29 Jan January 29, 2018

250 Hospitals Receive Healthgrades’ Top Clinical Excellence Awards

Healthgrades has released its Distinguished Hospitals for Clinical Excellence awards for hospitals rated in the top 5% in the nation with the lowest risk-adjusted mortality and complication rates across at least 21 of 32 common conditions and procedures. Healthgrades says patients treated in these hospitals have, on average, a lower risk of dying than if they were treated in hospitals that did not receive the designation. Click here for a state-by-state list of awardees.

Flu Season Worst in 10-15 Years

This year’s flu season is on track to be the worst in more than a decade, according to government data, and the season is not yet over.  Click here to see the last CDC map.  Click here for the Washington Post story.  Click here for the complete CDC flu webpage.

Alex Azar: New HHS Secretary

The Senate last week confirmed Alex Azar as the new Secretary of Health and Human Services. Azar was easily to confirmation  in a 55-43 vote, with six Senate Democrats and Independent Angus King joining nearly all Republicans voting in favor. Azar, a former pharmaceutical executive and twice-confirmed veteran of George W. Bush’s HHS, earned bipartisan respect in recent weeks for his familiarity with the enormous agency and a stated desire to reinvigorate relations with lawmakers on both sides of the aisle.  For more on Azar from the New York Times, click here, or for a different perspective from the Washington Times, click here.

Study Says 340B Pushes Hospital-Physician Mergers; Senator Wants Program Moved to CMS

According to a government-funded study published in the New England Journal of Medicine, the 340B drug discount program is likely to encourage hospitals to buy independent cancer practices, and other drug-intensive specialties. The authors state that cancer doctors were 230 percent more likely and ophthalmologists 900 percent more likely to work for 340B-eligible hospital systems.  Click here for the study.  Researchers also couldn’t find evidence that savings hospitals derive from the 340B program were invested in safety-net providers or to expand care for low-income patients, “contrary to the goals of the program,” they wrote. They further say that if policymakers want to use 340B to help expand care for the under-served, it “may be ineffective if they rely on indirect mechanisms with weak incentives.”  The study was strongly disputed by all the trade associations that support 340B.  Click here for the 340B Health response.

• Senate Finance Committee Chairman Orrin Hatch sent a letter to HHS Secretary saying the agency should consider moving the 340B program under the authority of CMS to improve oversight. The expansion of 340B under the ACA has exceeded HRSA’s ability to oversee program integrity, Hatch wrote. Click here for the letter.

Health Taxes Repeal Cost Taxpayers $31 Billion The repeal of certain health care taxes in the stopgap funding deal passed last week after the government shutdown will cost the federal government $31 billion, according to a new report from the Joint Taxation Committee. The spending law (HR 195), which funded the government through Feb. 8 and reauthorized the Children’s Health Insurance Program for six years, also delayed a myriad of unpopular taxes enacted by the Affordable Care Act. The measure delayed the so-called Cadillac tax, a fee on high-cost employer health insurance plans, by an additional two years until 2022, and  the medical device tax for an additional two years until 2020, as well as provide a one-year moratorium on the annual excise tax imposed on health insurers for calendar year 2019. For the full analysis from the JTC, click here.

Kentucky Sued Over Medicaid Work Rules Consumer advocacy groups last week filed a class action lawsuit to stop the state Kentucky from becoming the first state in the nation to institute Medicaid work requirements. The lawsuit alleges the Trump administration did not have the legal authority to approve work requirements, premiums, lockout penalties and other elements of Kentucky’s sweeping plan to transform its Medicaid program and that these new rules could potentially jeopardize access to health coverage for tens of thousands of low-income adults. Click here to read the lawsuit.

• Other states are considering adopting similar programs.  Click here for a Pew review.

