October 21, 2019

More than 100 CAHs Urge Senate To Change Surprise Billing Legislation
In letters to all 100 senators, more than 100 Critical Access Hospitals from 30 states urged the Senate to change the surprise billing legislation to be less burdensome on CAHs. “We strongly support the stated goal of the legislation – to protect patients from surprise medical bills from out-of-network providers the patient did not or could not choose. But the legislation goes far beyond this goal and imposes administrative requirements that will increase our costs by requiring additional staff; limit our ability to collect fees owed for services provided; and subject us to civil monetary penalties for items out of our control.   This bill could force more critical access hospital closures, further limiting health care choices for patients in rural areas.” Click here for the letter.
  • In a letter addressed to Seante leaders from 111 medical organizations, including the American Medical Association, the groups expressed their desire to end surprise medical billing without creating an imbalance in the private health care marketplace. The organizations state their main concern with the current plan that will artificially lower payment rates and not cover real costs. To read the letter, click here.
  • The conserative National Taxpayers Union is out with an article opposing surprise billing legislation that would benchmark prices, saying it could lead to shortages and unnecessary costs that burden patients and taxpayers and rural hospitals, click here.
House Rx Price Cutting Bill Advances; Senate Future Uncertain
The House Energy and Commerce Committee and the House Labor Committee have approved Speaker Nancy Pelosi’s drug pricing bill (H.R. 3). The bill would allow for Medicare to negotiate for lower drug prices on up to 250 of the most expensive drugs per year and would also allow Medicare to apply those discounts to private health plans throughout the country and apply a penalty to drug manufacturers who refuse to negotiate or fail to reach an agreement with the U.S. government. The penalty is said to start at 65 percent of the gross sales of that drug. The Congressional Budget Office estimated that the bill would save $345 billion for Medicare over seven years as well as provid savings that would result in lower premiums for commercial health insurance. While the bill is expected to pass the House, Senate Majority Leader Mitch McConnell declared the bill dead on arrival in the Senate. Click here for a summary of the bill of bill prepared by the Speaker’s staff. Click here for the Energy and Commerce markup and here for the Education and Labor markup. For the CBO estimate, click here.
  • What will House members do with the $345 billion in savings?  Create new Medicare benefits for hearing, vision and dental is the likely answer.  Click here to review the bills that also passed committee to expand benefits.

New Drug Prices Skyrocketing; New Generic Drug Consortium Makes First Delivery
New research finds that future new drug launch prices are predicted to skyrocket, according to 46brooklyn Research. Since 2006, the median monthly price of a new brand-name drug has increased by 381 percent, and the median monthly price of a new generic drug has increased by 712 percent. Meanwhile, Civica Rx, a group made up of health systems to develop their own generic drugs and combat shortages, made its first delivery of vancomycin hydrochloride to Riverton Hospital in Utah earlier this month. Civica Rx partnered with the supplier, Xellia Pharmaceuticals, to provide Vancomycin, which is expected to become available to its member hospitals at the end of this month. 16 other Civica Rx medications are in production to be delivered later this year. Click here for the 46brooklyn study and here for more on Civica Rx.

Number of Vaping Illnesses Grows; Illness Gets Official Name: EVALI 
The Centers for Disease Control and Prevention now says vaping has resulted in 33 deaths and 1,479 people falling ill from the products. The CDC is now calling the illness EVALI, which stands for e-cigarette, or vaping, product use associated lung injury. Additionally, the CDC warns healthcare providers that individuals who develop EVALI may be at risk for developing severe complications of the flu and other respiratory illnesses that spread during the winter. Both the CDC and the FDA continue to study the effects of vaping and e-cigarette. Click here for more information.
  • E-cigarette manufacturer JUUL announced last week that it would suspend all sales of its non-tobacco and non-menthol-based flavored pods pending FDA reviews, click here.

Teen Suicides Have Increased by 56 Percent: CDC
Suicide rates among people 10-24 years old are increasing, according to a new CDC report. Rates among this age range had been stable until 2007, when it increased 56 percent. Most recently, in the last five years, the suicide rates from 10-24 year-old individuals has surpassed the homicide rate. In 2017, suicide and homicide were the second and third leading causes of death for persons aged 15–19 and 20–24 – and ranked second and fifth among persons aged 10–14. To read the full report, click here.

