05 Feb February 5, 2018

February 5, 2018

Government Runs Out of Money Friday; More CHIP, Extenders, Health Centers May Be in New Deal

The House has announced that they in intend to vote on the next Continuing Resolution before the end of this week, with an intent to keep the government funded through March 22.  Key Committee staff say extending CHIP for a full 10 years (it was already extended for six additional years) would save the government several billion dollars – enough to pay for the Medicare extenders and health centers.  If the health centers aren’t funded, there could be considerable disruption to their operations (click here.) It is likely that a new draft of this plan could be revealed as early as Monday, February 5. To view the House Ways and Means Medicare Extenders plan from November 2017, click here.

CDC:  Flu Season Worst on Record; Hospitalizations at New High

The country’s flu season is getting worse and, according to acting Director of the CDC, is on track to be the worst season for flu hospitalizations since 2010. The CDC said that more people are currently hospitalized with the flu than at the height of the 2014-2015 season, the most severe since the agency began tracking that statistic and positive rapid tests in 2010. The CDC counted 16 additional flu-related deaths in children just over the last week, bringing this season’s total to 53. The CDC continues to recommend the flu vaccine, despite its questionable effectiveness against the H3N2 virus, which is causing the most problems this year. Click here for the latest CDC national map.  Click here for Friday’s conference call transcript with the CDC Director.  Click here for a very good Q&A with charts about why hospitalizations are so high.

• Pharmacy benefit managers are underpaying drug stores for the popular flu medication Tamiflu or its generic equivalent by as much as $60 or $70 a prescription during the worst flu seasons in recent memory, a National Community Pharmacists Association survey found. Click here for details.

CMS Proposes Significant Medicare Advantage Rate Increase; Plan Limits Opioid Prescriptions

CMS on Friday announced a 1.8 percent increase in Medicare Advantage payments next fiscal year. According to one independent analysis, plans would get about a 4.94 percent increase in revenues once patients’ medical conditions are taken into account. CMS also proposes to increase the percentage of ‘encounter data’ that they use to set rates to 25 percent, up from 15 percent this year and give the option to offer non-medical benefits such as portable wheelchair ramps. Additionally, CMS is proposing to complete in 2019 the transition to administratively-set rates for Retiree Plans that was originally scheduled to be completed in 2018. CMS states that they propose to include new measures and changes in existing measure specifications for the Star Rating System.  Click here for the Advance Notice, and here for the CMS fact sheet.  Click here for the NYTimes report.

• Under this MA Part D proposal, patients would have to consult their doctor and get approval from their drug plan if a new prescription puts them above recommended cumulative dose levels for morphine-like painkillers. Pharmacists could still dispense a 7-day supply of medication. Click here for details.

Medicare May Pay for More Telehealth This Year

The ability to reduce costs by using telehealth services is driving the effort to get Medicare to pay for a variety of new telehealth services, something that could happen as early as this year.  One analyst says a telehealth visit costs about a third of a trip to an urgent care center and tens times less than an ED visit.  There are several key bills that could break the Medicare spending log jam if passed later this year.  Click here for the report.

GAO Report Questions Value of Assisted Living Facilities

Federal investigators say they have found huge gaps in the regulation of assisted living facilities, a shortfall that they say has potentially jeopardized the care of hundreds of thousands of people served by the booming industry, according to a new New York Times report. The federal government lacks even basic information about the quality of assisted living services provided to low-income people on Medicaid, the Government Accountability Office, a nonpartisan investigative arm of Congress, says in a report to be issued this week. Click here.

HHS Indiana’s State Medicaid Waiver with Work Requirements

HHS on Friday announced that it has approved Indiana’s Medicaid waiver that includes work requirements for adults on Medicaid, making it the second state in the country to do so. Under a multifaceted 1115 waiver, able-bodied adults in Indiana’s Medicaid program will be required to work at least 20 hours a week or be enrolled in a qualifying job-training or educational program. It states that beneficiaries who do not meet the work requirement will lose coverage. Kentucky became the first state to gain federal approval for work requirements three weeks ago. Indiana plans to implement the requirements starting in 2019. Click here for the waiver acceptance letter.

