November 19, 2018

Bi-Partisan Senate Leaders Support Plan to Require Drug Prices in Ads
The next Senate Finance Committee Chair Chuck Grassley (R-IA) and Minority Whip Dick Durbin (D-IL) sent a letter to HHS Secretary Alex Azar and CMS Administrator Seema Verma to support the Administration’s proposal to require pharmaceutical companies to include list drug prices in television advertisements. The letter states that the average American sees nine drug advertisement a day, and direct-to-consumer ads inflate the demand for the most expensive drugs. They further state that they are “committed to helping reduce prescription drug prices by requiring price disclosure in direct-to-consumer pharmaceutical advertisements as well as other measures.” For the full letter, click here.
  • In stark contrast to the efforts of the President, Pfizer Inc. is raising the list price of 41 of its prescription drugs – 10 percent of its portfolio – on average by 5-percent, after holding off amidst pressure from the Administration, click here.
  • Generic drug manufacturers last week opposed the President’s new North American trade agreement, warning it would raise the cost of prescription drugs unless changes are made, click here.
Illness Costs Employers $530 Billion Per Year
That’s according to the Integrated Benefits Institute based on its Health and Productivity Questionnaire and nationally-representative data from the CDC and Bureau of Labor Statistics. The data shows that chronic health conditions result in approximately $198 billion worth of reduced performance each year, and absences due to illness, workers’ comp as well as family and medical leave cost about $178 billion annually. This amounts to 60 cents for every dollar spent on healthcare benefits for employees and their dependents. Additionally, chronic illness amounts to the equivalent of 527 million lost work days per year – or nearly 2% of the total labor inputs. Click here for more on the data.
  • According to Altarum Institute, health care spending in September was 4.8 percent higher than it was during the same period in 2017, and health care now represents nearly 21 percent of GDP, up from 19 percent two years ago, click here.
  • In an effort to lower health care spending, Walmart will require its employees to use certain hospitals for costly spine surgeries, click here.
CMS Touts Improper Payment Rate at Lowest Since 2010
In a blog post last last week, CMS Administrator Seema Verma announced that the Medicare Fee-for-Service improper payment rate is at the lowest it has been since 2010 – representing about a $4.5 billion decrease. Additionally, the agency has reduced improper payments in not only Medicare but also Medicaid and CHIP. Verma states that the reduction is due to metrics that the agency utilizes for measuring appropriate expenditures and an “effort to target root causes of improper payments.” The blog further details the work that CMS plans to continue across all sites of service within the Medicare FFS program. To read the full blog, click here, and the fact sheet in the improper payment reductions, click here.
Advanced Practice Nurses the Key to Primary Care Shortage?
A new report says that nurse practitioners could be a solution to the country’s primary care physician crisis. They contend that a significant amount of research shows that the quality of care provided by nurse practitioners is just as good and, in some cases, even better than the care provided by primary care physicians. However, many states limit the scope of practice of  nurse practitioners with supervisory requirements. Researchers recommend that lawmakers, hospital administrators, health care systems, and others involved in primary care should work to remove restrictions on nurse practitioners’ scope-of-practice, and physicians should work with nurse practitioners to build a workforce that is more responsive to communities’ health needs. Click here for the full report.
Physician Advisory Committee Will Review Cardiology and Oncology Bundles
The Physician-Focused Payment Model Technical Advisory, created by MACRA, has released the two proposals that it will vote on at its December 10th meeting – Bundled PCI Services in a Non-hospital Cath Lab and Making Accountable Sustainable Oncology Networks (MASON). The Bundled PCI proposes to allow qualified non-hospital cardiac cath labs to perform Percutaneous coronary intervention (PCI), also known as coronary angioplasty, on appropriate patients at a global bundled price. The MASON proposal, would use a combination of claims and clinical data to create an Oncology Payment Category (OPC) visible online to practices and CMS, to create an accurate cost target for an oncology bundle. Click here for the PTAC agenda, here for the Bundled PCI proposal, and here for the MASON proposal.
Current Law Hinders Telehealth Expansion
According to a report by CMS released last week, the laws governing telehealth actually limit it as a healthcare option for seniors. Without asking for legislative recommendations, the 21st Century Cures Act passed last year mandated CMS to compile a report on the number of Medicare enrollees using telehealth services as well as a review of the barriers to expanding usage. Almost 90,000 Medicare beneficiaries used 275,199 telehealth services in 2016, about one-quarter of 1%, or 0.25% of the more than 35 million fee-for-service Medicare beneficiaries. The low usage rate mainly due to the limits of the program under law — only certain providers are able to bill for telehealth and it is only for beneficiaries in rural areas with a shortage of health professionals or in a counties outside of a metropolitan areas. Click here for the full report.
In Era of High Deductible Plans, Providers Find Debt Collection Difficult
According to an investigation by Bloomberg News, physicians now see much of their job as dealing with debt collection from patients — as more than 50-percent of privately insured Americans under age 65 have deductibles anywhere from $1,300 to as high as $6,550 annually. Citing a 2015 report by Accenture, independent physicians cited reimbursement pressures as their biggest concern for staying in business.  Lab-testing corporation, Quest Diagnostics, reported $80 million in lost revenue as 20-percent of services billed to patients in the third quarter of this year went unpaid. Bottom-line, the increase of high deductible plans have led to increased debt for not only patients but also providers. Click herefor the full article.
Grassley Takes Finance; House Dems Working on Committee Assignments
Senator Charles Grassley (R-IA) says he will head the Finance Committee in the next Congress, the most important health policy committee in the Senate.  It is likely that he will make helping rural hospitals his highest health care priority.  House Democrats are still sorting out their committee positions.  There may be a contest for the Health Subcommittees of both Ways and Means and Energy and Commerce.  Before leaving for the year, Congress will work on funding the government (about a third of the government’s funding expires December 7).  Drug prices, shoring up the ACA, protecting pre-existing conditions are priorities of Democrats, while state innovations and flexibility in the health care market lead Republican agendas. Late last week, Health Affairs published a couple of articles detailing some of the questions both parties need to look at in the next Congress. Click here for the look at the “Democratic perspective,” andhere for the “Republican view.”
Suicide Rate Increasing Among Working Age Population: CDC
According to the CDC, the suicide rate among the US working age population increased 34 percent during 2000-2016. In 2012 and 2015, suicide rates were highest among males in the Construction and Extraction occupational group (43.6 and 53.2 per 100,000 civilian non-institutionalized working persons, respectively) and highest among females in the Arts, Design, Entertainment, Sports, and Media group (11.7 and 15.6 per 100,000, respectively).  From 2012 to 2015, suicide rates increased most for males in Arts, Design, Entertainment, Sports, and Media occupations (47 percent) and for females in Food Preparation and Serving Related occupations (54 percent). Click here.
  • Last week, CMS sent letters to State Medicaid Directors that outlines both existing and new opportunities for states to design innovative service delivery systems for adults with serious mental illness and children with serious emotional disturbance, click here.
Children’s Polio-Like Illness Continue to Spread
Acute flaccid myelitis, known as AFM, causes muscle weakness and in some cases paralysis in the arms or legs, terrifying parents and puzzling medical researchers, and now has 90 confirmed cases in 27 states of 252 reports in 39 states and Washington, DC. There are now 252 patients, most are children between the ages of 2 and 8 years, under investigation for AFM, an increase of 33 patients since last week according to the CDC. CDC announced an AFM task force of national experts last week in multiple disciplines to help us develop a comprehensive research agenda to further understand why AFM affects some children. However, combating the disease may be difficult as state and federal governments largely have stopped making new investments in public health and investments are already stretched. Clickhere for the CDC announcement, and here for an analysis from Pew.
FDA Steps Up Push to Stop Underage Smoking

