29 May May 29, 2018

House Plans To Take Up 70+ Opioid Bills Next Week

While Congress is in its Memorial Day recess this week, congressional staff is putting together a package of bills to tackle the opioid crisis. The package encompasses over 70 bills that were approved by the House Energy and Commerce Committee, the House Ways and Means Committee, the House Judiciary Committee and other House committees. The bills impact various parts of the health care system, including requiring Medicare to better identify seniors at risk of opioid misuse and temporarily lifting a Medicaid restriction on inpatient substance abuse treatment at medium-sized and large facilities. Additionally, the package also addresses patient privacy issues, building up the provider workforce, encouraging non-opioid treatments for pain, and giving law enforcement additional tools. For more details from the Energy and Commerce Committee, click here, more from the Ways and Means Committee, click here, and for the Judiciary Committee, click here.

• A coalition of medical and addiction services groups sent a letter to the HHS Secretary to plea for Medicare payment changes for surgical procedures assuring that patients have access to non-opioid pain medications, click here.
• Also introduced last week, the Fighting the Opioid Epidemic with Sunshine Act – backed by Sens. Chuck Grassley (R-I), Sherrod Brown (D-OH) and Richard Blumenthal (D-CT) – would require drug companies and medical device makers to publicly disclose payments made to providers for promotional talks, consulting, and other interactions, click here.
• The HHS Office of Inspector General testified before the Senate Special Committee on Aging on Preventing and Treating Opioid Misuse Among Older Americans, click here.

“Surprise” Emergency Room Medical Bills Are a Continuing Problem: Analysis

After reviewing more than 1,300 patient bills from emergency rooms from across the United States, a Vox media analysis says  the dominant storyline to emerge is what anyone who has visited an emergency room might expect: Treatment is expensive. Fees have risen sharply in the past decade. And when health insurance plans don’t pay, patients are left with burdensome bills. Click here for the story.

• The government’s new Medicare Handbook for seniors has a number of changes in it that at least one analysis will be good for providers because it makes Medicare Advantage look more attractive. Click here.

DOJ Expected To Increase Health Care Anti-Trust Enforcement Efforts

In a keynote address at the American Bar Association’s Antitrust in Healthcare Conference last week, Deputy Assistant Attorney General Barry Nigro said DOJ will rigorously prosecute Medicare fraudsters and price gouging by drug makers, and continue to cast a skeptical eye toward mergers, potential collusion among health systems and payers. Regarding exemptions and immunities from the antitrust laws, Nigro said, “Exemptions and immunities should be limited. Often, when an industry is bestowed with an exemption or immunity, competition is displaced, or cabined, by government regulation. The Division is skeptical of any claim that government regulation prevents competitors from exercising market power or that consumers do not benefit from the forces of competition to protect their interests.” Click here to read the entire speech.

New GAO Reports on 340B Expected this Summer

Following its testimony before the Senate Health Committee on the 340B drug discount program, the Government Accountability Office is due to release at least two more reports this summer. One report will look at the growth of contract pharmacies used to dispense 340B drugs and HRSA’s oversight of them, and a second will compare 340B and non-340B hospitals and how differences between them changed after Congress expanded the program under the Affordable Care Act. To read GAO’s latest testimony on the 340B program, click here.

Trump Administration Continues Push on Drug Price Reduction Plans

HHS Secretary Alex Azar will testify before the Senate Health Committee June 12th on the President’s plan to lower drug prices. This has become a major priority for the Administration involving several agencies. Click here for the hearing announcement. HHS has pushed the need for the plan by posting on its blog testimonials from patients who struggle to pay for drugs, click here.

• Who’s taking the behind-the-scenes-lead at the White House on the Administration’s drug plan?   Former pharma exec Joe Grogan has emerged as a major contributor, if not lead author, of the plan, according to a new report. Click here.
• The President also signed legislation, the Right to Try Act, that would allow terminally ill patients nationwide to directly request experimental treatments from drug makers and bypass the FDA, click here.
• A new analysis finds that the price of generic drugs has remained flat but the cost to seniors is increasing, click here.
• Another study finds that moving certain Part B drugs to Part D, which is included in the Administration’s drug proposal, would lead to beneficiaries to paying more, click here.
• Some physicians are weighing in with their own play they say will actually reduce drug prices, while Trump’s plan won’t.  Click here.
• Pharmaceutical giant Pfizer is paying $24 million to settle federal claims it illegally covered seniors’ co-payments for three of its drugs in order to boost profits, click here.

