June 10, 2019

CMS Chief Smacks Health Systems and Defends Site Neutral, 340B Payment Cuts
CMS Administrator Seema Verma is making it clear where CMS stands on major issues impacting health systems. Late last week in a blog post she called out large hospital systems for anti-competitive behavior, and said CMS policies like pay cuts for 340B drugs and site-neutral pay policies — both of which led to lawsuits over CMS’ authority to enact them — were put in place to help combat consolidation and physician movement from independent work to hospital employment.  Verma also says the government can exacerbate problems pointing  to a “thicket of regulations that CMS has rolled out over the years,” which she said has accelerated consolidation because the costs are too high for small, independent physicians to bear so they are forced to become hospital employees.  Click here to read her comments.

  • The Senate Judiciary Antitrust Subcommittee will hold a hearing this week to review consolidation in the health care industry. Click here to view the committee website with details about the hearing.
  • CMS will take another year to change an Obama-era proposal to update requirements for hospitals that participate in federal health programs: the Conditions of Participation. The 2016 proposal was scheduled to be finalized this month (click here for the proposed rule), but CMS will now have until June 16, 2020, to complete the task the agency announced last week.  The CMS attributed the delay to “the complexity and substantive nature” of the proposal. Click here for the delay announcement.

Congress Sends Pandemic Preparedness Bill to the President
The House has sent a final bill to the President for signature to reauthorize HHS efforts to respond to disasters and threats from emerging infectious diseases and chemical or biological agents. The bill (S. 1379), that stalled last year, was passed by the Senate in May. The Pandemic and All-Hazards Preparedness Advancing Innovation Act equips federal agencies to respond to new and emerging threats that jeopardize public health and reauthorizes or establishes critical programs designed to prepare for and respond to health security events, such as bioterrorism, emerging infectious diseases, and natural disasters. The bill is widely supported by providers and is expected to be signed by the President. Click here for a detailed summary of the bill. Click herefor the bill.

House Committee Reviews Upcoming DSH Cuts and Funding for More Programs
The House Energy and Commerce Health Subcommittee last week discussed various authorization and extender bills for a variety of programs including Community Health Centers, Special Diabetes Programs and mental health. Committee members overall showed strong support of these programs as ways to further health research and address the physician shortages across lower income communities across the country.  There was an emphasis on the need for longer periods of funding as an important way for these programs to recruit and retain talent. Many questioned where the money would come from to pay for these extensions and increased funding. The second panel of experts focused on the Disproportionate Share Hospital payment cuts that are scheduled to take effect October 1. Committee members agreed that these cuts should not go into effect in October because they would devastate hospitals in lower income communities; however, there was much discussion on the need for sweeping changes in how DSH payments are calculated. Click here to watch the hearing and view the bills discussed.

  • In a 7-1 ruling last week, the Supreme Court found that CMS changed its payment formula for disproportionate share hospitals illegally a few years ago without soliciting comments for the imposed cuts. While this staves off a large cut for certain hospitals this also sets a precedent that CMS has to do more thorough notice-and-comment rulemaking for any payment cuts. Click here for the ruling.

CMS To Publicly Disclose Poor Performing Nursing Homes
Following the release early last week (click here) of a previously undisclosed list of about 400 nursing homes with poor performance, CMS announced that it will begin posting the list publicly. The list, which will update monthly by CMS, consists of candidates for CMS’ Special Focus Facility program, which increases federal oversight for nursing homes with higher instances of poor care that can include documented cases of neglect and abuse. From about 400 candidates, CMS chooses 88 nursing homes to participate in the 21-year-old program. CMS still points consumers to Nursing Home Compare, which provides quality of care information for every nursing home that participates in Medicare and Medicaid based on an overall star rating from three factors: health inspections, staffing levels, and quality measures. For more from CMS, click here.