• About 25,000 adults were dropped from Indiana’s Medicaid rolls for failing to make monthly payments between 2015 and October 2017. The requirement, which was approved by the Obama administration as part of a deal to expand Medicaid eligibility in the state, mandates that enrollees make monthly contributions between $1 and $27 to health savings accounts. Click here for more.

MACPAC Recommends Letting States Force Medicaid Beneficiaries into Managed Care After originally postponing the vote in December, the Medicaid and CHIP Payment and Access Commission voted last week to recommend letting states force all Medicaid beneficiaries into Medicaid managed care programs without getting a waiver from CMS with two commissioners abstaining due to concerns about how doing so would affect the most vulnerable beneficiaries. Advocates concerned with the policy say that states should not be allowed to force managed care on beneficiaries with the most complex needs because restrictions on provider networks and services are more likely to harm them than other Medicaid populations. The recommendation would let states use state plan amendments to force beneficiaries into managed care plans without having to pass the cost-effectiveness test in waivers. To read more from the MACPAC meeting, click here.

CMS’ Innovation Center Analysis Questions Value

According to a new analysis of the $1 billion Center for Medicare and Medicaid Innovation initiative at CMS, the programs failed to produce significant net savings, although did lead to some positive results. The study shows that some of the initial Health Care Innovations Awards saved anywhere from $19 to $160 per patient per quarter, while others were linked to increased spending. Awards went to 108 providers nationwide to carry out “compelling new ideas” to lower costs and improve care. Many awardees suggested that their biggest challenge was getting reimbursement for non-traditional staff and services after CMS funding ended. Click here for the full RTI report, and here for the CMMI website.

National Quality Forum Submits Quality Measure Recommendations to HHS

A National Quality Forum work group last week submitted recommendations to HHS on 35 quality measures.  The Measure Applications Partnership (MAP) offers advice to the federal government on quality measures every year, recommendations that are often adopted.  All in all, MAP supported six measures and conditionally supported 25 measures (a designation most commonly made to note support of a measure pending NQF endorsement).  For more from NQF on the recommendations, click here.

• NQF is currently reviewing eight new measures under the Merit-based Incentive Payment System that track cost data for procedures and medical conditions including percutaneous coronary intervention, knee arthroplasty, cataract removal, lower limb revascularization, colonoscopy, intracranial hemorrhage and pneumonia; click here.

Overdoses on Campuses See Dramatic Rise; Colleges Stocking Up on Narcan

As the number of incidents among young adults keeps rising, colleges are increasingly stocking up on an easy-to-use opioid overdose antidote narcan. Opioids killed nearly 4,000 Americans ages 15 to 24 in 2016, nearly one-third more than the year before, according to a survey commissioned by the Hazelden Betty Ford Institute for Recovery Advocacy and The Christie Foundation. A concerning statistic also found that while over 30 percent of college students said they knew someone who had overdosed on pain pills or heroin, over 37 percent reported that they would not know what to do if they were present when someone overdosed. For more on the survey, click here.

• Leaders of the Senate Finance Committee sent a letter to health industry groups requesting input on potential policy changes to Medicare and Medicaid as part of efforts to address the opioid crisis, click here.

Non-Emergent Medicaid Transportation Program Under Pressure

That’s according to a recent Kaiser report that many states that use non-emergency medical transportation, or NEMT, worry that in the new Medicaid managed care era that it may no longer be funded. NEMT, created in 1966 along with Medicaid, is vital to many families, especially those with members with severe disabilities, to get to an from medical treatment. The program, that annually costs nearly $3 billion, may see cuts in the coming years due to the push to decrease funding and reports stating that it is rife with fraud and abuse. Click here for more.

