06 Mar March 5, 2018

March 5, 2018

Healthgrades Awards Best 50 and 100 Hospitals for 2018

Hospitals from 28 states made Healthgrades Top Hospitals list this year.  Healthgrades last week released America’s 50 and 100 Best Hospitals™ for 2018. The recipients, which represent the top 1% and 2% of hospitals in the nation, respectively, demonstrate superior clinical outcomes across the majority of common inpatient conditions and procedures and sustained this performance for at least five consecutive years, according to the Healthgrades announcement.

Healthgrades says patients treated in hospitals achieving the America’s 100 Best Hospitals Award™ have, on average, a 22.3% lower risk of dying than if they were treated in hospitals that did not receive this award. If all hospitals, as a group, performed similarly to hospitals achieving Healthgrades 2018 America’s 100 Best Hospitals Award, on average, 162,284 lives could potentially have been saved. Click here for a state-by-state list of 2018 awardees. Click here for the press release.

• Health policy expert, Ezekiel Emanuel, M.D., says hospitals are becoming obsolete.  Click here for his take.

340B Cuts Jeopardize Safety Net; 340B Reporting Bill Introduced; House 340B Bill Increases Co-Sponsors

Hospitals that treat large numbers of uninsured and low-income patients say critical patient services are in jeopardy after the Trump administration slashed $1.6 billion from a program that provides hefty discounts on certain drugs.  Click here for the report.  The Senate Health Committee indicated that they are planning an oversight hearing on the 340B drug discount program in early spring, but as early as next week.  Sen. Charles Grassley (R-IA) has introduced legislation to make hospitals report on savings they get from the 340B program. The Ensuring the Value of the 340B Program Act (S. 2453, click here) would make hospitals disclose acquisition costs for 340B drugs and reimbursement for those drugs from all payers, including Medicare, Medicaid, the Children’s Health Insurance Program, private health insurance and the uninsured. Meanwhile, the bill (H.R. 4392) introduced by Rep. David McKinley (R-WV) to overturn the CMS regulation to reduce payments to hospital on 340B drugs is now up to 189 co-sponsors; click here to see the list.

• The American Hospital Association released analysis last week that shows 340B hospitals spent more than $50 billion in community benefit in 2015, click here.  But two key senators are raising questions about benefits provided by not-for-profit hospitals.  Click here.
• A new analysis from GoodRx shows that list Rx prices are still going up a lot. The increase in cash prices over the past 12 months, per GoodRx: Diabetes medications: 15%, Birth control: 8%, Top 100 prescribed drugs: 6%, Generic drugs: 5%.  Click here for more.

Expand Hospital Readmission Penalties: MedPAC

MedPAC Commissioners last week discussed penalizing hospitals for all readmissions within 30 days instead of a small selected group of conditions that are currently measured for penalties. Congress had requested that the Medicare Payment Advisory Commission evaluate the effect of readmission policies had on observation stays and mortality. MedPAC’s conclusion was that readmission penalties have been successful and should be applied to all conditions. The recommendation is expected to be included in MedPAC’s June report to Congress. Click here to view the MedPAC slide deck.

Investigation: More than 260 Surgery Center Patients Die Since 2013

A joint investigation by Kaiser Family Foundation and USA Today shows that more than 260 patients have died since 2013 after in-and-out procedures at surgery centers across the country. For more than a year, using federal and state open-records laws, reporters gathered more than 12,000 inspection records and 1,500 complaint reports, as well as autopsies and EMS documents and medical records, together forming the foundation for this report. The study also found that surgery centers have steadily expanded their business by taking on increasingly risky surgeries. And some have been accused of overlooking high-risk health problems and treat patients who experts say should be operated on only in hospitals, if at all. And while most operations done in surgery centers are successful, some centers risk patient lives by skimping on training or lifesaving equipment. Others have sent patients home before they were fully recovered. Click here for the report.

Nearly a Third of Medicare Patients Have Surgery in Last Year of Life

Nearly 1 in 3 Medicare patients undergo an operation in the year before they die, even though the evidence shows that many are more likely to be harmed than to benefit from it, according to a new report.  The practice is driven by financial incentives that reward doctors for doing procedures, as well as a medical culture in which patients and doctors are reluctant to talk about how surgical interventions should be prescribed more judiciously, said Dr. Rita Redberg, a cardiologist in California featured in the Kaiser News article.  Click here.

Senators Want Health Care Pricing Transparency

A bipartisan group of senators announced last week they are seeking feedback from patients, providers and insurers to help them craft legislation that will make health care market pricing more transparent. A working group led by Sen. Bill Cassidy (R-LA) will first collect feedback about ways to lower health care costs. Other members of the group include Sens. Todd Young (R-IN), Chuck Grassley (R-IA), Michael Bennet (D-CO), Tom Carper (D-DE), and Claire McCaskill (D-MO). Cassidy said the group was seeking to know what information consumers currently have about prices and out-of-pocket costs; who should ultimately be responsible for providing information to consumers; and how to ensure that transparency requirements don’t “place unnecessary or additional burdens on health care stakeholders.” Responses to these and other questions posed by the workgroup are due March 23.  Click here for details.

