02 Sep September 2, 2019
Congress Returns and Renews Efforts To Pass Surprise Billing Legislation
Key House and Senate Committees will continue their efforts this week at weaving together surprise billing legislation that can pass both chambers. Advocacy groups are keeping up the pressure on policymakers. In one major campaign favoring providers’ ability to negotiate payment rates, more than $13 million has been spent since July advertising in more than 20 states by a group which calls itself Doctor Patient Unity (click here for the website), according to media reports. The ads are specifically targeting states with U.S. senators up for re-election in 2020, ranging from $1.1 million to $2.4 million in each of the following states: Minnesota, Kentucky, Michigan, Colorado, Arizona, Georgia and North Carolina and six-figure advertising purchases in Alabama, New Mexico, Maine, Massachusetts, Iowa and Texas. The ads express opposition to the benchmarking approach contained in the versions passed by the House and Senate committees and favored by insurers. The group’s website states that it “support[s] a federal solution to surprise medical bills that makes insurance companies pay their fair share and supports patients’ right to quality medical care.” Click here to view the ad.
- Eight major conservative organizations joined together last week to send a letter to Senate Majority Leader Mitch McConnell (R-KY) stating opposition to the proposals put forward so far to help shield patients from surprise medical bills. Click here to read their letter.
- California has seen a significant increase in the number of in-network doctors since implementing its surprise billing legislation in 2016, according to a new study funded by America’s Health Insurance Plans, click here.
Walmart as a Clinical Health Care Provider…It’s Happening
Walmart is moving into the provider market with the opening of a primary care clinic in Dallas, GA called Walmart Health located in building next door to one of its stores. Walmart is testing the concept with the initial clinic and could open more in the future and will offer primary care, including for mental health issues for patients. Dental care, counseling, labs, X-rays and audiology, among other services will be offered at the site starting on Sept. 13th. Walmart is already one of the largest pharmacy companies in the U.S., through in-store sections for prescription drugs in almost all of its 4,700 locations across the U.S. Additionally, health, wellness, clinical, and optical services, accounted for about 9%, or $36 billion, of Walmart’s roughly $332 billion in U.S. sales last year. Click here for more from CNBC.
CMS Reconsidering 3-Day Hospital Stay Requirement for SNFs
It appears as though CMS Administrator Seema Verma is re-thinking current government policies around the 3-day hospital stay rule prior to a nursing home admission. In a recent Twitter comment, Verma commented on the requirement saying “gov’t doesn’t always make sense.” Jumping on that comment, the nation’s largest nursing home association and assisted living association sent a letter to Verma imploring a change in policy – at least to include hospital observation stays as qualifying for the 3-day requirement. Click here for the letter. Click here for Verma’s Twitter message.
- The results of a five year study on over 14,000 Medicare beneficiaries admitted into LTCH hospitals reveal that 1-year survival rates of Medicare beneficiaries who were admitted to LTCH hospitals is at 45-percent; and with 5-year survival at 18-percent. For the full study click here.
- The cost of late in life long-term care is growing as the population ages, straining family finances and Medicaid budgets, click here.
Medicare Spent $29 Billion on Care Coordination and Planning Services in 2017
According to a recent analysis by the Government Accountability Office, there are 58 billing codes in Medicare’s physician fee schedule that could be used by providers to bill for services that cover some or all of the longitudinal comprehensive care planning (LCCP) services out of over 8,000 billing codes for office visits, surgical procedures, or other services. In a response to provider groups’ concerns that these codes do not sufficiently account for the LCCP-type services they provide to Medicare beneficiaries with complex medical needs, GAO reviewed the 58 codes and found that CMS spent almost $29 billion in 2017 on just those services alone. Of the 58 codes, 13 codes are more recent narrowly-defined codes introduced starting in 2013 that only cover LCCP-type services, those codes alone accounted for $467 million in 2017 from about 100,000 providers. To read the report, click here.
