January 6, 2020

January 6, 2020 – Happy New Year!

Over 300 Drugs Saw Price Hikes January 1
More than 330 drugs had their prices raised on Jan. 1, 2020, with more expected to rise over the course of the month, according to healthcare research firm 3 Axis Advisors. Most of the price increases were below 10 percent, with the median price increase around 5 percent, from just about every major drug manufacturer. The only notable companies not to increase their drugs were Allergan and Novartis that did increases in late 2019. House Speaker Nancy Pelosi (D-CA) was quick to jump on the issue with a tweet saying “Enough is enough…” and calling for the Senate to follow the House and pass a drug pricing bill. Click here and here for more on the increases, and here for Pelosi’s full tweet.

  • The New York Times investigates crisis facing the development of new antibiotics as financial outlook for the products is dim, click here.

FDA Finalizes Crackdown on Flavored E-Cigarettes with Limited Ban
The Food and Drug Administration last week released a final guidance document to attempt to crackdown on the sale of flavored e-cigarettes, specifically to adolescents and children. The finalized document was a scaled back, limited ban that will bar the sale of all sweet and fruity flavored vape pods and cartridges within 30 days, but allow gas stations and convenience stores to continue selling menthol flavors. Additionally, the guidance allows vape shops sell a broad range of e-cigarette liquids in so-called open-tank vaping systems, which are more commonly used by adults. The plan gives relief to free-market advocates and small vape shops and makers who complained that a sweeping flavor ban would close businesses; however, public health groups quickly slammed the guidance saying it was a “green light” for the industry to continue to target kids. Click here for the FDA summary, and here for the guidance document.

CMS Gives Insurers Extra Time to Respond to Price Transparency Rules
CMS announced on Dec. 27th that they would give the insurance industry an extra 15 days to respond to the proposed rules that would require insurance plans to disclose the rates they have negotiated with providers in their networks, as well as the amounts they will allow for out-of-network care. CMS states that the extension to Jan. 29th is “in response to public feedback and in consideration of the holiday season.” The 15-day extension is significantly lower than the three extra months that the industry had requested in immediate responses. Click here for the extension announcement and here for the CMS fact sheet on the rule.

  • A nurse and a doctor team up to suggest working together to tackle the “paperwork” problem in health care in an opinion piece in NYT, click here.
  • A glitch was discovered on Dec. 4th that allowed data, including demographic and treatment information, to flow to the wrong app or wrong beneficiaries through Blue Button 2.0, an application programming interface (API) that contains four years of Medicare Part A, B and D data for 53 million Medicare beneficiaries.  It is now corrected, click here.

Court Upholds ACA Risk Adjustment Program, Reverses Lower Court Decision
The 10th Circuit Court of Appeals reversed a lower Court decision last week and upheld the Affordable Care Act’s stabilization program known as risk adjustment that requires insurers to transfer money to plans with sicker enrollees. In an unanimous decision, the Court sided against New Mexico Health Connections, which contended that the government was “arbitrary and capricious” when it established the transfer formula that has used average statewide premiums to calculate the amount of money plans with healthier enrollees need to pay to other insurers, rather than looking at the premiums of individual plans. “The administrative record is replete with reasoned explanations for why HHS chose to use the statewide average premium in its formula,” Judge Scott Milne Matheson Jr. wrote in the opinion, also noting that none of the insurers objected to the formula when it was first proposed. To read the full opinion, click here.

Flu Cases Jump to 4.6 Million; Deaths Increase to 2,100
The flu season surges on with a vengeance. Over 39,000 hospitalizations have now been reported with widespread flu in 39 states, a 6.6 percent hospitalization rate. Of those states, 25 have high levels of flu reported. For the latest from the CDC, click here.

Health Systems Engage To Stop Human Trafficking
Trafficking occurs when someone exploits someone else sexually or makes them perform labor against their will. There’s a growing push among doctors, paramedics and other health-care professionals to help end trafficking. Organizations such as HEAL Trafficking, a group of survivors and professionals in 35 countries, are teaching health care systems to identify potential victims and respond to their needs. Click here for details.

CMS Convening Expert Technical Panels, Calls for Nominations
Shortly after the new year, CMS announced that the agency will be convening two technical expert panels – one to develop a days at home quality measure and one to develop a quality measure assessing delay in progression of chronic kidney disease (CKD). Both are expected to meet at least  through the end of this fiscal year. The agency is seeking nominations of people with the perspectives of healthcare providers, quality improvement professionals, performance measurement experts, purchasers, consumers, and patients. The deadline for nominations is Jan. 9th for the home quality measure and Jan. 13th for the CKD quality measure. Click here for information on how to be nominated.

Providers Raise Concerns Over Proposed Stark Law Changes
HHS is working on a major Stark Law overhaul and public comments closed on Dec 31. The general tone of the comments is one of worry. “Most clinicians are not looking to defraud the federal government; therefore, more paperwork requirements are not going to decrease the risk of harm,” the AMA said in comments to the rule. “This additional layering of more burden will lead to further physician burnout and potentially decrease desire in participation in value-based arrangements.” The American Hospital Association wants CMS to give more clarity on any monitoring requirements in the final regulation. The Federation of American Hospitals also wants CMS to adopt a waiver for any CMS-sponsored value-based care models to be exempt from the new requirements. For an overview of concerns about the change, click here. For Publicly Submitted comments to CMS click here.

Indian Health Service Struggling 
The Wall Street Journal takes a look into the chronically underfunded, overutilized Indian Health Service and makes recommendations on how to change spending practices and increase service utilization amidst a non-confrontational culture that can lead to the deferral of issues. Click here for more.

SDoH Adoption Aided by the Office of the National Coordinator
Since the release of ONC’s 2015 Certification Edition, 72 health IT developers have voluntarily certified 93 unique products to an SDOH-oriented certification criterion, according to the Office of the National Coordinator for Health IT. The agency works to create ways to capture and access SDoH data and include data elements like overall financial resource strain, social connection and isolation, and exposure to violence. To read more from ONC, click here.

  • One of the leading health system CEO voices on SDoH issues penned an op-ed calling for a national commission to outline a new health care delivery model for the country that includes SDoH solutions.  Click here.
  • The Department of Agriculture recently finished work on a new rule (click here) that may take food stamps away from nearly 700,000 Americans by tightening work requirements. Several times in the past year, the government has proposed cutting food stamp eligibility. The new rule is intended to save almost $8 billion over five years.

CMS to Hold a Webinar on the Direct Contracting Model Application
On Jan. 7th, CMS’ Center for Medicare and Medicaid Innovation will host a webinar to provide an overview of the Direct Contracting Model Application from 1:00-2:30 EST. The online session will provide an overview of the program and demonstrate the application portal for potential applicants. Providers will also answer questions from the live audience. To register for the webinar, click here and for more on the direct contract in general, click here.

New Study Claims Google Artificial Intelligence Outperforms Radiologists 
In a study published this year, a Google AI went head to head with radiologists to diagnose breast cancer. The study revealed that both the radiologists and the AI performed within UK practice benchmarks, but the Google AI did ultimately preform more accurately and more consistently than the human radiologists. To read the full study, click here.

Number of Children Ingesting Magnets More than Quadruples 
The dangers of magnets from popular desk toys for adults finds victims in children, according to almost 1600 reported cases to Poison Control in 2019. Despite warnings that these items are meant for adults and not for use by children, many children are ingesting these magnets and requiring emergency surgery as a result, to read more from the Washington Post click here.

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