• Cost is the No. 1 health care issue on voters’ minds in this election year. The latest Kaiser Family Foundation tracking poll finds that a plurality of all voters — 22% — rank costs as the health care issue they most want to hear candidates address in the midterms. Click here.

Congress Focuses on the Opioid Crisis

The House Energy and Commerce Health Subcommittee last week held the first of four planned hearings that reviewed eight opioid-related bills as part of a broader legislative push to address the addiction crisis. The bills covered a range of issues from cracking down on the trafficking of synthetic opioids to requiring additional training for clinicians who prescribe painkillers, and expanding access to substance abuse treatment in rural areas, among a host of other policies. The Full Committee Chairman Greg Walden stated during the hearing that he has an intent to have opioid legislation on the House Floor by Memorial Day.  The committee’s next two legislative hearings on opioid bills will be aimed at enhancing addiction treatment and recovery, as well as legislation dealing with insurance coverage.  Click here to view the hearing and read the written testimony.

• The Senate Health Committee examined the role of technology in preventing and treating addiction, click here. The Committee will hold a hearing this week on state programs to combat the crisis, click here.
• A bipartisan group of eight senators introduced a follow up to the 2016 Comprehensive Addiction and Recovery Act dubbed CARA 2.0 that outlines plans for spending some of the $6 billion in additional opioid funding in budget deal while proposing new policies addressing opioid prescribing. Click here for the bill, here for a one page summary, and here for a section-by-section.

White House Hosts Opioid Summit

The Trump administration is also focused on opioids – and the White House hosted a summit last week focused on its own efforts to address the crisis. HHS Secretary Alexander Azar stressed that the Trump administration views the opioid epidemic as a disease rather than a moral failing, and it will take that approach in its policy implementation. He followed that up by saying that the Department plans to dedicate $750 million in funding to researching non-opioid pain treatments through the NIH. Click here for more on the White House Summit.

• The Department of Justice launched a task force aimed at holding opioid manufacturers accountable for unlawful marketing practices and ensuring distributors obey DEA rules designed to prevent diversion and improper prescribing, click here.
• The CDC updated 12-month counts for overdose deaths in each of the 50 states and District of Columbia. The interactive tool provides the number of deaths for the 12-month period ending July of 2017 and graphs the percent change from the previous 12-months for each jurisdiction, click here.
• CMS has approved Medicaid waivers in Utah and New Jersey that their governors say will expand access to treatment for residents with opioid addiction, click here.
• FDA sends letter to online retailers requesting they limit the sale of an over-the-counter, anti-diarrheal medicine that drug users are taking to mimic a euphoric high from opioids, click here for details.

House Passes a Group of Health Care Bills

The House, in a mixture of overwhelmingly favorable roll call and voice votes last week, passed a group of health care measures. The legislation includes the following:

• The MISSION ZERO Act that urges military-civilian partnerships for trauma care (H.R. 880), click here.
• The Recognizing the importance and effectiveness of trauma-informed care Act that encourages the use and practice of trauma-informed care within the federal government (H Res 443), click here.
• The Congenital Heart Futures Reauthorization Act of 2017 that seeks to coordinate research on congenital heart disease (HR 1222), click here.
• The Sickle Cell Disease Research, Surveillance, Prevention, and Treatment Act of 2017 that seeks to coordinate research on sickle cell disease (HR 2410), click here.
• The SOAR to Health and Wellness Act of 2018 a bill to support health professional training to identify trafficking victims (HR 767), click here.
• The Action for Dental Health Act of 2017 that would authorize the Health Resources and Services Administration and Centers for Disease Control and Prevention dental health care grant programs (HR 2422), click here

CMS Announces Funding Opportunities for Help with QPP

Kate Goodrich, MD, Director, CMS Center for Clinical Standards and Quality & CMS Chief Medical Officer, last week requested help from clinicians, patients, and other stakeholders to develop, improve, update, and expand quality measures for use in the Quality Payment Program, Medicare’s physician payment program. CMS pledges to provide up to $30 million of funding and technical assistance to those who help with the project. Under the “cooperative agreements” CMS will collaborate with stakeholders to address essential topics such as: clinician engagement, burden minimization, consumer-informed decisions, critical measure gaps, quality measure alignment, consumer-informed decisions, clinician engagement, and efficient data collection that minimizes health care provider burden. Click here for more from CMS.

• A group of health policy experts are making a case for the elimination of MIPS, the Merit-based Incentive Payment System, used by Medicare for physicians not otherwise in an advanced alternative payment program.  Click here for their Health Affairs article.

