July 23, 2018

Hospitals’ 340B Lawsuit Fails; Congress Considers Action

A federal appeals court has dismissed the hospitals’ lawsuit over CMS cuts to Medicare reimbursement for 340B drugs, restating the lower courts decision that hospitals sued before they had been hurt by the policy. Specifically, the three-judge panel of the United States Court of Appeals for the District of Columbia Circuit upheld the lower court opinion that the Courts did not have jurisdiction to review the lawsuit since the hospitals had failed to pursue the proper appeals process through CMS. The hospital associations expressed disappointment that the court again failed to rule on the merits of the case, and stated that they expect to refile in district court soon while the Administration praised the decision. To read the Appeals Court decision, click here.

  • In a new report, the GAO examines the differences between 340B and non-340B hospitals. Click here.
  • The House Energy & Commerce Committee is reviewing a dozen different 340B proposals and whether to pursue a compromise bill in the fall. The committee reviewed the bills at a July 11 hearing. Click here to see the bills.
Trump Administration Opens the Door To Drug Importation, Keeps Pressure on Pharma
The Trump administration is now open to using prescription drugs imported from overseas — ones that have not been approved by the Food and Drug Administration — to combat high drug prices in limited circumstances. The FDA said it plans to create a working group to examine how to safely import drugs in a specific situation: when there’s a sharp price increase for an off-patent drug produced by a single manufacturer.  Click here for the government’s announcement. Over the past couple of weeks, Pfizer, Novartis, and Merck announced that they would either maintain current prices or actually cut some costs.  And now, HHS’ Inspector General is proposing a rule to remove safe safe harbor protections for drug rebates paid to insurers and pharmacy benefit managers. For more on what the drug companies are doing, click here. To see the safe harbor regulation notice, click here.
  • On Wednesday, the Senate HELP Committee will mark up a bill (S 2554) that would prohibit any insurer offering plans on the exchanges from blocking pharmacists from telling patients if a prescription drug would be more affordable if they paid with cash rather than through their insurance, click here.
House Likely To Pass Health Tax and HSA Reform Bills this Week
The House will vote on three bills this week that will eliminate or delay certain health care taxes and make adjustments to health savings accounts. The bills will allow for a permanent repeal of the medical device tax, a two-year delay of the health insurance tax, a reversal of the ACA’s ban on using tax-preferred accounts for over-the-counter medicine, and tweaks to health savings accounts such as allowing balances to carry forward. What is not included is legislation that would delay the 40 percent tax on high-cost plans (known as the Cadillac tax) or mitigate the employer mandate. Clickhere to view the three bills on the House Rules Committee website.
House Committee Holds Stark Law Modernization Hearing
The House Ways and Means Health Subcommittee conducted a hearing last week on the modernization on Physician Self-Referral Law with Deputy HHS Secretary Eric Hargan and various private sector witnesses. Hargan concentrated his testimony on the Department’s desire to roll back Stark Law’s regulations citing our country’s move towards a more value-based system. Many Republicans discussed issues impacting clinicians inability to coordinate care and to provide higher quality of care due to tight regulations on facilities such as physician-owned hospitals; Democrats concentrated their discussion on the administration’s attempts to chip-away at the ACA. Statements also turned towards the likelihood that a conflict of interest exists more with rural providers than urban because there are fewer practitioners. To view the hearing and read the written testimony, click here.
  • In an op-ed, former HHS Secretaries Kathleen Sebelius and Tommy Thompson state that the Stark Law is standing in the way of popular quality improvements, click here.
More Doctors are Filing Defamation Lawsuits Against Patients Posting Bad Reviews
Doctors and hospitals are taking patients to court over negative comments on social media rating websites, according to a new media report. This is leading to patients facing huge legal bills for posting critiques against health care providers. The suits are specifically against the patients’ own postings, as doctors typically are unsuccessful against third-party websites such as Yelp. However, a study found that physicians rarely win the cases and sometimes must pay the patients’ legal fees. Physician-patient confidentiality rules also complicate options for doctors. Click here for the story.
Rural Congressional Districts Have Highest Opioid Prescription Rates: Study
Rural congressional districts in the South, Appalachia, and the rural West had the highest opioid prescription rates, according to a new study.  Urban centers showed the lowest rates. Alabama-4, represented by Republican Rep. Robert Aderholt, had nearly 1.7 opioid prescriptions per person in 2016. The rest of the top five are also Republican districts – Rep. Hal Rogers (KY-5), Rep. Chuck Fleischmann (TN-3), Rep. Phil Roe (TN-1) and Rep. Bradley Byrne (AL-1). Clickhere for the study.