Medicare Part D Out-of-Pocket Costs Have Risen Significantly in Part Due to Multiple Sclerosis Drugs
According to a new report released last week in JAMA, over the last 10-years, rising prices for multiple sclerosis drugs caused Medicare spending for these medicines to increase more than 10-fold, and Part D beneficiaries saw their out-of-pocket costs increase more than sevenfold. Using claims data from 2006 through 2016 from a 5% random sample of Medicare beneficiaries, the researchers found that spending on multiple sclerosis drugs per 1,000 beneficiaries by the health program jumped from nearly $7,800 in 2006 to more than $79,400 in 2016. Additionally, out-of-pocket patient spending per 1,000 beneficiaries rose from $372 to nearly $2,700 for patients with multiple sclerosis during that same period of time. The conclusion is that the high costs for these drugs have greatly influenced the overall average cost for drugs under Part D. Click here for the study.
- The conservative advocacy group American Action Forum has launched a seven-figure ad campaign across dozens of House districts to rally lawmakers against Democratic efforts to allow Medicare to directly negotiate drug prices, calling the plan “government price controls,” click here.
Key House Leader Calls for Investigation into Elder Abuse and Neglect at Nursing Homes
A new report by HHS Inspector General states that about 20-percent of seniors who are admitted to emergency rooms were there because of elder abuse or neglect at skilled nursing facilities. In response to the investigation, House Ways and Means Committee Chairman Richard Neal (D-MA) sent letters to the Department of Justice and CMS pointing out the severity of the incidents in question – including broken femurs, cracked skulls, and sexual abuse – as well as facilities’ abysmal failure to report the incidents. Survey agencies investigated and substantiated 69 incidents as abuse or neglect, but only two were reported to local law enforcement. “These trends are unacceptable,” the Chairman wrote. Click here for the HHS IG report, and here Chairman’s letters.
Surgeon General Warns Young People and Pregnant Women Against Using Marijuana
The Surgeon General has issued an advisory emphasizing the importance of protecting youth and pregnant women from the health risks of marijuana use, warning it poses risks to developing brains. In the first advisory against the drug since 1982, officials said the best science available suggests no amount of marijuana use during pregnancy or for youth is known to be safe. In 2017, about 9.2 million people ages 12 to 25 reported that they used marijuana in the last month and use in pregnant women more than doubled in the past 15 years, from 3.4 percent to 7 percent. HHS is also launching a public awareness digital campaign with $100,000 President Donald Trump donated from his salary, department officials said. To read the advisory, click here.
- California may be following Colorado, Florida, and Washington in allowing parents to administer medical cannabis to K-12 students on campus with CA SB223 (19R). These bills come in the wake of increased medical usage of cannabis, including the Epidiolex, an anti-seizure drug approved last year by the FDA. For the full text of the bill click here.
- The DEA announced the necessary steps to improve access to marijuana research. The DEA will also issue regulations to expand the quantity and variety of marijuana that it permits for use in officially sanctioned scientific and medical research. After finalizing the rule, the agency said it will begin reviewing 33 grower applications. Click here for the DEA notice.
CDC Issues Vaping, Cannabis Warnings
Health investigators are now trying to determine whether a particular toxin or substance has sneaked into the supply of vaping products, whether some people reused cartridges containing contaminants, or whether the risk stems from a broader behavior, like heavy e-cigarette use, vaping marijuana or a combination.On Friday, the Centers for Disease Control and Preventionissued a warning to teenagers and other consumers, telling them to stop buying bootleg and street cannabis and e-cigarette products, and to stop modifying devices to vape adulterated substances. Click here for the CDC warning.
- According to HHS, as of August 27, 2019, health departments from 25 states have reported 215 possible cases of pulmonary illnesses from users of e-cigarette products, resulting in one death, and additional reports are under investigation, click here.
- The FDA and the CDC are working to investigate the incidents of severe respiratory disease associated with use of e-cigarette products, click here.
- Vaping one time – even without nicotine – can damage blood vessels, reduce blood flow and create dangerous toxins, according to a new study published in the journal Radiology, click here.