President Set to Sign Veterans Bill to Expand Private Sector Health Care Access

Both the House and Senate overwhelmingly voted to pass the bi-partisan bill, S.2372, designed to broaden access to care for veterans from the private sector.  The bill now heads to the President for his signature. The MISSION Act would also consolidate the Veterans Choice Program with other community care programs that provide medical care to veterans outside the VA system, and authorize $5.2 billion in funding to keep it running through fiscal year 2019. The President is expected to sign the bill. To view a Strategic Health Care summary of the bill, with links, click here.

Senate Committee Advances Bioterrorism/Pandemic Legislation

The Senate Health Committee last week overwhelmingly endorsed legislation to renew programs to respond to bioterrorism and pandemics like influenza and Zika. The panel voted 22-1 to advance a reauthorization bill, S. 2852, the Biomedical Advanced Research and Development Authority. The bill would give additional flexibility to prepare for pandemic flu, antimicrobial resistance and other significant threats. Additionally, it would reauthorize the Strategic National Stockpile and the BioShield Special Reserve Fund, and set up a national advisory committee on seniors and disasters. The legislation reauthorizes the Hospital Preparedness Program with an increase that sets total annual funding at $385 million between 2019 and 2023. Click here for a summary of the bill, and here for the legislation.

Congress Renews Focus on Graduate Medical Education Funding

Republican senators last week raised concerns with how the graduate medical education system is working, suggesting that there are inequities in the distribution of residency slots and asking whether training should be based out of clinics and health centers rather than hospitals. Sen. Bill Cassidy (R-LA) voiced concerns about the “geographic maldistribution” of residency slots, noting that the Northeast — particularly New York and Boston — has a high concentration of slots.  During a hearing, Kristen Goodell, assistant dean for admissions at Boston University School of Medicine, said the way that spots are distributed should be changed so that more slots are allocated to places where they are needed.  On the other side of the Capitol, House Energy and Commerce Health Subcommittee members praised the Children’s Hospitals Graduate Medical Education program, which provides money to hospitals that train pediatricians.  Funding for the program expires later this year, but committee Chairman Greg Walden (R-OR) indicated the bill would pass the House before the authorization runs out in the fall. Click here for the Senate HELP hearing, and here for the Energy and Commerce hearing.

• New study finds that, after ACA implementation, teaching hospitals increased their overall community benefit spending while their charity care spending declined, click here.
• A new media analysis provides details on how not-for-profit hospitals spend tens of millions of dollars every year on lawyers and bankers from the issuing of debt.  Click here.

CBO Says President’s Budget will Decrease Federal Health Spending; Trump Threatens Shutdown

The Congressional Budget Office last week released an analysis of the President’s fiscal year 2019 budget and found that it would reduce federal spending for health care by $1.3 trillion, or a total of 8 percent, through 2028. Most of the savings, $954 billion between 2019 and 2028, comes from the proposal to phase out major provisions of the Affordable Care Act and replace federal subsidies with block grants to states. This proposal largely mirrors the one set forth by Sens. Lindsay Graham (R-SC) and Bill Cassidy (R-LA) last fall that would repeal Medicaid expansion under the ACA, establish per-capita caps and provide $120 billion for block grants to states in fiscal 2020. To read the full report, click here.

• Complicating this year’s budget picture is a new threat from the President to shutdown the government if Congress sends him another $1 trillion-plus government-wide spending bill, like it did in March, click here.

Slight Rise in Uninsured in 2017: CDC

According to the 2017 National Health Interview Survey released last week by the Centers for Disease Control, the national rate of uninsured Americans went up slightly but not significantly in 2017, to 29.3 million people, or 9.1 percent of the population, up from 28.6 million in 2016. The study found that in 2017, 9.9 million people under age 65 purchased insurance on the state or federal exchanges and that adults between ages 18 and 64 were less likely to be uninsured if they lived in a state that had expanded eligibility for Medicaid than if they lived in a state that hadn’t. To read the full report, click here.

• A new poll suggests that between 49 and 59 percent of voters in six key states said they hold Republicans  responsible for insurance premium increases, click here.
• CBO’s projections that 5 million more Americans will be uninsured in 2027 because of the removal of the ACA’s individual mandate penalty is a main reason for the increase, click here.