Senators Introduce Bill to to Strengthen Mental Health Parity Laws
Sens. Bill Cassidy (R-LA) and Chris Murphy (D-CT) have introduced a bill that they state will reduce administrative barriers that are limiting patient access to mental health services. The legislation aims to improve transparency and accountability to help consumers have access to mental health and substance use services included in their health plans and strengthen compliance with mental health parity laws by requiring issuers or plans to submit comparative analyses upon request from federal agencies. This bill builds upon the Mental Health Reform Act co-authored by the same Senators in 2016 and signed into law by President Obama. Click here for more on the bill from the authors.

Insurance Association Offers Proposal to Lower Seniors Prescrpition Out of Pocket Costs
America’s Health Insurance Plans has proposed to federal lawmakers a plan designed to make drug manufacturers pay more to support Part D enrollees.  AHIP says a “Maximum Out of Pocket” limit for Part D — that would put a hard cap on how much Part D enrollees pay in a year for their medications — would save thousands of dollars a year for low income seniors. Currently, the Part D “catastrophic” program is designed to protect enrollees who aren’t eligible for low-income subsidies that allows for enrollees that reach a certain spending threshold ($6,350 in 2020), they only pay 5% of their drug costs the rest of the year, however fewer than 10% of seniors with Part D enter the catastrophic phase each year. AHIP proposes that drug makers simply profit off the program and should have some “skin in the game” and pay some of the costs once seniors reach the catastrophic phase instead of being entirely on the health plans and government. To view the proposal, click here.

Far More Hospitals in Health Systems Participated in CMS’ CJR and BPCI Payment Models
A report released by the Agency for Healthcare Research and Quality shows that about 28 percent of hospitals that are part of health systems participated in a Medicare bundled payment model in 2016, compared with only 8 percent of hospitals not part of health systems. AHRQ looked at both Comprehensive Care for Joint Replacement (CJR) model and the Bundled Payments for Care Improvement (BPCI) initiative. The report also found that the larger the system the more likely they were to participate in one of the models. Click here to view the report.

CMS Accelerates Its Regulatory Reduction Initiative
Building off the initial request in 2017, CMS has released another request for information seeking new ideas on how to “continue the progress of the Patients over Paperwork initiative.” The program aims to streamline regulations and to cut the red tape in the healthcare system. Specifically, CMS would like input on ways to improve:

  • Reporting and documentation requirements
  • Coding and documentation requirements for Medicare or Medicaid payment
  • Prior authorization procedures
  • Policies and requirements for rural providers, clinicians, and beneficiaries
  • Policies and requirements for dually enrolled (i.e., Medicare and Medicaid) beneficiaries
  • Beneficiary enrollment and eligibility determination
  • CMS processes for issuing regulations and policies

For more on the request, click here, and for the Federal Register notice, click here.

Study Shows Patients Satisfied with Non-Opioid Pain Relief When Instructed on Alternatives
A study published in the Journal of the American College of Surgeons found that patients who were instructed on how to manage pain without opioids were satisfied with alternative pain relief techniques, such as ibuprofen and acetaminophen. In fact, patients were asked to rank their pain and satisfaction on a scale of one to ten, and the average pain ranking was one, and the average satisfaction ranking was ten. This may shed light on the possibility for post-surgery care that can exclude opioid treatment. Click here for the full study.

Drug Pricing Under More Scrutiny as PhARMA Banks on Cancer Drugs
A new EvaluatePharma report shows how heavily the pharmaceutical industry is banking on oncology. Of the almost $224 billion of development spending for pharma in 2019, $91.1b is for developing cancer treatments. Global drug sales are expected to reach $1.18 trillion in 2024, compared to $843 billion in 2019, and $239 billion of the 2024 total is expected to be spent on orphan drugs that treat small populations. For the full report click here.

  • The FDA announced a way to facilitate access to unapproved therapies for patients with cancer: This to be achieved through two programs, Expanded Access and the new the Project Facilitate pilot program. For the FDA press release click here.
  • A CDC publication highlights how much more cancer survivors pay out-of-pocket on medical expenses than those who do not have a medical history with cancer. This study found that about 25% of cancer survivors reported financial hardship and 33% reported psychological hardship because of their cancer treatment and its lasting impact. Click here for the CDCs Morbidity and Mortality Weekly Report.
  • As the drug pricing debates rage on, a group of senators wrote PhARMA June 5th imploring the drug manufacturers work them to improve transparency and bring down cost. “We cannot understand why Americans pay two to six times more than the rest of the world for brand name prescription drugs,” and proposes that drug companies should not charge more in the United States than they do in the Canada, Germany or Great Britain. To read the full letter, click here.