- The Federal Trade Commission has opened an investigation into whether e-cigarette company Juul used deceptive marketing to appeal to youth through means such as social media influencers, click here.
Administration Proposal to Relax Nondiscrimination Protections Could Limit Health Services To Immigrants
Within a larger proposal to relax nondiscrimination protections in health care for LGBTQ populations, women and people with disabilities, a provision to ease-off an Obama-era federal rule requiring that medical providers let patients know about their right to language interpretation services could have a huge impact on the immigrants, according to a review of the rule by the Pew Charitable Trusts. The period for public comment ended earlier this month, the final rule may be released at any time. Under the proposed rule, patients would still have a right to language services, they simply might not know they do or how to go about getting those services. America’s Health Insurance Plans called the current rule “excessively burdensome while adding little value for consumers,” but other associations such as the American Academy of Family Physicians, the American Academy of Pediatrics, the American Psychiatric Association and the American College of Obstetricians and Gynecologists oppose the proposal. Click here for more from Pew, and here for the proposed rule.
Medicare Pays Twice for Hospice Rx: HHS OIG
HHS’s Office of the Inspector General has released a new report on Medicare as a follow up to a report it had done on Medicare Part D Payments. In 2009, the report discovered that hospice stays, paid by the day and inclusive of medications used to treat illness, were being paid twice. Once as a part of the hospice stay under Medicare Part A, and again under Medicare Part D plans. According to the OIG, at issue is about $200 million in double payments. For the entire report click here.
California Makes Bold Move to Prevent Student Suicides
A new law in California requires that all student IDs in grades 7 through 12, and in college, must bear the telephone number of the National Suicide Prevention Life, 800-273-TALK (8255). According to the CDC, suicide was the second-leading cause of death in the United States among people ages 10 to 24 in 2017, and the rate among teenagers has risen dramatically over the past two decades. The idea behind the law is to give students a clear understanding that immediate help is readily available and most research suggests that talking openly about suicide may reduce the risk of suicidal thoughts. Click here for more on the new law.
Obesity Linked to Slowing Progress of Reducing Heart Disease Mortality
Reducing the number of deaths related to cardiovascular disease has been slowing in recent years, leading to concerns that the obesity epidemic in the United States is undoing improvements in heart health. The study, by researchers at Northwestern University and University of Liverpool, shows that although the death rates from heart disease, diabetes, stroke and related disorders have been decreasing for decades, the rates have recently slowed or stalled mostly due to growing rates of obesity. The authors suggest early intervention to combat obesity in children and lifelong ongoing obesity prevention will help to reverse this course. To read the study, click here.
FDA Recommends Healthcare Facilities to Replace Reusable Duodenoscopes with Safer Options
The FDA has recommended that healthcare manufacturers and facilities transition from reusable duodenoscopes to disposable models. Duodenoscopes are cameras used to examine patients internally. Because current, reusable models cannot be properly sterilized and frequently spread infection, the FDA has recommended the transition to disposable duodenoscopes. Currently, there are no completely disposable duodenoscopes, however there are duodenoscopes with disposable components, which help to lower contamination, while new disposable devices are being created. Click here to read the FDA’s announcement.
Vitamin D Supplements May Not Strengthen Bones
Vitamin D might not be much help for strengthening bones among healthy adults without osteoporosis, even at doses far higher than recommended daily allowances. According to new research, in a clinical trial assessing three levels of daily vitamin D supplementation — 400 IU, 4,000 IU, and 10,000 IU — radial volumetric bone mineral density (BMD) was significantly lower among those (ages 55-70) taking higher doses for 3 years. Click here for details.
New Research on Air Pollution Examines Influence on Mortality
New research in the New England Journal of Medicine examined the link between particulate matter concentration and mortality and found data to suggest that as the concentration increased, so did excess mortality. While the study, which looked at pollutants and associated mortality across 652 cities throughout the world, it mainly focused on information from East Asia, North America, and Europe, and less on Latin America and Africa, limiting it from being globally representative. To learn more, click here.