FDA Commissioner Scott Gottlieb last week announced a number of actions aimed at addressing the rising trend of youth nicotine use. To start, the agency banned the sale of sweet and fruity flavored vapors at most convenience stores and gas stations unless the products are in closed-off areas that are inaccessible to minors, as well as halting online purchases until company websites install age-verification safeguards. Additionally, the FDA will advance a Notice of Proposed Rulemaking that would seek to ban menthol in combustible tobacco products, including cigarettes and cigars. Saying that curbing youth usage of tobacco is the highest priority, the Commissioner stated, “And when it comes to protecting our youth, we’ll continue to actively pursue a wide range of prevention and enforcement actions. We’ll leave no stone unturned.” For the full statement, click here.

  • According to the National Youth Tobacco Survey released by the CDC, E-cigarette use rose 78 percent among teens and 48 percent among middle school students in 2018, click here

100 Hospitals, Quest Diagnostics, LabCorp Now on Apple Health App
Following LabCorp, Quest Diagnostics is now connected to its patients through an Apple’s Health app. Patients will now be able to access their health information including allergies and immunizations through the iPhones HealthApp in addition to the MyQuest app already available on smartphones, tablets, or desktop computers. About 100 hospitals have also signed a deal with Apple to use the Health app. Health Professionals are hoping that this move helps the patient be more informed about their health and take more steps to manage it. By integrating MyQuest with the Apple Health App, patients will now be able to integrate their lab data into the overall picture of their health. Click here for more.


More Evidence that Low-Carb Diet Is Good for Overall Health

A new study found that overweight adults who cut carbohydrates from their diets and replaced them with fats greatly increased their metabolism. Participants in the study who were on the low-carb diet burned an average of 250 more calories per day than people on a high-carb, low-fat diet. This study challenges the conventional wisdom that reducing portion sizes and lowering fat intake is the key to weight loss. Researchers believe this study has the potential to improve the success of obesity treatment. Read the study here.


Love of Coffee Is in Your Genes

So says a new study from Northwestern University that found the more sensitive people are to the bitter tastes of caffeine, the more coffee they drink and the sensitivity is caused by a genetic variant. The researchers collected data from over 400,000 people and concluded that coffee consumers acquire a taster ability to detect caffeine due to the learned positive reinforcement of stimulation elicited by caffeine. People have learned to associate “good things” with the bitter taste of caffeine and therefore drink more of it. The findings suggest our perception of bitter tastes, informed by our genetics, contribute to our drink preferences. For the report from Northwestern University, click here. For the full published study, click here.

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