05 Jul Weekly E-bulletin

CBO: Senate ACA Replace Bill Has Huge Negative Impact on Medicaid Spending in Future Years

Perhaps making Senate Majority Leader Mitch McConnell’s job of passing an ACA repeal and replace bill even more challenging, the Congressional Budget Office late last week released an analysis showing Medicaid spending under the Better Care Reconciliation Act of 2017 would be about 35 percent lower in 2036 compared with CBO’s extended baseline. In other words, the senate GOP bill (BCRA) would have even a larger impact on Medicaid in future years. Click here for the newest CBO report.  In case you missed it, click here for the previous CBO report showing 22 million would lose coverage in the first 10 years under the BCRA.

• For a closer look at how the senate bill would impact Medicaid, click here for a very good and brief summary.
• The Senate bill hits states harder that expanded their Medicaid programs. See the WSJ story here.
• States depending on provider taxes to supplement their Medicaid payments also take a big hit.  Click here.
• The Trump Administration says the coverage is unfair in that Medicaid spending still increases under the Senate bill, just at a much slower rate. Here’s the graph Secretary Price tweeted last week.
• For a graphic look at how premiums would be impacted under the senate bill, click here.
• Even FitchRatings says public and non-profit hospitals would be hit by the Senate bill.  Click here.
• Insurers remain unhappy with the loss of the individual mandate in the Senate bill.  Click here.

List of GOP Senators Against the BCRA Grows; Trump Weighs In

Somewhere between 7 and 12 GOP Senators are either against or seriously concerned publicly with the Better Care Reconciliation Act, according to their own news releases and other published report.  They’re back home this week hearing from their constituents.  The GOP can lose only two of their own and still pass the bill.

• Business Insider identified 9 of them.  Click here.
• CNN identified 13 and created several different categories of their positions.  Click here.

President Trump tweeted earlier this week that the Senate should repeal and delay if they can’t replace right now. Majority Leader McConnell said he would continue to work on replace.  Click here.

• The CBO has now been asked to score two versions of the updated bill, as McConnell works to find 50 votes. Click here for a summary.

Medical Tort Reform Bill Passes the House

Before leaving for the July 4th Recess, the House passed a bill to cap non-economic awards at $250,000 and limit contingency fees in medical malpractice lawsuits involving government subsidized care last week. H.R.1215 – Protecting Access to Care Act of 2017 – applies to health care providers, including nursing homes, and makers of drugs and medical devices. The Congressional Budget Office estimates the bill would save more than $50 billion over the next ten years. Economic damages would not be capped under the legislation. The bill passed 218 to 210 with 19 Republicans voting against it and no Democrats voting for it. To view the bill language, summary, and cost estimate, click here.

Drug and Device Companies Paid Over $8B to Docs and Hospitals Last Year: CMS

The drug and medical devices industries made $8.18 billion in payments to doctors and hospitals in 2016, according to new CMS data (click here) released last Friday. Nearly half of the amount paid — $4.36 billion — was for research. Another $2.8 billion went toward a variety of “general” uses, including consulting, speaking fees, travel and lodging, meals and royalty and licensing fees. The remaining $1.02 billion went to physicians with an ownership or investment interest in a drug or device company. CMS for the first time also released a map (click here) showing payments on a state-by-state basis.

• A California bill that restricts Rx companies from giving gifts to doctors passed the Assembly health committee last week after a protracted debate on whether the legislation could hinder physician education. Click here for the text.
• A nonprofit charity that helps patients pay their drug co-pays is under an IRS investigation because the drug companies that fund the charity are also overwhelmingly those benefiting from its work. Click here for the Bloomberg report.

