June 3, 2019

White House May Issue Sweeping Price Transparency Order 
According to various reports, the White House is working on an Executive Order that will require complete price transparency for a broad range of providers and manufacturers across the health care industry. Rumors have been swirling for weeks that it will include everything from creating an app to compare provider prices to a listing of all major drug prices. Most likely, the order will call for different Departments and Agencies across the government to promulgate regulations to implement the policies. The order is expected to be released mid to late June. For more from the Washington Post, click here.

House Committee To Take Up Bill To Postpone DSH Cuts, Extend Medicare/Medicaid Programs
On Tuesday, the House Energy and Commerce Committee will hold a hearing entitled, “Investing in America’s Health Care” that will review several pieces of legislation on expiring authorities. The draft bills – that have yet to be released – are expected include extending various expiring Medicaid, Medicare, and health care programs such as mental health services, community health centers, Money Follows the Person, and spousal impoverishment program for as much as 5-years with an increease in funds. Also planned for the hearing is a bill that will wipe away the upcoming disproportionate share hospital payment cuts from the ACA that are scheduled to go into effect on October 1st to the tune of $4 billion and increasing amounts in the following years. Funding for the bills have not been identified yet. Click here for the hearing information as it becomes available.

Government Cracking Down on Hospitals Accused of Violating Stark Law 
Kaiser Health News is reporting that various hospitals across the country are being accused of violating federal laws designed to keep financial considerations from influencing doctors’ decisions and the federal government is suing them for it. These suits allege that hospitals are grossly overpaying doctors or offering incentives like free office space in exchange for the downstream revenue that doctors create through referrals. These efforts run in direct contradiction to federal self-referral bans and anti-kickback laws that are designed to prevent financial considerations from influencing physicians’ clinical decisions known as the Stark law that prohibits physicians from referring patients for services that they would have a financial interest. Hospitals potentially found in violation state that that the generous salaries that it gave doctors were the only way it could provide specialized care to local residents. For the full report, click here.

  • In a survey of 162 healthcare executives the most common answer, by more than 36-percent, found that fraud and abuse laws, like the Stark Law, don’t support new models of care, click here.

Children Covered Under Medicaid/CHIP Fell By More Than 2 Percent Last Year
A new report by Georgetown University Health Policy Institute shows that the total Medicaid and CHIP enrollment for children fell by more than 2 percent last year. The researchers point to the combined effect of reduced funding for outreach and changes to immigration policy that could be scaring off potential enrollees. Additionally, the authors cite “State specific factors” including eligibility system implementation challenges; use of electronic data to verify eligibility; slow adoption of ACA simplification measures; and stricter, more frequent reviews of eligibility. The article make several recommendations on how to prevent more children from losing coverage. Click here for the report.

Report Finds Surprise Billing “Network-Matching” Proposal Will Save $7 Billion
The Council for Affordable Health Coverage has released a report that finds the new proposal to stop surprise billing practices through the implementation of “network-matching,” suggested by the Senate Health Committee, could save the federal government as much as $7 billion over 10 years. Additionally, the report found that the bill introduced by Sens. Bill Cassidy (R-LA) and Maggie Hassan (D-NH) to halt the practice could actually lead to an increase in premiums due to the costs of their proposed dispute resolution process. Alternatively, the proposal by the House Energy & Commerce Committee, which sets a benchmark payment rate, could end up being budget neutral. This all comes as the various Congressional Committees scramble to come up with policies to curb the practice of surprise billing. To read the CAHC report, click here.

  • At least 43 million Americans have overdue medical bills on their credit reports according to a federal Consumer Financial Protection Bureau report, click here.

New U.S. Diabetes Cases Drop 35 Percent Over Last Decade 
The British Medical Journal’s Open Diabetes Reach and Care recently published a report stating new cases of  diagnosed patients fell to 6 per 1,000 adults in 2017 from 9.2 per 1,000 in 2009. “The findings suggest that our work to stem the tide of type 2 diabetes may be working – but we still have a very long way to go,” Ann Albright, director of the Division of Diabetes Translation at the CDC said in a statement. “We must continue proven interventions and deploy innovative strategies if we’re going to see a continued decline in type 2 diabetes among Americans.” For the full report, click here.

Melanoma Fatalities Fall Dramatically
Fatalities from melanoma have fallen dramatically in the past decade, according to an annual cancer report released this morning by the National Cancer Institute. Annual death rates from melanoma declined 8.5 percent among men from 2014 to 2016 and 6.3 percent among women from 2013 to 2016. The improvements are even greater among African Americans, who develop melanoma less often but of more severe varieties. Click here for the report.

Long-Awaited PACE Program Rules Finalized by CMS
After more than 2 years from when the proposed rule was published, CMS released a final rule updating the Programs for All-Inclusive Care for the Elderly (PACE) rule.  The proposed rule was published in August 2016.  (PACE regulations were last updated in 2006.)  Though established in 1997, PACE providers today care for less than 50,000 Medicare and Medicaid beneficiaries in 31 states. The new rule provides more administrative and regulatory flexibilities, such as letting one member of the care team serve in multiple roles, and includes patient protections, such as sanctions and civil monetary penalties for PACE organizations that don’t comply with the rules. Click here for the CMS Fact Sheet, and here for the rule.

