June 17, 2019

New MedPAC Report Identifies ACO Limitations, Recommends Changes
New research suggests a popular care model in the Medicare program may not be well suited to restrain spending growth for patients with catastrophic health problems.  The Medicare Payment Advisory Commission’s June report to Congress found that program beneficiaries who remain continuously enrolled in Accountable Care Organizations over a four-year period had 10% lower health-care spending growth than other beneficiaries in their markets. But spending growth for beneficiaries who switched ACOs—doctors and hospitals who band together to manage care for Medicare patients—or were assigned out of them over that same period from 2012 to 2016 was nearly 14% higher than other enrollees in their areas.  Click here for the MedPAC report, turn to page 177.

  • Click here for an excellent summary of the MedPAC report to Congress.

MACPAC Makes Major Medicaid Recommendations To Congress
Congressional Medicaid advisers late last week released their June report with some major recommendations.  The report from the Medicaid and CHIP Payment and Access Commission says Congress should remove the rebate cap on outpatient prescription drugs in Medicaid — a change that would decrease federal spending by between $15 billion and $20 billion over 10 years, according to the Congressional Budget Office. MACPAC also recommends legislation to provide state Medicaid programs with a 180-day grace period to cover new drugs after approval by FDA. Click here for the report and a summary.

House Labor-HHS Appropriations Bill Would Stop Short Term Health Insurance Plans, Make Other Changes
The House began debate on a Mini-Omnibus Appropriations package last week, and will continue the efforts into this week, which includes the appropriations funding for the annual Labor-HHS bill. Over 200 amendments will be debated with over 50 already voted on and accepted last week including language that would prevent the Administration from enforcing a rule that allows sales of short-term, limited duration health insurance plans that do not have to comply with the Affordable Care Act. The Senate is not expected to begin the Appropriations process until at least mid-July. Click here for the bill and all amendments up for debate. Click here for amendments results last Wednesday, and here for those last Thursday.

New Coalition Formed To Push Surprise Billing Solutions; Congress Still Uncertain on Best Path 
America’s Health Insurance Plans, the Blue Cross Blue Shield Association, the National Association of Health Underwriters, and America’s Physician Groups among others announced the formation last week of the Coalition Against Surprise Medical Billing. Among their proposals would be for Congress to require set rates for out-of-network services and mandate hospitals declare in or out of network status of physicians for patients. The coalition estimates that reforms like rate setting and offering patient protections for out-of-network emergency care could save more than $25 billion over the next decade. To read the “solutions” from the newly formed group, click here.

  • With a common, bi-partisan consensus that surprise medical billing is a problem, the House Energy and Commerce Health Subcommittee agreed to do something but could not agree on what – price setting, network adequacy, arbitration, benchmark payments, click here.
  • AHA weighed in on the Senate bi-partisan bill, “Stopping the Outrageous Practice of Surprise Medical Bills” (S. 1531), saying they support the work of the co-sponsors but outline concerns with the bill, click here.
  • A recent GAO Report found that about 2/3 of air ambulance transports for patients with private insurance were out-of-network leading to an average $10,000 “surprise bill,” click here.

Newly Re-Vamped CMS Star Rating System May Need More Work
Based on a study released in JAMA, the star rating system that CMS uses may not give the best indications of which is “best.” The study of almost 2,800 hospitals, of which 150 had a 5-star rating, revealed that hospitals that offer more comprehensive services score lower across the board. This finding remained consistent even with the removal of specialty hospitals. For the full study, click here.

Medicare-for-All Debate Continues in House Committee
Medicare-for-All was back in debate last week in another House Committee, this time the Ways and Means Committee where the same partisan arguments were made: Democrats want to move towards universal coverage and Republicans argued against the cost of the proposal that they fear would lead to less personal control of health care. The hearing was emotionally charged from the beginning, and committee members on both sides of the aisle spoke with emotion and shared personal stories more than they discussed concrete policy. Witnesses Tricia Newman from Kaiser Family Foundation and Former CMS Administrator Donald Berwick agreed that the government should work towards a universal system however, it needs to be carefully considered in a multi-step process. Grace-Marie Turner from the conservative Galen Institute spoke about how such a system would increase costs and limit patient choice, especially among the most vulnerable. To view the hearing click here.  For Newman testimony, click here, for Berwick, click here, and for Turner, click here.

  • Click here for a NYTimes story on how some lawmakers and clinicians are going door-to-door to find support for Medicare-for-All.
  • Washington State is working on a state-backed public option plan to be launched in 2021 that will offer lower premiums and pay lower rates to providers, click here.

Drug Companies File Suit to Prevent Listing Prices in Ads
Pharmaceutical manufacturers Amgen, Merck, and Lily along with the Association of National Advertisers filed a lawsuit in the U.S. District Court for the District of Columbia to prevent a rule that requires advertisements to state the list price of drugs from taking effect on July 9. HHS finalized a rule last month that requires drug manufacturers to include prices for certain high-priced pharmaceuticals and biologics in television ads. In a statement, the groups assert that, “Not only does the rule raise serious freedom of speech concerns, it mandates an approach that fails to account for differences among insurance, treatments, and patients themselves, by requiring disclosure of list price. Most importantly, it does not answer the fundamental question patients are asking: ‘What will I have to pay for my medicine?'” Click here for the full statement.

