June 25, 2018

340B Hospitals Denied Claims Appeals on Drug Payments

In an effort to press a federal court decision to stop CMS’ 340B payment cut,  hospital representatives sent a letter to the U.S. Court of Appeals detailing how two Medicare claims processors recently told hospitals that their appeals of 340B payments would not be considered. Claims processor Noridian states that hospitals “do not have appeal rights” and National Government Services stated that “an appeal will not be considered when submitted to dispute CMS’ 340B national payment policy.” Combined, the two contractors process claims in 23 states and are the first level of appeal for disputes. Click here for the letter.

  • The head of the agency that oversees 340B to the Senate HELP Committee last week that HRSA has limited authority to administer the program.  It was the third congressional hearing on the 340B program. To read her testimony, click here.
  • Trust has hit a new low for pharma in a new national survey. The 13-point drop from 51% to 38% was the category’s biggest plummet in the five years the firm has been tracking sentiment. Click here.
  • There are  more companies lobbying on the drug pricing issue than ever before. The industry’s biggest trade group has also increased dues for its member companies by 50% in order to raise $100 million for an influence campaign to stave off possible pricing regulations by Congress. Click here for details.
  • So…why won’t competition bring down drug prices?  Great perspective.  Click here.

House Passes Major Legislation To Fight the Opioid Crisis

The House last week finished a voting marathon on opioid bills; the Senate is expected to consider its opioid package later this summer; a House-Senate Conference to reconcile the dozens of bills that are being adopted will follow. H.R. 6 serves as the legislative vehicle for many of the 55 House-passed bills designed to curb opioid addiction efforts and advance treatment and recovery initiatives, improve prevention, and bolster efforts to fight illicit synthetic drugs like fentanyl. Click here for the full list of provisions in H.R. 6.  Strategic Health Care clients will receive a more detailed summary later this week.

  • The government is stepping up seizures of medications from Canada and other countries shipped through the mail, click here.
  • A new study finds that the amount of prescription opioids being sold in the United States has declined by 11 percent in 2017 as compared to the previous year, click here.
  • The National Business Group on Health last week issued a list of recommendations on how employers can prevent opioid abuse, click here.
  • The Healthcare Leadership Council released its National Dialogue for Healthcare Innovation’s Opioid Crisis Solutions Summit: A Roadmap for Action, click here.
  • Drug use and engaging in sexual intercourse is down among high school students according to the CDC’s 2017 National Youth Risk Behavior Survey, click here.

CMS, Congress Appear Ready To Tackle Stark Reform

CMS last week issued a request for information on how to reduce the burden of the physician self-referral law. The Stark law — named for former congressman Pete Stark (D-CA) who sponsored the original bill in 1989 — bars physicians from referring patients to care settings where they could have some financial gain. Medicare officials are now seeking information on how Stark regulations hinder care coordination and how to overcome those barriers, while making sure self-referrals would be transparent and wouldn’t unnecessarily raise costs. Public comments on the RFI are due by August 24, 2018. Click here for the RFI.

  • Sen. David Perdue (R-GA) introduced legislation last week that would make changes to the Stark Law to simplify regulations governing physician self-referrals, click here for Perdue’s press release and here for the bill language.

Freestanding EDs Have Lower Admission Rates than Hospital-Based EDs:  Study

A new report published this month in the American Journal of Emergency Medicine shows that hospital-based emergency departments were 20-percent more likely to admit patients than freestanding EDs. Focusing on patients with chest pain, COPD, asthma, and CHF, the researchers speculated that the higher percentage was due to two factors –

  • Hospital-based physicians were under pressure to ease ease waiting room congestion and ‘turn’ beds, and
  • Facility-related factors drive higher rates of admission from EDs such as occupancy rates, higher number of inpatient beds, being in an urban location, and having a level 1 or 2 trauma center.

Researchers also point to other influences including convenience, transportation costs, availability of outpatient follow-up, and social supports. To read the full report, click here.