High Disenrollment Rates and Costs in Medicaid Expansion States: Study

Across plans and states, the Medicaid expansion population experienced high disenrollment rates, indicating that, as in other Medicaid eligibility groups, there is substantial churn in this population, according to a new report from Avalere. Even after adjusting for age and gender, claims costs increased steadily over time, suggesting that expansion enrollees have complex and/or chronic conditions. Click here for the report.

• A number of GOP dominated states may move to expand their Medicaid programs, according to some analysts.  Click here.

States Leading on ACA Reforms

A handful of Democratic-led states are gearing up to curb further health care premium rate hikes by enacting laws and adopting insurance regulations designed to shore up the traditional insurance industry and restore parts of the ACA, known as Obamacare. At the same time, at least one Republican-leaning state has moved to further unravel the federal health law by encouraging insurance companies to offer cheap policies with fewer benefits. Others are expected to follow.  Click here for the report.

Americans Confused Over Insurance Mandate Repeal: Kaiser Poll Nearly half the public is unaware that the requirement for most Americans to have health insurance coverage has been repealed, according to a new poll. 46 percent said Congress had not passed a law to repeal the individual mandate, while 36 percent said they had, and another 18 percent weren’t sure. Lawmakers effectively repealed the requirement as part of the GOP tax overhaul legislation that became law late last year. While the mandate is still technically in law, the penalty for not having coverage is now $0. The change does not take effect until 2019, meaning the 2020 tax filing season would be the first time that taxpayers would not face a penalty for going without coverage. To read the full results from the KFF poll, click here.

• A new GAO report finds that roughly one percent of those enrolled in ACA plans were fraudulent, including dead people, click here.

Price Increases, Not Care Needs, Driving Cost of Health Care

A new analysis by the Health Care Cost Institute of private health plans found that the increasing prices for many health care services and prescription drug costs are driving up spending in the sector between 2012 and 2016. The cost of prescription drugs increased by 25 percent while their use grew a modest 1.8 percent. Additionally, emergency department prices grew by 30 percent while visits increased just 2 percent, the report found. Overall, total spending per person is now growing at faster rates than prior years, with 4.6% growth in 2016 compared to. 4.1% growth in 2015, which followed 2 years of sub-3% growth from 2012 to 2014. Click here to see the full analysis.

Senators Push CMS on Giving Pharmacy Discounts to Patients

A CMS proposal to require that pharmacy discounts on drugs be passed on to Medicare recipients, not insurers or pharmacy benefits managers, got a boost from a bipartisan group of senators last week. 21 senators led by West Virginia Republican Shelley Moore Capito and Montana Democrat Jon Tester sent a letter to the agency endorsing the idea requiring such pricing concessions to be passed through to consumers.  CMS has estimated the idea would save beneficiaries $10.4 billion over 10 years. CMS sought feedback on the proposal in a November rule for 2019 Medicare outpatient prescription drug benefits.  Click here to read the letter.

Google’s Predictive Analytics Focuses on Hospital Outcomes

Some of Google’s top researchers are trying to predict your medical outcome as soon as you’re admitted to the hospital.

A new research paper, published last week with 34 co-authors and not peer-reviewed, claims better accuracy than existing software at predicting outcomes like whether a patient will die in the hospital, be discharged and readmitted, and their final diagnosis. To conduct the study, Google obtained de-identified data of 216,221 adults, with more than 46 billion data points between them. Click here for details.

• Electronic health records may not be able to accurately determine case mix, according to a study published January 18 in the American Journal of Managed Care. Click here.
• Fairview Health Services CEO James Hereford called Epic Systems Corp. an “impediment to innovation” and said there is an opportunity for health care executives to exert more influence over the Wisconsin-based electronic-medical-records giant. Click here.

Fentanyl Report Prompts Calls for Stricter Mail Screening Senators last week called for tougher screening of international mail shipments to prevent overseas drug manufacturers from sending deadly narcotics to patients in the United States. Members of the Senate Homeland Security and Governmental Affairs Permanent Subcommittee on Investigations discussed the results of a recently released report released that showed how easy it is to purchase the powerful opioid fentanyl online. The U.S. Postal Service, Customs and Border Protection, Drug Enforcement Administration and other agencies try to screen packages for illegal contents but, with nearly 500 million international packages coming to the U.S. each year, it’s nearly impossible for them to catch all illegal shipments. Click here for the report on fentanyl mailing shipments, and here to view the hearing and read the testimony.

