June 4, 2018

S&P: CMS’ 340B Rule Could Hurt Many Hospitals; HRSA Delays Drug Company Penalties

Standard and Poor says CMS cuts to 340B drugs could force smaller, rural, and high DSH covered entities to serve fewer patients and create a huge strain on emergency departments. The report states, “In these cases, cuts to the program are likely to further stress already-constrained operating performance, adding to financial pressure and possible negative rating actions.” Also last week, the Health Resources Services Administration that oversees the 340B program released a final rule delaying penalties on pharmaceutical manufacturers that raise prices of 340B drugs too quickly. This will be the fifth time the rule has been delayed since the policy was mandated by the Affordable Care Act. Click here for the full report from S&P, and here for the HRSA ceiling price rule.

  • A report published in JAMA Internal Medicine says entities that were early participants in the 340B program spent more on uncompensated care and were more likely to provide low-profit services as compared with nonparticipants. Click here.

Many Women with Breast Cancer Don’t Need Chemo: New Study

Many women with early-stage breast cancer who would receive chemotherapy under current standards do not actually need it, according to a major international study that is expected to quickly change medical treatment,” according to a report in the NY Times. The study found that gene tests on tumor samples were able to identify women who could safely skip chemotherapy and take only a drug that blocks the hormone estrogen or stops the body from making it. Click herefor the report.

ED Use Drops, Spending Doubles

According to new data from the Health Care Cost Institute, emergency department use was down between 2009 and 2016, however ER spending per person nearly doubled, click here.

Four More Die from E. coli in Romaine Lettuce

Four more people have died from eating romaine lettuce tainted with E. coli, the CDC reported late last week.
That brings the total death count from the recent E. coli outbreak to five. In the past two weeks, an additional 25 people have also become ill from eating contaminated lettuce, the CDC announced. In total, 197 people across 35 states have become sick since March 13. Click here for more from the CDC.

Key GOP Senator Releases Plan To Make Health Care Affordable

U.S. Senator Bill Cassidy (R-LA) has released a white paper entitled, “Ideas to Make Health Care Affordable Again.” Cassidy, a physician, says there needs to be more transparency in pharmaceutical prices. He says there needs to be greater use of free-standing emergency centers and allowing purchasers of drugs to buy products abroad when there is only one U.S. generic manufacturer. He also reiterated his call to reform the ACA and stabilize the marketplace. To read the white paper, click here.

CMS Says Quality Payment Program Exceeds Participation Goal in Year One

CMS Administrator Seema Verma last week detailed how the Quality Payment Program created under MACRA has exceeded expectations with 91 percent of Merit-Based Incentive Payment Systems (MIPS) eligible clinicians participating. Additionally, the submission rates for Accountable Care Organizations were at 98 percent and clinicians in rural practices were at 94 percent. Verma also praised the work that the agency has done in the “Patients over Paperwork” initiative and promised more to come. Click here to read the post.

  • New study published in the New England Journal of Medicine offers evidence that the quality measure for hospital readmission rates is getting less accurate over time, click here (subscription required).

Senate Committee Releases 22 Bills to Tackle the Opioid Crisis, Holds Field Hearing

The Senate Finance Committee has released 22 bills with the aim of reducing opioid abuse in Medicare and Medicaid, including several that mirror measures already approved by House Committees. The bills would make changes to Medicare or Medicaid to provide more information about substance abuse treatment and non-opioid pain therapies, expand telehealth services, and identify over-prescribers of opioids. This was followed up with a field hearing in Bensalem, PA where they heard testimony from government agencies, Independence Blue Cross, as well as a patient currently in recovery who discussed issues with payment policies. Click here for the bills introduced, and here to read the field hearing testimony.

  • The FDA announced it will collaborate with select companies to develop products to help with the opioid crisis, click here.
  • The Congressional Research Service released a report on prescription drug monitoring programs, that found that annual operating costs can range from $125,000 to nearly $1 million in each state, click here.
  • According to the AMA, between 2013 and 2017, the number of opioid prescriptions decreased 22.2 percent, by more than 55 million, click here.
  • A recent study found traces of oxycodone within the tissues of mussels in the Puget Sound region of the greater Seattle area, click here.
  • SAMHSA announced funding availability for mental health awareness training for up to $47.4 million over the next three years. Applications are due by Friday, June 8, 2018, click here.

Virginia is Latest State to Expand Medicaid

Virginia last week became the second state during the Trump Administration to expand Medicaid. The new policy will expand the program’s benefits to about 300,000 people. Virginia would be required to cover $269 million of costs between fiscal years 2019 and 2020, while the federal government would pay $3.12 billion, according to the latest report from the state’s budget office. Most of those costs are covered by provider taxes, particularly from hospitals. It is expected to take effect Jan. 1. Virginia will join 32 states and the District of Columbia in expanding Medicaid coverage. To read the state’s budget report, click here.