Doctors Publish Opinion Piece in JAMA in Support of Single Payer
In a surprising turn, the Journal of American Medical Association published an opinion piece by a couple of physicians last week that supports the position that the U.S. should turn to a fully government-financed healthcare system. Written by Drs. Steffie Woolhandler and David Himmelstein, the co-founders of Physicians for a National Health Program, the piece makes the case to their fellow physicians on the merits of a single payer system like the one in Canada. This comes as the AMA is due to have their annual meeting this week and will debate whether to drop its opposition to government-financed healthcare. Click here for the piece in JAMA.

Record Setting 15 New Cancer Treating Drugs Being Developed
IQVIA Institute released its annual global oncology trend report, revealing that last year 15 new cancer treating drugs were being developed around the world. Spending for cancer treatments has had double digit growth for the fifth year in a row, reaching over $150 billion, and the number of drugs in the pipeline for late-stage development is up by 19 percent in 2018. The average annual cost of new medicines continues to trend upward, although the median cost dropped by $13,000 in 2018 to $149,000, and cost per product ranged between $90,000 and over $300,000. For the full report for 2019, click here.

  • NIH reports that cancer deaths are actually trending down, click here.
  • More information about the increasing cost of cancer drugs can also be found in a new report from JAMA released this week, click here.

Almost 1,000 Cases Leads to Largest Measles Outbreak in More Than 25 Years
According to the CDC, 971 cases of measles have been reported in the United States this year already, the highest total in 27 years in less than half a year – the next closest was a full year of 963 cases in 1994. Much of the spread of the highly contagious virus this year is occurring among children and adults who were not vaccinated because of mistaken beliefs about the health risks of the measles shot. Experts also point to outbreaks in ultra-Orthodox Jewish communities in New York City and Rockland County, N.Y. as a driving force behind the epidemic. If this outbreak continues to grow, the U.S. will lose its World Health Organization designation for eliminating measles in 2000 after a 40-year campaign agains the disease. For more from the CDC, click here.

US Taxpayers on the Hook for $146 Million Loan Default for Nursing Home Company
An expose from the New York Times takes a look at a little known government program run by HUD that could leave taxpayers footing the bill for a defaulted loan to the tune of $146 million. Rosewood Care Centers stopped making mortgage payments in 2013, and finally defaulted on a government guaranteed mortgage in August ’18. Since August, HUD has spent more than $15 million to keep the facilities open on top of the $146 million it dispensed to Rosewood’s lender. The agency estimates that the facilities are worth approximately $95 million, and HUD will have to continue to fund the facilities to keep them open until or unless buyers can be found. For the full article from the Times, click here.

Palliative Care: Beyond Hospice 
Hospice and palliative care are often seen as one as the same; however, while hospice cannot exist without palliative care, palliative care can exist without hospice. Palliative care for those not immediately terminally ill is something that increasingly the healthcare sphere is becoming more aware of, according to an article from PEW. Palliative care is seen as a strategy to maximize the quality of life for a patient, even if it does not necessarily extend it. According to Mount Sinai’s Center to Advance Palliative Care, less than a quarter of U.S. hospitals had a palliative care program in 2000. By 2016, three-quarters of hospitals did. Click here for more information on states with expanded definitions of palliative care.

HHS Pain Management Task Force Issues Final Report
The Pain Management Best Practices Inter-Agency Task Force, a federal advisory committee established by the Comprehensive Addiction and Recovery Act of 2016, has released its final report on acute and chronic pain management best practices, calling for a balanced, individualized, patient-centered approach. Click here for the report.

Existing Prescription Drug Monitoring Programs May Contain Errors 
According to a recently released report from HHS and their Pain Management Best Practice Inter-Agency Task Force, as they currently exist prescription drug monitoring programs may contain errors and therefore should not be used as a sole determinant to cut patients off from pain prescriptions. “PDMP data alone are not error proof and should not be used to dismiss patients from clinical practices,” the report states. It also says EHR vendors should integrate PDMPs into their system design at “minimal to no additional cost or burden to providers.” For the full report from HHS, click here.

The World Health Organization Declares “Burnout” an Official Medical Diagnosis
The term “burnout” has been used by doctors for years to explain the lack of motivation people may have for their job, school, etc, often after being overworked. Burnout can lead to many mental health problems and now it can be diagnosed – and coded – by a doctor as an official diagnosis in a patient that exhibits these three symptoms: exhaustion, increased negative feelings about one’s job, and reduced professional efficacy. Click here for the WHO ICD-11 definition.

  • According to a new study, approximately $4.6 billion in costs related to physician turnover and reduced clinical hours is attributable to burnout each year in the United States, click here.

The Integrative Human Microbiome Project is Moving Forward
Three recent studies from the NIH have been complied to complete the second phase of the Human Microbiome Project, the NIH research initiative to improve understanding of the microbial flora involved in human health and disease that was launched in 2007. While the first phase focused on the general microbiome of a healthy human, the second phase focuses on the relationships of the microbiome and host in different conditions. The three studies each examined one unique host condition: pregnancy and preterm birth, inflammatory bowel diseases, and stressors in prediabetic patients. To review the culmination of all three studies, click here.

The Use of Pool Chemicals Account for 4,535 Emergency Room Trips a Year
With over 55-percent of poisonings occurring at private residences directly from pool chemicals, there is now a push for more regulated education on the dangers of pool chemicals among pool owners. The new data from the CDC outlines the magnitude of the issue and finds that 36-percent of patients were children. The Model Aquatic Health Code recommends that pool owners take more precautions when working with their chemicals, including the usage of a mask and gloves. They also recommend that pool owners store their chemicals in places out of reach of children. Click here for the study.

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