October 8, 2018

Massive Opioid Package Heads to the President

The Senate last week passed the compromise 660 page opioid package by a vote of 98-1 and sent it to the President who is expected to sign the bill that aims to combat the nation’s ongoing opioid crisis. H.R. 6, the Support for Patients and Communities Act, includes contributions from at least 70 lawmakers and encompasses law enforcement, health care, and state and local governments. Additionally, it makes changes to Medicare and Medicaid to cut back on prescriptions and allow for more treatment coverage. More than 63,600 Americans died from drug overdoses in 2016. Two-thirds of them involved a prescription or illegal opioid, according to the Centers for Disease Control and Prevention. Click here for the legislation and here for a 27-page section-by-section summary.

  • The bundled payment systems for inpatient and outpatient services may create financial incentives for hospitals that could result in greater opioid use, which may need to be tracked — so said MedPAC last week, click here.
  • A study by the Johns Hopkins, funded by HHS, found that insurance policies often don’t cover non-opioid treatments for lower back pain, creating a barrier to reducing the use of prescription pain drugs, click here.
  • A decade after Congress required insurers to improve mental health coverage, a new report finds most states are failing to enforce the standards, click here.

MedPAC Considers Changes To ED Payment Codes

The Medicare Payment Advisory Commission last week updated details on two congressionally mandated MedPAC reports focused on post acute and emergency care.  The first will look at the payments for defined episodes of post-acute care, augmenting its prior development of a common prospective payment system for home health agencies, skilled nursing facilities, inpatient rehabilitation facilities and long-term care hospitals. Additionally, commissioners discussed policy issues related to urgent care centers and emergency departments, as well as the coding of ED visits and an analysis showing coding has shifted toward higher levels. To address the shift, MedPAC staff proposed using a single code  for ED evaluation and management visits or creating national coding guidelines. Click here for the PAC presentation, and here for the ED presentation.

  • HHS Inspector General finds that $5.7 billion in Medicare payments to inpatient rehabilitation facilities in a single year were unreasonable and unnecessary, click here.

A Decline in Out-of-Network Coverage Driving Surprise Emergency Department Billing

A new study has found that one major reason surprise medical bills are increasing is that coverage for out-of-network care is going down. According to a Robert Wood Johnson report, only 29 percent of insurance plans in the individual market provide any benefits for out-of-network providers, down from 58 percent three years ago. Additionally, coverage is also declining in the market for small businesses – 64 percent of small-group plans offer some out-of-network coverage, down from 71 percent in 2015. Click here for the study from RWJF.

  • Nashville-based Envision Health has launched a campaign to end ‘surprise’ bills as they continue their fight with UnitedHealthcare over ED billing, click here.

Medicare Advantage Premiums Declining, Plan Choices Increasing: CMS

CMS last week announced that, on average, Medicare Advantage premiums will decline while plan choices and new benefits increase. In addition, Medicare Advantage enrollment is projected to reach a new all-time high with more than 36 percent of Medicare beneficiaries projected to be enrolled in Medicare Advantage in 2019. This news comes as the agency releases the benefit and premium information for Medicare health and drug plans for the 2019 calendar year. Click here for details.


ObamaCare Insurers Returning To Profitability: Analysis

In the first half of 2018, insurers with plans in the individual market saw the best financial outcomes they have seen since the passage of the Affordable Care Act, according to a brief from the Kaiser Family Foundation. Insurers increased 2018 premiums in response to anticipated changes to the ACA by the Trump administration but reaped larger-than-expected profits as a result, so the insurers are not expected to increase premiums as much in 2019, according to the brief. Click here for more.


The Nation’s Health Care Economy in a Steady, Moderate Growth Period

The health sector appears to be in a post-recession, post-expanded coverage period of steady, moderate growth. In 2016, 2017, and the first half of 2018, total health expenditures and spending on health care services have been growing at annual rates between 4.3% and 4.8%.  This, according to the newest report from the Altarum Institute.  “The share of the population with health care coverage has plateaued. Health care job growth, after accelerating in late 2014 and 2015 has slowed to around 2.0% since Q2 2017. Potential near-term disruptions to this stability include changes to laws around coverage or the next economic downturn.”  Click here for their very good report.


US Hospitals Often Pay Six Times More for Medical Devices than European Facilities

U.S. hospitals paid anywhere from two to six times more than European countries for various heart implants, such as stents and pacemakers, according to a new study. Researchers looked at data from a large hospital survey to determine the prices for hospitals in the U.S., U.K., France, Italy and Germany. The study found that Germany paid the lowest prices out of all of the countries, often paying as much as $1,000 less than US counterparts.  Click here for the study in Health Affairs (subscription required) or here for a report from Healthcare Finance.


CMS Changes Process that Determines Coverage of Technologies

CMS last week announced changes to the way contractors decide which technologies are covered by publishing a revision to Medicare’s Program Integrity Manual. Medicare Administrative Contractors (MACs) determine which healthcare items and services meet requirements for Medicare coverage — taking into account local variations in the practice of medicine — through “local coverage determinations” or LCDs. LCDs are issued when national determinations do not exist, or when MACs need to further define a national determination. The updated manual responds to Congress’ requirement in the 21st Century Cures Act for more transparency in the LCD process and aims to ensure an open LCD process that meets patients’ needs. The changes will clarify and simplify the process, helping to ensure that companies can get therapies and devices to patients more efficiently. Click here for details.