  • Change in default settings in the electronic health record system reduced opioid prescriptions study finds, clickhere.
Hospital Executives Say Cost Control Is 2018’s Top Priority
Hospital CEOs identified “preparing the enterprise for sustainable cost control” as this year’s most pressing issue, according to a new Advisory Board report. The topic scored the highest among CEOs than in previous years, getting 61.6% of the CEOs to address it as their highest concern. It usually only receives 50-55% of the vote each year. This view shows a shift from previous years, in which revenue growth dominated as the number one priority for executives. To read the summary, click here.
  • One of the major contributing factors to the high cost of American health care is ‘administrative costs.’  Clickhere for a good overview from the NYTimes.
CMS’ Bundled Payment Initiative Did Not Improve Most Patient Conditions
According to a new study published in the New England Journal of Medicine last week, CMS’ bundled payment initiative did poorly for most conditions by most measures. The study found that while the joint replacement bundle has showed good results, the authors concluded that bundling for other conditions such as pneumonia, sepsis, and congestive heart failure, the results did not show significant changes for patients. The researchers state that the bundled payments did not produce significant cost savings, or boosts to quality; however, they caution that the program was voluntary, which may have biased the results. To read the study, click here.
Almost Half Urgent Care Patients Prescribed Antibiotics Inappropriately
46 percent of urgent care patients were prescribed inappropriate antibiotics than in other medical settings, according to a new study. A review of 2014 claims data from employer-sponsored health plans found that these patients received antibiotics for conditions like the flu and common cold, which don’t require antibiotics. This is very high as compared to 25 percent of patients in emergency departments, 17 percent in doctor’s offices and 14 percent in retail clinics. To read the study, click here.
Senate Report Says Anthem ER Denials Often Overturned; Georgia ER Docs Sue 
Anthem Blue Cross Blue Shield notified policyholders last year that it would deny emergency room claims for services related to conditions it later deemed non-emergent.  However, according to a report by Senator Claire McCaskill (D-MO), many denials were overturned on appeal. According to Anthem, the insurer denied more than 12,000 claims on the grounds that the visits were “avoidable,” but when patients challenged their denials, Anthem reversed its decision most of the time. The report suggests that the high rate of reversals shows that Anthem did not do a good initial job of identifying improper claims. Meanwhile, emergency doctors in Georgia filed a lawsuit against Anthem over the policy stating that it violates ACA, and civil rights. To read the full Senate report, click here, and here for the lawsuit.
Insurers Are the New ‘Big Brother’: Report
A report by ProPublica details how health insurers are collecting personal data on customers including race, education level, TV habits, marital status, net worth, posts on social media, and what they order online among other details to predict how much they will spend on health care, click here.
Women in Rural America Travel Dangerous Distances to Deliver
Women in rural America are facing increasingly difficult obstacles during their pregnancies. This new profile details the extensive hurdles patients face in the wake of OB and rural hospital closures. At least 85 rural hospitals — about 5 percent of the country’s total — have closed since 2010, and obstetric care has faced even starker cutbacks as rural hospitals calculate the hard math of survival, weighing the cost of providing 24/7 delivery services against dwindling birthrates, doctor and nursing shortages and falling revenues. Read more here.
  • Rural health workers share their perspectives on the problem of lack of services in rural America here.
  • The Critical Access Hospital Coalition advocates for the financial viability of rural hospitals in Washington, D.C.. Read more about the CAH Coalition here.

More Young Americans Are Dying of Alcohol-Related Liver Disease
Deaths from liver-related illnesses have risen sharply in the US, especially among young people. A study recently published in the journal BMJ reported that from 1999 to 2016, annual cirrhosis deaths increased by 65 percent to reach 34,174. The largest increase in mortality was associated with alcoholic cirrhosis in the 25 to 34 years old age group. The number of people in this age group who died annually from alcohol-related liver disease nearly tripled from 1999 to 2016 to reach 767, an average annual increase of about 10 percent. Additionally, the study showed a large spike in mortality starting in 2009 which the researchers suggest could be connected to the global financial crisis and the resulting financial stress on young people. To read the full study, click here.

Hot Dogs and Jerky Lead to Mania?

A new study published in the journal Molecular Psychiatry has associated meats treated with nitrates with mania. Most meats that fall under this category are cured meats like hot dogs and beef jerky. The study found an independent and strong association between cured meats and current maniacs.  Click here for the study.

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