State Insurance Exchanges See Unexpectedly Strong Enrollment Open enrollment on the state insurance exchanges officially concluded last week on Wednesday, January 31st, and preliminary numbers show sign-ups are keeping pace with last year. The relative success has surprised many who expected a significant drop-off following the Trump Administration’s decision to cut the enrollment period by half one year ahead of schedule while simultaneously cutting outreach. While Republicans have largely moved on from repeal, consumer groups are maintaining pressure headed into the elections. More than 300 groups signed onto a Jan. 25 letter asking Congress to protect the exchanges, Medicare and Medicaid. Click here for the survey from the Kaiser Family Foundation, and here for the letter from the consumer groups.

2017 Saw the Most Hospital Mergers: Report

Hospitals announced a total of 115 merger transactions in 2017, according to a report from Kaufman Hall, the most since the group began monitoring hospital M&A in 2000. Many of those deals included big price tags—11 deals in 2017 involved sellers with net revenues of $1 billion or more.  The total number of deals represents close to a 13% increase from 2016.  As the healthcare industry evolves, it’s becoming more and more imperative for hospitals to build scale and grow their organizational reach, according to the report. Click here for the report.

State-By-State Breakdown of 83 Rural Hospital Closures Of the 26 states that have seen at least one rural hospital close since 2010, those with the most closures are located in the South, according to research from the North Carolina Rural Health Research Program. 14 hospitals in Texas have closed since 2010, the most of any state. Tennessee has seen the second-most closures, with eight hospitals closing since 2010, followed by Georgia with six closures, then Alabama, Mississippi and North Carolina, which have each seen five hospitals close over the past eight years. Click here for the research.

Congress Weighs Pharmacy Rules Five Years After Deadly Outbreak A House Subcommittee is investigating whether pharmacy regulations enacted after a 2012 meningitis outbreak that killed 60 people have been too onerous and are preventing patients from accessing certain drugs. Last week, the House Energy and Commerce Health Subcommittee heard from FDA Commissioner Scott Gottlieb about the agency’s oversight of compounding pharmacies. Compounding pharmacies take drug ingredients and and mix them in strengths, dosages and forms specific to individual patients. Prior to the 2012 outbreak, the FDA left regulation of compounding pharmacies to states. But in 2013, Congress passed legislation requiring new regulations for some compounders. Click here to view the hearing and read the written testimony.

CMS Cancels Innovation Center’s Direct Decision Support Model

The Trump administration has announced it canceled a CMS Innovation Center program that sought to help sick participants make decisions about their care. The Direct Decision Support Model was to enlist the help of outside organizations to provide health management and decision support services to as many as 700,000 seniors with seven specific conditions, including arthritis, prostate cancer and heart disease. The program accepted applications last year but was never formally launched. Click here for more from CMS.

CDC: More Women Giving Birth in Early 30s

Women between the ages of 30 and 34 had a higher birth rate than women age 25 to 29 for the first time since reliable national records have been available, according to CDC’s final data for 2016. The birth rate for women in their early 30s was 102.7 births per 1,000 women in 2016, the highest rate the group has seen since the 1960s and the highest rate for any age group in 2016. For women between 25 and 29, the birth rate was 102.1 births per 1,000 women, a two percent drop from 2015. The overall number of overall births also declined slightly.  Click here for more from the CDC.

Omega-3 Supplements Don’t Protect Against Heart Disease

Supplements containing omega-3 fatty acids, the oils abundant in fatty fish, are ineffective for the prevention of heart disease, a large review of randomized trials has found.No matter how the researchers looked at the data, they could find no association of the supplements with lowered risk for death from heart disease, or with nonfatal heart attacks or other major cardiovascular events. Click here for more.

NIH: Music is Good for YOU!

According to the National Institutes of Health, playing an instrument or listening to tunes can boost your health. NIH’s music and health initiative has found that music is good for the brain and nervous system as well as overall health. There’s evidence that music may be helpful for people with health conditions, including Parkinson’s disease, Alzheimer’s disease, dementia, traumatic brain injury, stroke, aphasia, autism, and hearing loss. Click here for more.