October 28, 2019

Healthgrades Releases 2020 Analysis of Top Performing Hospitals
The annual report featured hospitals from  the nearly 4,500 hospitals nationwide that were evaluated based on clinical outcomes across 32 procedures and conditions. The Healthgrades’ 2020 Specialty Excellence Award ranks hospitals that are found to be in the top 10% in key specialties such as cardiac surgery, stroke care, joint replacement and critical care. Also released last week was the 2020 Report to the Nation that provides consumers with the information of hospital quality finding that patients treated at hospitals receiving a 5-star rating have a 49-percent lower risk of dying and a 59-percent lower risk of experiencing one or more complications during their stay. To view both the Report to the Nation and the list of top performing hospitals, click here.

Leapfrog Survey Says Surgery Centers, HOPDs Can Improve Safety
Nonprofit organization Leapfrog Group surveyed 321 ambulatory surgery centers and 1,141 hospital outpatient departments regarding their safety practices. The survey found 65% of providers performing procedures were board-certified. The survey also reported data highlighting concerns about sanitary measures; none of the ambulatory surgery centers and only 6% of hospital outpatient departments surveyed used electronic monitoring. Without electronic monitoring, staff cannot be monitored to ensure that proper sanitary procedures are followed. Likewise, only 53% of ambulatory surgery centers and 69% of HOPDs hold their leadership accountable for maintaining good hand hygiene among providers. To read the entire article, click here.

House Rx Pricing Plan Moves Forward; Bills Would Add Dental, Vision, Hearing Coverage
The House Ways and Means Committee was the third panel to advance Speaker Nancy Pelosi’s drug pricing package that would allow the government to negotiate drug rates and set an international index on prices among other policies. The mostly party line vote of 24-17 on H.R. 3 was after a nearly 12 hour markup session that saw Democrats repeatedly vote down Republican amendments that would have altered the bill. The committee also approved three bills that would add dental, vision, and hearing coverage to Medicare Part B as well as a bill that would expand a health workforce training program for low-income individuals. Multiple reports state that the bill will not be voted on until mid-November at the earliest. Click here to view the details of the bills.

  • STAT reports on the power of the Director of the President’s Domestic Policy Council, Joe Grogan, over the White House’s drug pricing policy including killing HHS’ rebate rule and pushing for coverage of pricey cancer drugs known as CAR-T as well as his disagreements with HHS Secretary, click here.
  • Energy and Commerce Health Subcommittee will hold a hearing on the global pharmaceutical supply chain on Wednesday that will look at how the federal government and industry can work together to ensure the safety and security of active pharmaceutical ingredients obtained from foreign sources, click here.
  • The generic drug lobbying group, the Association for Accessible Medicines, launched an ad campaign last week targeting policymakers calling for an exemption to penalties on raising prices contained in H.R. 3, click here.
  • The pharmaceutical manufacturer Amgen announced that it it will permanently lower the price of its cholesterol medicine Repatha by 60 percent next year selling it for $5,850 as compared to its regular price of more than $14,000, click here.
  • Research published in JAMA shows that nearly 1 in 8 U.S. pharmacies closed between 2009-2015, affecting mostly urban areas, click here.
  • Delivery giant UPS announced last week that it is expanding drone-delivery services to CVS Pharmacy, Kaiser Permanente, pharmaceutical distributor AmerisourceBergen, and the University of Utah health system including delivering prescriptions and retail products from stores to homes, click here.

Judge Reaffirms Decision that CMS’ HOPD Site Neutral Payment Cuts Is Unlawful
In a decision released last week, US District Court Judge Rosemary Collyer has reaffirmed her decision that recent Medicare cuts to clinics owned by hospitals were unlawful and should be reversed, jeopardizing the Administration’s push towards site-neutral payments for hospital outpatient departments. The Trump administration had asked if the regulation could remain in place while deciding whether to appeal her decision and argued the agency should be given another chance to justify its site-neutral policy as a permissible way of addressing an uptick in the volume of outpatient clinical services and their accompanying costs. In the new opinion, Collyer rejected CMS’ motion to modify the order and issued final judgement so CMS can appeal should it choose to, which it is expected to do shortly. Site-neutral payments, a priority for CMS Administrator Seema Verma, are popular with health care economists and some experts who say they are essential for promoting competition and lowering health care costs. Click here for the Judge’s opinion.

  • In a blog post early last week, Administrator Verma touted new efforts to combat waste, fraud, and abuse in the Medicare program, click here.