Pfizer Under Fire for Not Disclosing Findings of Possible Alzheimer’s Drug
A recent expose from the Washington Post reveals in 2015 a team of Pfizer researchers found that their rheumatoid arthritis therapy, Enbrel, appeared to reduce the risk of Alzheimer’s disease by 64 percent. These results came from analyzing insurance claims within Pfizer’s database, and were further supported by data Pfizer took from other databases and the usage of other strong anti-inflammatory drugs. Internal reports showed Pfizer decided against funding the expensive clinical trial claiming the drug’s effectiveness on Alzheimer’s was not scientifically likely. Click here for the Washington Post article.

Bipartisan Bill Would Lift Ban on Physician-Owned Hospitals
The ACA put into effect several restrictions on existing Physician-Owned Hospitals, and banning the creation of new ones. H.R. 3062, the Patient Access to Higher Quality Health Care Act of 2019 would repeal the ban. Bill sponsors said, “Our legislation would repeal restrictions on many of our nation’s top performing hospitals and allow them to compete and focus their attention on patient care.” For the full text of the bill,  click here.

CVS Taking Deeper Dive as a Health Care Provider; More Efforts To Reduce Costs
CVS’ “MinuteClinics” can now provide diagnoses and basic treatments, but now the company has debuted its latest healthcare solution: HealthHub. Unlike MinuteClinics, HealthHub clinics will be staffed by nurse practitioners who will provide more acessible preventative care, and can also provide phlebotomy, diabetes screening, and sleep apnea assessments, among other services. By increasing access to preventative care, CVS hopes to drive down healthcare costs. By the end of 2021, CVS anticipates over 1,500 locations open across the nation. For a report from CNBC, click here.

  • To stem the rising tide of healthcare cost, Kaiser Health News took a closer look at telemedicine. If telehealth makes health care more accessible, people may end up using more of it; However, if telehealth serves as a substitute for office or hospital visits, it could drive costs down. KHN indicates that reimbursement rates being set appropriately will be key. For the full article click here.
  • Vox has released the results of its year long investigation with the Health Care Cost Institute into emergency room fees. The investigation revealed that while the number of visits have gone down, the fees have gone up $3 billion from 2009 to 2015. For the full investigation click here.

Sleep, Not Laughter, May Be the Best Medicine
The value of sleep is examined as a health benefit compared to the value of other traditional mediations. Not in terms of replacement, but as a way for the body to heal itself and the consequences of disrupting patient’s sleep for monitoring and tests while in the hospital. NY Times analysis comes after a study released earlier this year examining the same thing. For the story in the Times, click here. For the referenced study click here.

The World Health Organization Study Calls for Improved STI Data
A recent WHO study calls for improved STI data collection to create a more reliable baseline to monitor outbreaks. The study estimated a total of 376.4 million new curable STIs worldwide (including chlamydia, gonorrhea, trichomoniasis, and syphilis) in men and women 15-49 years old in 2016. While this data does not show a significant increase from the 2012 data, it was recently discovered that the small island states in Oceania have the highest prevalence and incidence for all four STIs evaluated in this study. A transition from WHO region reporting to country level reporting will be able to more accurately identify these outbreaks. Click here for the full study.

Children Teased About their Weight Are More Likely to Gain More
A new NIH study showed that children of similar obesity status differ in their long-term weight gain based on how often they are teased about their weight. It is theorized that being teased can cause children to engage in even more unhealthy behaviors, such as binge eating and exercise avoidance. It is also can be explained that the chronic stress added to the children being bullied could stimulate the release of additional cortisol, which may lead to weight gain. This study further emphasizes the negative effects that bullying can have on children and directly refutes the traditional idea that overweight people are likely to be motivated to lose weight as a result of being teased. Click here for the NIH report.

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