Oncology Group Sues to Stop Sequester Cuts to Cancer Drug Reimbursements

The Community Oncology Alliance has filed a lawsuit against CMS stating that the agency should stop applying a 2% sequester cut to Medicare Part D drug reimbursement. COA charges that the cut to Part B reimbursement is “illegal and unconstitutional.” The non-profit organization states that the automatic across-the-board cuts hurt patients in the form of less access to cancer care as treatment is pushed into higher cost hospital settings. They further state that since the cuts went into place in 2013, about 135 independent community cancer clinics have closed and about 190 clinics have been acquired by hospitals. Click here to view the suit.

  • The American Cancer Society and other stakeholders have updated their screening guidelines for colorectal cancer recommending that individuals 45 years and older receive regular screenings. Click here.
  • A brief from the Kaiser Family Foundation looks at how the President’s plan to reduce drug costs could affect Medicaid drug spending, including the Medicaid Drug Rebate Program. Click here.
  • The FDA outlines new steps the agency is taking to address the cause of more of intravenous drug shortage situations, click here.

State Officials Worry About “Scam Artists” in Association Plans
As the Department Labor finalizes the new rules for the new associations health plans, states worry that they will attract “unscrupulous operators to sell cheap policies with skimpy or nonexistent benefits,” according to a new report. These new, cheaper plans will not be required to have mental health care, emergency services or other types of coverage required by the ACA, making them much less expensive than the policies on the health care exchanges. Prior to the ACA, similar plans became insolvent resulting in hundreds of thousands of beneficiaries with hundreds of millions of dollars in unpaid medical bills from canceled plans. Click here for the study.

  • AHIP warns that ACA marketplace plans are likely to have double-digit premium increases next year, click here.
  • A new CBO analysis expects the number of uninsured people to rise over the next decade. They also provide an estimate the impact of two recent proposed federal rules on association health plans (AHPs) and short-term plans. Click here for the CBO report.
  • A new national survey of Americans 40 and over found they are not planning for their own long-term care needs, click here.
  • A new analysis has found that the individual mandate had big impact on coverage rates, click here.

GAO Announces New Board Members to MedPAC

The Governmental Accountability Office, the agency in charge of selecting the members of the Medicare Payment Advisory Committee, announced five new commissioners:

  • Karen DeSalvo, MD, MPH, MSc, Professor of Medicine and Population Health at the Dell Medical School at the University of Texas in Austin, TX (former Obama Administration Health Official);
  • Marjorie Ginsburg, BSN, MPH, Sacramento, CA;
  • Jonathan Jaffery, MD, MS, MMM, Professor of Medicine at the University of Wisconsin School of Medicine and Public Health in Madison, WI;
  • Jonathan Perlin, MD, PhD, MSHA, President of Clinical Services and Chief Medical Officer of HCA in Nashville, TN; and
  • Jaewon Ryu, MD, JD, Executive Vice President and Chief Medical Officer for Geisinger Health System in Danville, PA (Dr. Ryu has been reappointed).

Their terms will expire in April 2021; click here for more from GAO.

CMS to Bring Back Re-Tooled Home Health Demo

CMS announced last week it plans bring back a revised version of a home health demonstration that it stopped just over a year ago following concerns from beneficiary advocates and home health providers that the demo found more paperwork errors than fraud. CMS proposes to cut pay 25 percent to providers in demonstration states that don’t submit all claims for either pre- or post-pay review and after providers establish a good track record, they won’t have to submit all claims in the future. The previous version of the demo didn’t give providers the option of post-pay reviews. To read the announcement in the federal register, click here.

In Rural America, Tightened Access to Medicaid Means Tough Choices
Medicaid work requirements have now been implemented in a number of states to increase restrictions on access to Medicaid. 24 percent of rural kids live in poverty compared with 19 percent of urban kids. These additional restrictions are disproportionately harming those in rural areas where access to work, health care providers, and affordably priced groceries is already limited, according to an analysis. Stakeholders are urging improvements in policy to be sensitive to rural areas.  Click here to read more.

  • AHRQ study find that telemedicine is generally clinically effective but whether it saves money or gives higher quality care still unknown, click here.
  • The CAH Coalition is actively working to improve tele-health access and funding for Critical Access Hospitals.  Click here to learn more about the Coalition

China has Surpassed the U.S. in Healthy Life Expectancy

According to recent data released by the World Health Organization, China has now surpassed America in healthy life expectancy for the first time ever. This means a baby born in the US in 2016 can expect to expect to experience 68.5 years of healthy life, compared to 68.7 years for Chinese babies. Overall life expectancy for American babies is still greater than for Chinese babies, 78.5 years and 76.5 years respectively. However, U.S. overall life expectancy continues to trend downward from its peak in 2014 at 79 years. Click here for the study.

Nurse Salaries Highest in California, Hawaii 

Latest statistics from the Bureau of Labor statistics shows that nurses in California and Hawaii have the highest salaries, For details from the Bureau of Labor, click here.

Hypertension Costs Grow

Hypertension health care cost $131 billion per year, with a patient average of $2,000, according to the American Heart Association, click here.


‘Healthy Obesity’ Still Unhealthy: Study

A Nurses’ Health study shows that women with “healthy obesity” are still at high risk of heart attack and stroke, click here.

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