ACA’s Silver Plan Premiums to Drop 4 Percent; Number of Plans Increase
CMS has announced that premiums for popular marketplace silver plans on will decline for the second year in a row with a drop on average of 4 percent next year. The Administration also announced that 20 additional insurance plans will be available when enrollment opens next week for 2020 health plans and only 12 percent of enrollees will live in a county with one insurer, down from 20 percent this year. The average premium for the benchmark plan will drop from $406 to $388 in states relying on the federal enrollment platform and about two-thirds of enrollees that receive subsidies – about 87 percent of the market – will pay less than $75 per month. CMS did point out that for those whose earnings are too high to receive subsidies, more than a third will pay over $500 per month in premiums and another third will pay between $300 and $500. For more from CMS, click here.

  • CMS released information on the federal health insurance exchange 2020 open enrollment period, click here.
  • House Energy and Commerce Republicans sent a letter to CMS last week over concerns with the ACA Navigator program that was created to provide consumer assistance for the health insurance exchanges, click here.
  • A new analysis shows that the number of children in the U.S. without any kind of insurance rose by more than 400,000 between 2016 and 2018, click here.
  • According to researchers, payers have the strategies to mitigate rising healthcare costs but lack the incentive and ability to effectively do so, click here.
  • Lyft rides will now be covered by Medicaid in five more states, after success with the Arizona program, click here.
  • A new study says that the Medicare for America proposal would cause a third of people on employer sponsored plans to lose coverage by 2032, click here.

CMS Administrator Grilled by Democrats; GOP Committee Releases ACA Replacement Plan
During a hearing entitled “Sabotage: The Trump Administration’s Attack on Health Care” that had one witness, CMS Administrator Seema Verma, Democrats grilled the official on the Administration’s handling of the ACA, Medicaid expansion, pre-existing condition, among other issues. Verma also repeatedly refused to discuss how the health system will be stabilized if a federal court strikes down the Affordable Care Act, saying the President has a plan but did not disclose the specifics. She was also quizzed on about the Administration’s focus on short-term health plans, which do not require coverage of preexisting conditions. Click here for Verma’s written testimony and watch the hearing.

  • The Republican Study Committee, the largest caucus for House Republicans, released a plan to replace the ACA that would roll back Medicaid expansion and much of the regulations governing the individual market and instead offer federal block grants to states to help establish their own health insurance markets, click here.
  • The conservative group Freedomworks spent a record $2.7 million on lobbying from July to September, mostly opposing Medicare for All, drug pricing reforms, and surprise billing legislation, click here.

FTC Investigating Health Care Mergers
The Federal Trade Commission has revealed that it was reviewing data on health care company mergers including insurers and hospitals. Payors Aetna, Anthem, Blue Cross Blue Shield of Tennessee, Cigna, and UnitedHealthcare as well as Ballad Health and Cabell Huntington Hospital, two systems that both completed controversial mergers, were asked to submit information regarding patient billing, employee wage data, and other information to assist in the commission’s study. The FTC is in the preliminary stages of studying government sanctioned hospital mergers, called certificates for public advantage, to assess how such deals impact consumer prices and health care quality. For more from the FTC, click here.

HHS Providing Over $300 Million in Loan Repayment to Doctors Caring for Underserved
The U.S. Department of Health and Human Services announced that it will be awarding $319 million in scholarships and loan repayments through the National Health Service Corps to doctors and students in rural areas. Approximately $80 million will go to those in areas combating the opioid epidemic. The following programs are supported by the funds: National Health Service Corps Loan Repayment Program; National Health Service Corps Substance Use Disorder Workforce Loan Repayment Program; National Health Service Corps Rural Community Loan Repayment Program; National Health Service Corps Scholarship Program; National Health Service Corps Students to Service Loan Repayment Program; and National Service Corps State Loan Repayment Program. To read the full statement from HHS and learn more about the funded programs, click here.

Fentanyl Deaths Highest in East, Meth Deaths Highest in the West/Southwest: CDC
The CDC has released regional analysis on deaths from overdoses finding that fentanyl-related deaths had the highest levels in the eastern U.S., while methamphetamine-related deaths were high in the western and southwestern regions of the country. The report looked at the drugs most commonly involved in fatal overdoses nationwide in 2017. It states that drug-related deaths peaked at 72,000 that year with nearly 40 percent involved the synthetic opioid fentanyl, 23 percent heroin, 21 percent cocaine and 13 percent meth. Click here for more from the CDC.