U.S. Healthcare Spending Increases; Rx Leads the Way; Home Health Has Slowest Growth
An Altarum analysis shows total spending on prescription drugs increase by 8.5 percent year-over-year. Spending on healthcare overall, was 4.5-percent higher in August 2019 than it was in August 2018, resulting in $3.87 trillion. While spending on prescription drugs grew the fastest, spending on home health care grew the slowest, at 1.5 percent. The total 4.9 percent growth rate on national health spending for the year to date is closely on par with CMS’ 4.8-percent prediction for the year. Click here to read more.
  • A recent study from the Society of Actuaries estomates the economic toll of non-medical opioid use from the last four years to be at least $631 billion, click here.
Medicaid Spending To Increase by 6.2% in FY20
According to a new report from the Kaiser Family Foundation, states are budgeting for an increase in Medicaid funding for FY 2020 fueled by rising prescription drug costs, provider rate increases, the opioid epidemic, and higher costs for care for the elderly and disabled. While the data shows an average expected increase of 6.2 percent, Medicaid enrollment is expected to increase less than 1 percent next year. The survey also contains information on state Medicaid programs including but not limited to work requirements, social determinates of health, and the opioid epidemic. Click here for a summary. To view the full report, click here.
Some Insurers Cover Genetic Tests for Psychiatric Drugs, Despite Controversies
Companies have created genetic tests with a goal to allow patients to save time finding effective psychiatric medication and avoid the lengthy trial/error process of trying to find a proper medication, as well as to prevent insurance companies from paying for the medications a person does not respond to. Even though the FDA warns against genetic testing for psychiatric drugs, claiming that such tests might lead patients to taking the incorrect drug, UnitedHealthcare began covering these services this past month as part of its group and individual plans. As a result of United’s decision to cover genetic testing, the CEO of one of the companies that manufactures the tests hopes the decision will lead to more insurance companies including genetic testing for psychiatric drugs in order to stay competitive.  Click here to learn more on the controversy.
Study: U.S. has Greatest Number of Top-Ranking Hospital Cities
According to a new study, the United States has the greatest number of high-ranking hospital cities among developed countries, with Boston ranking second overall. But Boston is the only U.S. city in the top 10, with Los Angeles ranking next at 26. The top U.S. cities include Boston, Los Angeles, New York, Baltimore, Chicago, San Francisco, Ann Arbor, San Jose, California, Houston, and Seattle – in that order. The ranking was based on infrastructure of health centers, quality of care, and access. However, when considering access alone to health care, U.S. cities rank low among developed countries. To see the full report by Medbelle, click here.
Many Women Work in Health Care, but Not at the Top
New data finds what women make up 75 percent of the entry-level health care workforce, while only 33 percent account for jobs at the C-suite level. In contrast, men account for 25 percent of the entry level jobs and 67 percent of the top leading roles. According to the report, one cause for this disparity is due to women being held back at early parts of their careers in lower level leadership roles – at the manager/director levels. The research also found that opportunities for growth decline in the very early stages of health careers, due to strict credential requirements for jobs in patient management and clinical care. Barriers to obtaining extra credentials often get in the way so that women can never make it into senior positions. Click here for the Women in the Workplace report from McKinsey & Co. and Lean In.
Medical Regulatory Burden Continues to Increase
The Medical Group Management Association has published the results of its annual Regulatory Burden Survey that looked into satisfaction with prior authorization requirements, Medicare Quality Payment Program requirements, and other regulatory issues. The report found that 86 percent of participants considered the overall regulatory burden on their practices over the past year had increased, 96 percent agreed that a reduction in regulatory burden would allow their practices to reallocate resources to patient care, and 80 percent agreed that a reduction in regulatory burden would allow their practices to invest in new technology. Click here for the full report.

In an Attempt to Prevent Seniors from Falling, Hospitals Are Producing an “Epidemic of Immobility”
In response to reports that falls are the leading cause of fatal and nonfatal injuries for Americans aged 65+, hospitals have produced an “epidemic of immobility” to ensure that patients never fall. By forcing elderly patients to be sedentary, their muscles can deteriorate enough to cause severe long-term health complications. The incentives to prevent falls stems from 2008 when CMS declared that falls should never happen and the government added new penalties on hospitals. However, to combat the issue of being bed-ridden, hospitals are now developing new ways to get their patients moving. Click here to read more.

CMS Plans for Stricter Watch on Nursing Home Investigators
The Centers for Medicare and Medicaid Services has announced it will be revamping its nursing home evaluation system in order to hold inspectors more reliable. In the brief, CMS shared that it is evaluating the current State Performance Standards System to make changes to improve quality, performance, and consistency. Specifically, these changes are aimed to make sure that conducted inspections are timely and correct. CMS plans to review the new state performance indicators every quarter, which previously would occur at the end of every fiscal year. Click here for the CMS brief.
Native Americans are Seeking Non-Government Run Health Care
With an increasing number of deaths from inadequate care for diseases, including Tuberculosis, Native Americans are looking to escape from its current HHS-run health care system. Sioux San hospital, of South Dakota, was shut down by Congress two years ago after inspectors found that lack of care was causing deaths. The hospital is currently being run by the non-profit Great Plains Tribal Chairmen’s Health Board, representing a number of tribes in the area. The plan is to reopen the hospital with better qualified doctors, workers, and new equipment. The plan would cost millions that the non-profit would need to raise as quickly as possible, but Native Americans are confident that this is the best option to address the problem at hand. To read the full report from the New York Times, click here.
Study: Long Working Hours Associated with Stroke
A new study from the American Heart Association, finds strong association between long working hours and stroke. The study defines long working hours as working 10 or more hours per day for 50 or more days per year. The findings not only suggest that exposure to long working hours over 10 or more years are significantly associated with stroke, but younger people who were exposed were at an even higher risk for stroke. The association showed no differences between men and women, but was stronger in white collar workers under 50 years of age. Click here to read more.
Researchers Using Genetic Testing to Prevent Comas from Type 1 Diabetes
Researchers from the University of Virginia are running genetic testing on kids to see if they are at a higher risk of developing Type 1 Diabetes. According to scientists, there are dozens of gene variations to look for, which makes the disease complex. The testing will allow for children who are found to have a 4 in 100 risk of developing the disease to receive proper testing later on and have a better chance of identifying when the disease manifests. Researchers hope that this will lessen the number of kids who end up in a diabetic coma, because they are unaware that they have the disease. Over 2,000 kids have been tested with 60 carrying the higher genetic risk. To read more, click here.
Corticosteroid Injections May Accelerate Osteoarthritis Damage in Knee and Hip
With osteoarthritis affecting more than 30 million adults, many turn to corticosteroid injections to ease pain and inflammation when other methods have not worked. However, a new study showed that 36 out of 459 patients who received the injection developed new or worsened joint issues, including fractures or dying bone tissue. While other treatments are available, patients who find short-term relief from the injection may feel that the pain relief outweighs the potential risks. To read the full study published in the journal Radiology, click here.
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