• The DEA published a rule last week that will allow nurse practitioners and physician assistants to have the authority to prescribe and dispense detox treatments as part of the Comprehensive Addiction and Recovery Act (CARA), click here.
• House Committee on Oversight and Government Reform Chairman Trey Gowdy sent a letter to the Office on National Drug Control Policy requesting information efforts to implement recommendations from the president’s opioids commission, click here.
• The FDA and FTC have sent joint warning letters to the marketers and distributors of 12 unapproved opioid cessation products.  The agencies say the products were illegally marketed with claims that they were effective treatments for opioid addiction and withdrawal, click here.

CMS Chronic Care Management Code Saves Money

CMS’ Chronic Care Management (CCM) payments to doctors that go towards helping patients outside of traditional office visits saved an average of $74 per patient per month in the first 18 months that it was available to clinicians, according to an analysis released last week by the CMS Innovation Center. CMS began offering the CCM code in January 2015 to pay for non-face-to-face care like telephone check-ins and general care management with the goal of improving Medicare beneficiaries’ access to chronic care management in primary care. Over 684,000 beneficiaries received CCM services during the first two years of the payment policy. To read the full report, click here.

Rural Hospital Closures Disproportionately Harm Seniors Older adults living in rural areas are particularly hurt by the closing of rural hospitals in their home communities. Seniors in rural areas are less likely to receive all of the medical attention they need following a rural hospital’s closure, and the lack of access to transportation or family caregivers exacerbates their difficulty accessing care. Each hospital closure leads to an average of 150 jobs lost, and hospital closures are expected to increase with the financial difficulties rural hospitals are facing. Click here for more.

• The CAH Coalition is advocating for increased government support. Click here to learn more.

Adult Smokers May Get Help Quitting from E-Cigarettes

A new Congressionally-mandated report by the National Academies of Science found that e-cigarettes are much less harmful than conventional cigarettes and could help adult smokers quit. However, researchers state that substantial evidence still shows that young people who use e-cigarettes are at higher risk of taking up conventional cigarettes. The report found e-cigarettes contained lower levels of toxic substances than conventional cigarettes. It noted there was not sufficient evidence to definitively say e-cigarettes could cause cancer and recommended more research on short- and long-term health effects and their relationship with conventional smoking. Click here for the overview of the report.

Birth Defects Linked to Zika on the Rise from Local Transmission

Zika-related birth defects have increased significantly in areas where the virus has been transmitted locally, including Florida, Texas and Puerto Rico, according to the CDC. The new report details a 21 percent increase in Zika-linked medical conditions in areas with local transmission in the second half of 2016, compared to the first half of the year. The researchers said the spike of new cases involved birth defects like deafness, eye problems, and joint issues. The report further stated that many of the mothers who had babies with Zika-linked birth defects had not been tested for Zika early enough and in some case not at all. To read the full report, click here.

‘Tide Pod Challenge’ Craze Poisoning More Youth

As the Tide Pod Challenge that shows kids biting into brightly colored liquid laundry detergent packets posted to social media continues to sweep the internet, the detergent brand’s social media team is tackling the issue. Tide released a public service announcement about the “Tide pod challenge” on social media, featuring the New England Patriots’ Rob Gronkowski discouraging people from playing around the laundry detergent packets. The American Association of Poison Control Centers warned of a spike in teenagers eating the laundry product, which it says can cause seizures, respiratory arrest and even death. Poison control centers said they handled 39 cases of intentional misuse among 13- to 19-year-olds in the first 15 days of the year, compared to about 50 for all of last year. Click here to view the PSA.