Nurse Licensure Compact Now Requires Criminal Background Check

The National Council of State Boards of Nursing has launched a new version of the Nurse Licensure Compact that requires federal fingerprint criminal background checks.. Twenty-nine states have passed legislation to join the new agreement. More states are expected to sign the agreement now that criminal background checks are required.  Nine states have legislation pending to join.  Among states participating in the new nurse licensing compact are Iowa, Kentucky, Tennessee, Delaware, Idaho and Arizona. Click here for details.

Federal Judge Says Insurers Risk Adjustment Program Must Be Rewritten

The formula used by HHS to determine which Obamacare insurers must pay into a program designed to protect them from big losses is “arbitrary and capricious” because it wrongly assumes that the program must be budget neutral, a federal judge ruled last week. The court vacated the rules established by HHS for assessing payments under the “risk adjustment” program and directed the department to redo the formula, casting uncertainty over billions of dollars in payments that have been made since 2014.  The risk adjustment program was one of three tools established by the ACA to mitigate risk for insurers entering the exchanges. The other two programs — risk corridors and reinsurance — expired after three years, but the risk adjustment program is permanent. The case could have national implications. Other insurers that have been forced to pay into the program could file similar claims based on the ruling. Click here for the ruling.

Universal Flu Vaccine in the Works

The National Institute of Allergy and Infectious Diseases last week released its strategic plan to develop a universal flu vaccine. Writing in the Journal of Infectious Diseases, NIAID officials stated that they will focus resources on researching influenza transmission, how the infection develops over time, how immunity to the virus occurs and how to design a vaccine. The stated goal is to make the vaccine at least 75 percent effective and last for at least one year. To read more from NIAID, click here.

CVS and Aetna Face House Committee on Merger and Impact on the Supply Chain

Officials from CVS Health and Aetna faced questioning last week from a key House Subcommittee about their planned $69 billion merger. Representatives easily dispensed with queries about whether the deal will hamper independent pharmacies or reduce competition in the pharmacy benefit management sector. Instead, the officials promised that the new health care juggernaut will bring much-needed innovation and efficiency to the health care sector. Click here to read the written testimony and watch the hearing.

CDC: 1 in 14 women still smoke while being pregnant In 2016, the CDC detected about 1 in 14 pregnant women who gave birth in the United States smoked cigarettes during her pregnancy with the prevalence varying greatly by state. Sadly, the smoking rates in pregnant women continue to increase. The prevalence of smoking was the highest in West Virginia, where 25.1% of women reported smoking at any time during pregnancy, and lowest in California, which was 1.6%. The prevalence of was highest among non-Hispanic American Indian or Alaska Native women at 16.7%, followed by non-Hispanic white women at 10.5%. However, the higher the education level, the less the prevalence of women smoking while pregnant – women with a high school diploma or GED (12.2%), women with some college or an associate’s degree (7.9%), and women with a bachelor’s degree or higher had a prevalence of smoking during pregnancy of 1.0% or less. Click here for the full report

Seven Organizations Recognized as Champions of Rural Health Care

The Health Resources and Services Administration last week announced seven rural community-based organizations recognized for their outstanding work through their grant programs funded by the Federal Office of Rural Health Policy. The organizations were acknowledged from across the nation as champions in providing high-quality access to health care in rural communities specifically for their work in developing and implementing innovative strategies; adopting evidence-based/promising practice models; leading sustainable advancements in increasing access to health care; and improving health care quality within rural communities. According to HRSA, the champions also exhibited success in disseminating their lessons learned beyond local audiences and exhibiting leadership through mentoring, coaching and partnerships. To view the awardees and read more on the program, click here.

Critical Access Hospital Leaders Discuss Strategies for Success CAH leaders feel the pressure to be agile and innovative in order to continue providing critical care to their communities in spite of financial and regulatory challenges. Challenges unique to Critical Access and other rural hospitals include, “limited funding, regulatory restrictions, problems with transportation, broadband internet accessibility and the unique characteristics of the population.” To hear more from these leaders about the challenges and solutions they have found for their communities from NPR, click here.

• The CAH Coalition is actively working with Congress and federal agencies to support the needs of Critical Access Hospitals. To read the CAH Coalition’s most recent newsletter, click here.

Red Wine’s Health Benefits Grow  Red wine prevents heart disease, as well as gum disease. Red wine contains polyphenols, which are a series of micronutrients with antioxidant properties which have shown to protect against free radicals, a highly reactive oxygen molecules created as a normal byproduct for metabolism. In the study conducted by Valencian, scientists compared the effect of two types of polyphenosl typically found in red wine as well red wine and grape seed extracts on three harmful oral bacteria: Fusobacterium nucleatum, Streptococcus mutans, and Porphyromonas gingivalis. As a result, two red wine polyphenols were found to be most effective at repelled harmful oral bacteria and preventing them from attaching to healthy tissue. Click here for the full report