Employer Health Costs Remain Relatively Stable: Milliman

The growth in health care costs for employer-based coverage remains mostly under control, according to the latest installment of the Milliman Medical Index — one of the most widely respected measurements of those costs. For example, Milliman reports the cost of employer-based health coverage rose by about 4.5% from 2017 to 2018.  That’s the second-lowest rate of growth since 2001, but it’s still a spike of more than $1,200 for the year. Click here for the Milliman report.

Battle Rages Between Largest Insurer and Renal Provider

America’s largest health insurer, UnitedHealth Group, has filed a pair of lawsuits against kidney care company American Renal Associates alleging that the national dialysis chain conspired to funnel patients into private insurance plans to pump up its profits. UnitedHealth alleges that the dialysis company engaged in a “fraudulent and illegal scheme” to dupe Medicare and Medicaid beneficiaries into enrolling in the insurer’s ACA plans. They additionally contend that the company offered joint venture agreements to lure nephrologists out of United Healthcare’s network so that American Renal Associates could then bill United higher rates for dialysis care. Click here for details.

Cancer Death Rates Continue Steady Decline

According to the National Cancer Institute, cancer death rates have declined steadily declined over the last two decades among men and women and across all ethnic groups. The report details how from 1999 to 2015, the overall death rates from cancer decreased by 1.8 percent per year among men and 1.4 percent among women. In the last four years of the time period, the study – a joint effort among the National Cancer Institute, CDC, the American Cancer Society and the North American Association of Central Cancer Registries – shows that the rates decreased for 11 of the 18 most common cancer types in men and for 14 of the 20 most common cancer types in women. Click here for the report.

• The House last week passed S. 292, the Childhood Cancer STAR Act, by voice vote, that will help advance both research on and treatments for pediatric cancer, click here.

Congress Starts Work on Maternal Mortality

Both the House and Senate are set to work on the rising maternal death rates in the United States in the coming months. Every year, 65,000 American women almost die from pregnancy or childbirth and hundreds more die, with an unclear picture as to why. The House Energy and Commerce Health Subcommittee is planning to hold a hearing on maternal mortality, as requested in a letter from the committee’s Democratic leadership.  Over in the Senate, Patty Murray (D-WA), the top Democrat on the Health Committee, said she has been pressing for consideration of a maternal mortality prevention bill – the Maternal Health Accountability Act.  It has 26 co-sponsors. Click here for a good media report on the topic, here for the Energy and Commerce letter, and here for the Senate bill.

HRSA Grant Will Train Rural Veterans for Nursing
A nearly $1 million grant from HRSA has been awarded to St. Scholastica, a private college in Duluth, MN, to train veterans from rural areas in the nursing field. The INVITE – Implementation of a Nursing Veterans’ Initiative to Transform Education – program will provide rural Minnesota with growth in the nursing workforce while utilizing the student veteran population at St. Scholastica. Click here to read more about the program.

• The Critical Access Hospital Coalition in Washington, D.C., continues its work with CAHs across the country to address funding and workforce needs. Click here to learn more about the CAH Coalition.

Report Finds Disappointing Results in CMS’ Comprehensive Primary Care Initiative

The Comprehensive Primary Care Initiative has failed to lower Medicare spending or improve quality, according to a new research report. The researchers proposed three key reasons for the disappointing results of the Obama Administrations initiative:

• Weak financial incentives for primary care practices in the program, the specialists they work and their patients.
• Barriers to practice including reporting burdens, limited access to data and poor health IT.
• Other non-CPCI practices made improvements on their own, which raised the performance bar for the primary care practices to show results.

The report said the CPC program and its offshoot, CPC+, have had a lot of attention paid to them from health IT vendors and value-based pay enthusiasts, although not always good attention. Overall, CMS’ Innovation Center has struggled to demonstrate that its value-based pay models actually save money in practice. Click here for the study.

Primary Care Physicians Unaware of CMS Payments for Chronic Care Management

A majority of primary care physicians say they are unable to adequately address the needs of their patients with multiple chronic conditions. But many are also unaware of a Medicare program that will reimburse them for services that help keep tabs on those patients between doctor visits, according to a new survey.  Click here.