read the letter, click here.

The ACA Was Great for California Hospitals’ Profits
A new report released by the National Bureau of Economic Research shows that California hospitals increased revenue and profitability under the Affordable Care Act, mostly due to Medicaid expansion. On average, from 2014 to 2016 hospitals grew their annual Medicaid revenue by about $55,000  per bed, up 27% over pre-ACA levels, or an additional $4.1 billion in Medicaid payments to hospitals in the state annually. For private hospitals, the average revenue went up by about $90,000 per bed, or 9%, and government hospitals, which served the bulk of indigent patients before the ACA and Medicaid expansion, increased revenue by about $200,000 more per bed, or about 25%. To read the report, click here.

When Is a Surgeon Too Old to Operate?
The physician work force, like the rest of the population, has grown substantially grayer in recent years. Almost a quarter of practicing physicians were 65 or older in 2015, according to the American Medical Association. In 2017, more than 122,00 physicians in that age group were engaged in patient care.  Health care researchers and analysts are debating what, if anything, to do about this tide of aging practitioners. Click here for the story from the NYTimes.

Genetic Testing for Medical Conditions Debated as 23andMe Get FDA OK
23andMe has said that its health tests can raise awareness about various medical conditions and empower consumers to take charge of their health information. But doctors and geneticists say that the tests are still more parlor trick than medicine. Last month, the DNA-testing company 23andMe secured Food and Drug Administration approval for a new screening for gene-based health risks. Along with celiac disease, Alzheimer’s, Parkinson’s, breast cancer and several other medical conditions, the company can now screen clients for two mutations that have been linked to colorectal cancer. But “F.D.A.-approved” does not necessarily mean “clinically useful.” 23andMe relies on much simpler technology than tests that you’d get at your doctor’s office. Click here for the detailed NYTimes editorial.

Worst Measles Outbreak in Decades
That’s according to the CDC in New York and Washington states. Over the past four months, there were 200 confirmed cases in New York, the most since 1989, and 37 confirmed case in Washington state, the most since 1996, mostly due to lowered rates of vaccinations for children in both states. There were 349 measles cases in the US in 2018, the second-highest total since measles was declared eliminated in the U.S.  Through Jan. 24, the CDC reported 52 cases in seven states: Washington, Oregon, Connecticut, New York, New Jersey, California and Georgia. Click here for more on the outbreak from the CDC.

White House Office of Drug Policy Releases National Strategy
The President’s Office of National Drug Control Policy has released its annual National Drug Control Strategy offering recommendations focusing primarily on treatment, prevention, and stopping the flow of illegal drugs into the Unites States, very similar to the most recent previous report in 2016. The report was put out shortly after the Drug Czar, Jim Carroll, was sworn into office on Thursday and endorses HHS’ assessment that the CDC’s 2016 prescribing guidelines, which proposes to limit the use of prescription opioids among chronic pain patients in primary care settings and to also expand the policy to treatments for acute and post-surgical pain.  The strategy also emphasizes the importance of working with other countries to disrupt the supply chain and curb internet sales of illicit drugs. To read the report, click here.

Nearly Half of Americans Have Some Form of Cardiovascular Disease
A new study released by the American Heart Association shows that 121.5 million Americans, or about 48.5 percent, was diagnosed with heart or blood vessel disease as of 2016 and deaths from cardiovascular disease rose from more than 836,000 in 2015 to more than 840,000 in 2016. Published in the Association’s journal Circulation, the study did find, however, that there have been significant declines in smoking, a major risk factor for developing heart disease as from 2015 to 2016, 79 percent of adults identified as nonsmokers, up from 73 percent in 1999-2000. To read more on the study, click here.

Trying to Quit Smoking? Go For the E-Cigarettes
That’s according to a British study recently published in the New England Journal of Medicine. E-cigarettes are almost twice as effective at helping smokers quit as nicotine replacement therapies such as lozenges and patches. Researchers at Queen Mary University of London found that 18 percent of the e-cigarette users were smoke-free after a year, compared with 9.9 percent of those in the nicotine-replacement group. The researchers concluded that e-cigarettes were more effective for smoking cessation than nicotine-replacement therapy, when both products were accompanied by behavioral support. Click here for the report.

Fasting Could Boost Metabolism: Study
A recently study suggests that fasting is linked to increasing human metabolic activity, reversing effects of aging, and generating antioxidants. Researchers analyzed whole blood, plasma, and red blood cells of four fasting individuals, found several antioxidants and 44 metabolites to significantly increase within 58 hours of fasting. Some metabolites that decline with age were also found to increase in level, indicating fasting can help increase longevity and offer a rejuvenating effect. The authors suggest that future studies will involve investigating other ways to induce metabolic changes. To read the study, click here.

Former Ohio Medicaid Director Joins Strategic Health Care
Barbara Sears, who led Ohio Medicaid through numerous innovation initiatives, has joined Strategic Health Care as a Partner.  The department was the cornerstone of the Governor’s Office of Health Transformation, which Governor John Kasich created in 2011. In conjunction with the Office of Health Transformation, the Ohio Medicaid team implemented a series of innovative policy initiatives that have modernized the Medicaid program by improving the quality of health services at a substantial value to Ohio’s taxpayers. Sears was also the Assistant Director for the Governor’s Office of Health Transformation. Click here for more about Barbara.

Also joining Strategic Health Care as Vice President of Regulatory Affairs is David Introcaso, Ph.D., who began his career in Washington at DC General Hospital in the mid-1990s.  Since then he has worked at NIH/NINR, at the Agency for Healthcare Research and Quality (AHRQ) as agency’s Evaluation Officer, as a Public Health Analyst in the Assistant Secretary of Planning and Evaluation (ASPE), he served as Health Policy Adviser to House Majority Leader, Rep. Steny Hoyer, and has numerous years of experience working as a consultant for, among others, the American Heart Association, the American Public Health Association, the National Hospice and Palliative Care Organization and for UnitedHealth Group.  David has taught as an adjunct at the University of Chicago and the George Washington University and among other awards was a three-year W. K. Kellogg Foundation National Leadership Fellow (1993-1996).

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