Final Rule Allows Employers to Use Health Reimbursement Arrangements for Employees to Purchase ACA Plans
HHS, Labor, and Treasury Departments last week released a final rule to make it easier for employers to use health reimbursement arrangements through subsidies to help their employees purchase ACA Marketplace plans beginning in January of 2020. The Administration states that the rules are a way to make it easier for employers, particularly small- and mid-sized companies, to offer coverage to their workers. HHS estimates that the rule could impact 11.4 million workers giving them coverage through HRAs of which 800,000 are thought to be currently uninsured. The final regulations include safeguards meant to prevent employers from dumping their sickest workers into the ACA markets and ban these workers from the short-term plans. Click here for the rule and here for the frequently asked questions on the rule.  Click here for the WSJ story.

  • According to the Wall Street Journal, religious organizations in which members pay each other’s medical bills are increasing in both membership and complaints as more consumers say that bills aren’t being paid or are paid late, click here.

Congress Raises Serious Concerns with Fentanyl Use
As a part of an ongoing investigation by a key House committee, letters were sent to six different federal agencies requesting briefings “As overdose deaths involving fentanyl continue to rise, we remain concerned about the impact of this epidemic on the public health, and we are committed to identifying further solutions to stop the flow of deadly illicit fentanyl into our communities,” the bipartisan committee leaders wrote in each of the letters. “Therefore, to assist the Committee’s investigation, please provide a briefing on these issues to Committee staff.” To read the letters, click here.

Digital Visits Improve Patient Quality of Life: Study
A new study published in JAMA Oncology found that digital visits with patients through telemedicine efforts improves patient quality of life and decreases time in the hospital, especially for late-state cancer patients. Through digital visits, patients are able to speak with their doctors in the comfort of their own home and describe any and all symptoms they are experiencing. Researchers found that, in the case of late-stage cancer patients, telemedicine led to them spending less time traveling to medical centers as well as decreased time in post-acute care facilities, ultimately allowing for less stress for the chronically ill patients. Click here for the study.

Suicide, Alcohol, and Drug Death Rates Are Very Regional in America
A new report out by the Commonwealth Fund shows that these types of epidemics impact different regions of the country in unique ways. For instance, New England, the Mid-Atlantic, and the Southeast have been especially hard-hit by the opioid epidemic, states like Montana, Nebraska, and the Dakotas have had higher rates of death from suicide and alcohol use in 2017 than by the drug epidemic. The 2019 Scorecard on State Health System Performance looks at all 50 states and the District of Columbia to assess each on a wide range of measures from access to care, outcomes, and various disparities. Top performers were Hawaii, Massachusetts, Minnesota, Washington, Connecticut, and Vermont.  Conversely, Arkansas, Nevada, Texas, Oklahoma, and Mississippi ranked at the bottom. See how your state ranked and view tables, graphs and an interactive map, click here.

Study Shows Correlation Between Some Long-Term Care Cases and Suicide
A new study from the University of Michigan reveals that of 47,759 suicide deaths between 2003 and 2015, researchers identified 1,037 associated with long-term care facilities. During this period the study indicates that approximately 2.2 percent of suicides among adults 55 and older were associated with transitioning into long term care facilities or while living there. For the full study, click here.

Spending at Least 2 Hours a Week in Nature Is Good for Health
The relationship between time spent in nature and self-reported health and well-being data was examined in a recently published Nature study and found a connection between the outdoors and healthy living. According to the researchers, there was a significant increase in reporting of good health and/or well-being when participants reported some contact with nature (marked by 60min blocks) as compared to those who reported no contact. The positive association was seen at 120 minutes per week and peaked at 200-300 minutes per week, with no further gain after that point. To read the full study, click here. Click here for the NYTimes story.

Americans Are Exercising More: CDC
According to the Centers for Disease Control and Prevention, regular exercising among Americans is trending up. HHS’ 2008 guidelines for physical activity recommended that Americans get at least 2.5 hours of moderate-intensity aerobic activity a week and do muscle-strengthening exercises at least twice a week. Since that time, overall American adults meeting physical activity guidelines increased from 18.2% to 24.3% in 2017, and from 19.4% to 25.3% in urban areas and from 13.3% to 19.6% in rural areas. There is still room for improvement, according to the report’s authors, as communities can improve neighborhood designs as well as provide better access to recreational facilities to encourage people to be more active. To view the CDC report, click here.

Type A Blood Can Be Converted To Universal Donor
A new study published in Nature Biology has found that a bacterium in the human microbiome  could remove the antigens from Type A blood to allow it to be converted to a universal donor. This would change blood need, as only seven percent of people in the United States have an O- blood type, the universal donor for transfusions. This new research could greatly increase the supply of blood around the world. Click here for the study.

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