  • Hundreds of hospitals are bringing lawsuits in state courts against opioid manufacturers and distributors, citing the surging cost of treating patients, click here.
  • The Drug Enforcement Administration proposed new regulations last week to improve the agency’s ability to oversee production of pain medications and limit excess quantities of certain drugs, click here.
  • FDA and FTC warn a company marketing unapproved cannabidiol products with unsubstantiated claims to treat teething and ear pain in infants, autism, ADHD, Parkinson’s and Alzheimer’s disease, click here.

Social Determinants of Health Could Be Easier to Track with ICD-10 Z Codes
eHealth Initiative has released new tools to help promote the use of ICD-10-CM, codes that provide data regarding a patient’s circumstances that influence their health status, including potential health hazards. The company partnered with payer organizations including Humana and United Healthcare as well as provider groups, including the American Hospital Association, to develop a “more consistent approach to encouraging the use of ICD-10-CM codes” for the social determinants. This would enable healthcare professionals to identify upstream factors that may impact a patient’s health and allow these professionals to better address patient’s needs. To read more, click here.

Racial Bias in a Medical Algorithm Favors White Patients: Study
The widely used algorithm that assesses whether patients will benefit from additional medical services greatly underestimates the needs of black patients, according to a new study; The Washington Post reports that if the algorithm’s bias was corrected, the number of black patients at risk for medical complications would be doubled. This has contributed to the racial disparities seen between white and black patients. Although the algorithm ultimately missed a large portion of individuals who could have benefited from additional services, the underestimation was not  intentional; the algorithm, instead, excluded race as a factor to take into account. Click here for the full study.

FDA to Crack Down on Sale of Risky Homeopathic Remedies
In a new statement from the Food and Drug Association, Commissioner Scott Gottlieb announced a new plan to regulate homeopathic remedies with the greatest risk of danger. The amount of homeopathic remedies claiming to cure a variety of ailments, including cancer, are on the rise and many do not cure the diseases and are harmful. The FDA’s plan will scrutinize products targeted towards children, those containing dangerous ingredients, and those that claim to cure conditions such as addiction, cancer, and heart disease. The plan will not remove products from the market. To read more, click here. To read the full release from the FDA, click here.

CMS Seeking Applications for Primary Care First
CMS release a Request for Applications (RFA) for its new Primary Care First financing program. Primary Care First offers a payment structure for the delivery of advanced primary care and is based on principles from similar programs including Comprehensive Primary Care Plus. CMS will provide population-based payments for practices caring for patients who are chronically ill. The pilot program will last for six years and applications are being accepted until December 6, 2019. To read the full report from CMS, click here.

NIH Announces Collaboration with Bill and Melinda Gates Foundation in Fight to Cure HIV
The National Institutes of Health announced a collaboration with the Bill and Melinda Gates Foundation to fund research to find the cure for sickle cell anemia and HIV. NIH and the Foundation will each contribute $100 million over the next four years to fund the high reward research that seeks to use gene-based treatments. In addition to finding a cure, the collaboration hopes to define long-term opportunities for advancing late-phase clinical trials. NIH believes that gene therapy will be the most effective approach. To read the full statement from NIH, click here.

FDA Approves New Cystic Fibrosis Therapy
The FDA has approved Trikafta, the first triple-combination therapy that can treat cystic fibrosis. The drug is approved for patients 12 years and older and can be used for the “F508del mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene”, thus accounting for approximately 90% of CF cases. The drug will target the mutated CFTR protein to help it function more effectively. The FDA approved the drug within a timespan of three months using multiple expedited programs and approved Trikafta before its goal date of March 19, 2020. To read the FDA news release, click here.

Stethoscope Threatened by Modern Technology
The stethoscope was invented two hundred years ago and is a staple in the medical world, but new hand-held devices are threatening to put an end to the use of stethoscopes. Hand-held ultrasound devices are just as easy to use as a stethoscope and allow doctors to see, rather than hear, what is going on. Recent studies have shown that doctors practicing internal medicine and emergency medicine are prone to miss heart murmurs when using a stethoscope. Currently, the ultrasound technology is very expensive and most doctors and hospitals are not likely to switch until the price drops. To read more, click here.

No Evidence that 3D Mammograms Work Despite Marketing Push
Patients are finding themselves being pressured into getting 3D mammograms with claims that they are capable of showing everything. The US Preventive Services Task Force however, claims that there is no evidence to support that they work any better than traditional mammograms. The reason for the marketing push? Money. Companies are paying doctors to influence their patients, marketing directly to patients, lobbying, and hiring advocates to claim the 3D mammogram is superior. According to reports, the 3D mammogram is only likely to find additional cancer in 1 out of 1,000 scans. To read the full report, click here.

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