Trump Administration Finalizes Association Health Plan Rule

The Administration finalized a rule that expands the availability of alternative insurance plans, known as Association Plans, that are not required to meet the Affordable Care Act standards. Under the rule, plans will not be allowed to charge more or deny coverage to people with pre-existing conditions however, they are not required to offer ACA’s 10 essential health benefits. Additionally, association plans do not have to comply with limits on higher premiums based on age or gender. The Final Rule also allows AHPs to be formed based on a common geographic test, such as a common state, city, county, or a metropolitan area across state lines. Critics of expanding AHPs have argued that they will provide inadequate benefits and will likely draw the healthiest consumers out of the exchanges, further destabilizing the health insurance market. The rule will begin to phase in starting on September 1st. Click here for the rule and here for the fact sheet.  Click here for an excellent Health Affairs analysis.

  • A new analysis predicts that more than 3 million people will exit ACA plans for association health plans by 2022, click here.
  • Last year’s tax cut will lead to a spike in health care premiums across the country, according to the Center for American Progress. Click here.
  • Saying that the Aetna acquisition of CVS Health will increase premiums and out-of-pocket costs, the AMA is urging Federal regulators to block it. Click here.
  • Montana saved $15.6 million in 2-years in the state’s health plan using reference pricing. Click here.
  • Patients in rural America are less likely to have healthcare from their employer.  Click here for the report.
  • After years of pullbacks, insurers are increasing their footprints in the Affordable Care Act marketplaces next year, despite uncertainty including the latest court challenge to the health law. Click here.

Farm Bill Barely Passes the House, Includes Work Requirements for SNAP Program

In a very close 213-211 vote, the House passed its version of the farm bill, H.R. 2, with 20 Republicans voting no with all the Democrats. Included in the $860 billion package is a controversial provision that would put stricter work requirements on recipients of the Supplemental Nutrition Assistance Program (SNAP), otherwise known as food stamps. The Senate is expected to vote, perhaps as early as this week, on its bipartisan farm bill, which makes only administrative changes to SNAP. The stark differences in the bills could lead to a contentious Conference Committee later this summer. Click here for more on the House-passed bill.


Leapfrog: Hospital-Acquired Infections on the Rise

A new report by The Leapfrog Group shows that one out of 25 patients in the U.S. contracts a hospital-acquired infection every day resulting in billions of wasted dollars and 90,000 deaths annually. Additionally, the data shows that the percentage of hospitals with zero infections has declined significantly since 2015. The report looked at five specific infections – central line associated bloodstream infections (CLABSI), catheter associated urinary tract infections (CAUTI), surgical site infection after colon surgery (SSI: Colon), methicillin-resistant staphylococcus aureus (MRSA), and clostridium difficile (C. diff). All five examined saw a rise in all categories.  To read the full report, click here.

  • The Leapfrog Group also responded to the CMS Inpatient Payment rule, specifically opposing the proposal to remove measures like catheter-associated urinary tract infections and Clostridium difficile from its inpatient quality reporting program, click here.

FCC Approves $172 Million Increase for Rural Health Care Program
A majority of the FCC Commissioners approved an increase in the funding cap for the Rural Health Care program. The program, which helps rural providers afford improved telecommunications and broadband services, had not seen an increase in the $400 million cap since inception in 1996. In recent years, demand for funding has exceeded available funds as rural hospitals continue to struggle with finances. Click here to read FCC Chairman Ajit Pai’s statement on the increase.

American Cigarette Smokers at an All-Time Low: CDC

According to the Centers for Disease Control and Prevention, only 13.9 percent of American adults are smokers, down from 15.5 percent in 2016, which is the lowest percentage level ever recorded. The data found that cigarette smoking was more prevalent for people not living in metropolitan areas (21.5 percent) compared to people in metropolitan areas (11.4 percent). This was the first time that analysis looked at the difference between urban and rural areas. To view the data analysis, click here.


Fewer Births Than Deaths Among Whites in Majority of U.S. States

Deaths now outnumber births among white people in more than half the states in the country, demographers have found, signaling what could be a faster-than-expected transition to a future in which whites are no longer a majority of the American population. The Census Bureau has projected that whites could drop below 50 percent of the population around 2045, a relatively slow-moving change that has been years in the making. But a new report last week found that whites are dying faster than they are being born now in 26 states, up from 17 just two years earlier, and demographers say that shift might come even sooner. Click here for the CDC report.

Gaming Disorder Will Be Included in ICD-11

The World Health Organization now classifies gaming disorder as a disease under the International Classification of Diseases.  Click here.

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