Analysis of Nurse Ratios Shows More Costs Than Savings

The Massachusetts Health Policy Commission recently reviewed and published a proposal to require hospitals to meet nurse-to-patient staffing ratios. The study found that while the proposal would create savings up to $47 million tied to reduced turnover and fewer workplace injuries, it increase costs by as much as $950 million.  Nurses associations have long advocated for ratio requirements that would mandate hospitals have specific registered nurse-to-patient staffing ratios. Click here for the analysis.


Five-State Study Looks at How to Boost Vaccinations in Low Income Communities

A new CDC study is looking at how to improve vaccination rates among low-income children and pregnant women, using statewide registries intended to track the immunization histories of all residents. The $880,000, three-year review will look at data in Colorado, Hawaii, Kentucky, Montana and New Mexico and will investigate the numerous obstacles these states face, including privacy and technological issues. Officials would like to not only identify patients who are due for vaccinations through the registries, but also to reveal population groups whose immunization rates could be improved using targeted campaigns. The project particularly aims to identify children and pregnant women in Medicaid who need vaccinations. For more on the study from Pew Charitable Trust, click here.


VA Medical Centers Increase Star Ratings
The US Department of Veterans’ Affairs released star ratings for VA facilities last week showing 66 percent of VA Medical Centers have improved in overall quality in the third quarter – with the largest gains seen in areas where there were VA-wide improvement initiatives, such as mortality, length of stay and avoidable adverse events.. The quality of the care received is evaluated and aggregated to a star rating system 1 to 5 based on benchmark quality of care delivery at VA medical centers across the nation. Additionally, eight of the high risk facilities being monitored are no longer considered high risk and another 12 facilities show major improvements. Click here to view the medical centers ratings.


Rural Hospitals Save Lives with Telestroke Care
Patients in rural Illinois are able to receive care close to home despite the lack of neurologist on staff in their hospital. A new telestroke care program in Illinois has significantly cut response time in those most crucial moments immediately following a stroke. The program has already shown great improvements for patient recovery when a neurologist can consult into smaller towns and underserved areas. To read more about the program, click here.

  • The Critical Access Hospital Coalition advocates for telehealth expansion opportunities for rural hospitals in Washington, D.C.. Read more about the CAH Coalition here.

FDA Continues Crackdown on E-Cigarettes
In a continued effort to curtail the use of e-cigarettes, the FDA seized more than 1,000 documents from Juul Labs in San Francisco last week. The FDA has been more focused on Juul because of what they call “kid-friendly” flavors such as chocolate cupcake, tutti frutti, etc. The inspection was part of the FDA’s review of Juul’s marketing and design tactics. This came on the same day that the Centers for Disease Control released new data showing Juul’s sales growing more than seven-fold from 2016 to 2017. Click here for more on the raid and here for the CDC report.

  • Senator Dick Durbin (D-Il) and Senator Lisa Murkowski (R-AK) asked the FDA to ban fruit and other kid-friendly flavors of e-cigarettes, click here.
  • Teens who use e-cigarettes are more likely to smoke cigarettes and increase their usage of both products over time, according to the Rand Corporation, click here.

Cervical Cancer May Soon Be Eliminated in Australia

Cervical cancer could be eliminated in Australia within the next two decades because of a government program to vaccinate children against the cancer-causing human papillomavirus, according to a new report. The study, published in The Lancet Public Health, found that by 2028, fewer than four women in every 100,000 could be diagnosed with cervical cancer annually in Australia — effectively eliminating the disease as a public health problem. And by 2066, the researchers say, less than one woman per year could receive that diagnosis. Click here for the report.


Study: Alternative Cancer Treatments Result in Higher Death Rate

A small but significant number of cancer patients reject the treatments offered by mainstream oncologists and seek instead alternative remedies that may sound wonderful to a layperson but lack the support of scientifically valid research.  In a recent study by researchers at the Yale School of Medicine of 281 patients with potentially curable cancers of the breast, lung, colon-rectum or prostate that had not yet spread beyond their site of origin, the use of alternative medicine in lieu of conventional cancer treatments resulted in an overall death rate two and a half times higher than the rate experienced by patients getting standard therapies. Click here.


Study Shows the Benefits of Virtual Reality for Exercise
New research has shown that immersing oneself in a virtual reality environment during a workout helps to boost performance and endurance, as well as reduce the levels of perceived pain. Scientists conducted the study on 80 participants who reported significantly lower pain and effort and exhibited longer time to exhaustion. Researchers expect the study to have major implications for exercise regimes. For the full study, click here.


Most Googled Aliments by State: Some are…Interesting

Not surprising, in the D.C. area, the most googled health symptom is stress but others may surprise you. For instance, New Mexico it’s the word Flem, in South Carolina it’s Dark Green Stool, and in New Jersey it’s Lucid Dreams. While there was a wide range of symptoms that seemed to concern people in each state, most states are googling symptoms that could be related to the cold and flu. To view the full map, click here.

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