Former VP Biden Announces Cancer Initiative

Former Vice President Joe Biden announced the launch of a private-sector cancer initiative meant to build on the progress of the cancer research started at the end of the Obama Administration. The new “Biden Cancer Initiative” will officially be a part of the former Vice President’s foundation, which he launched with his wife Jill back in February. The cancer initiative is applying for tax-exempt status with the Internal Revenue Service and for the time being is being funded by the broader Biden Foundation and according to its website the initiative has already raised at least $2 million since it started. The mission of the initiative is “to develop and drive implementation of solutions to accelerate progress in cancer prevention, detection, diagnosis, research, and care, and to reduce disparities in cancer outcomes.” Click here for more on the website.

Appropriators Propose Increase in FDA Budget

The House Appropriations Committee began to review the proposed appropriations bill for the Department of Agriculture, which includes the Food and Drug Administration last week.  The Appropriations Subcommittee advanced the bill by voice vote last week that proposes to slightly increase the FDA’s funding levels however it would not be by asking the industry to pay more as the Trump Administration has suggested. The Agriculture appropriations bill released would give the FDA $5.1 billion in fiscal 2018, an increase of $456 million from 2017 levels. The bill calls for $2.8 billion in taxpayer funding for the FDA, which is equal to 2017 levels. The bill includes legislative riders would extend the current delay in the FDA’s efforts to regulate the two products, especially electronic cigarettes. For the draft bill, click here, and for the overview of the bill, click here.

CDC to Looking at Air Quality in Rural Areas

There are rural and urban differences in environmental health data related to air and drinking water quality, that is according to the Centers for Disease Control and Prevention (CDC). The findings from the latest CDC Morbidity and Mortality Weekly Report Rural Health Series show that air quality significantly improves as areas become more rural, but measures indicate that water quality decreases. Researching and understanding the differences between rural and urban areas could lead to public health interventions that are geographically targeted to address factors that contribute to poorer health outcomes. According to researchers, the “findings suggest a continued need to develop more geographically targeted, evidence-based interventions to prevent morbidity and mortality associated with poor air and water quality.” Click here for the CDC report.

Grants Announced for Nutrition Services for Seniors

HHS has announced the Innovations in Nutrition Programs and Services grant to support innovative and promising practices that enhance the quality and effectiveness of nutrition programs for older adults. The HHS Administration for Community Living (ACL) will provide up to $250,000 to four applicants whose program outcomes should include improved collaboration with local health care entities, lower health care costs for specific populations, or reduced need for institutionalizing older adults. Applicants must demonstrate extensive knowledge and present a proven track record of expertise concerning the nature of nutrition for older individuals and the business of nutrition program administration within the aging network in order to be considered for the grants, proposals are due Aug. 7th.  To review the grant opportunity, click here.

GAO: Safety Net Hospitals Score Low, Small Hospitals Score High in Value-Based Purchasing

According to a GAO report released last week, safety net hospitals, which serve a high proportion of poor patients, generally scored lower on quality and efficiency than other facilities participating in the Hospital Value-Based Purchasing Program.  Hospitals with fewer than 100 beds, whether in rural or urban areas, generally scored higher. The financial ramifications typically weren’t that large as most facilities incurred a bonus or penalty of less than $100,000 in fiscal year 2017. In the report, GAO also points out a flaw in the scoring methodology – hospitals with missing quality scores were more likely to qualify for bonuses. Click here for the GAO report.

CMS Proposes Less than 1% Pay Increase for Dialysis Facilities

CMS has released its annual proposed pay rule for the End-Stage Renal Disease Prospective Payment System that would increase pay to dialysis facilities by 0.8 percent on average in 2018. For hospital-based facilities, CMS projects an increase in total payments of 1 percent, and the projected increase for freestanding facilities is 0.8 percent. The changes would translate to a roughly $100 million increase in overall Medicare spending on end-stage renal disease reimbursements. The proposed rule also asks providers to submit feedback on Medicare’s regulations as part of CMS’ bid to “transform” the program. Additionally, the rule also proposes updates to the acute kidney injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities to individuals with AKI. Click here for the CMS fact sheet, and here for the proposed rule.

FDA Offers Plan to Clear Backlog on Orphan Drug Requests

The FDA has unveiled its plan to modernize the review process for orphan drugs which includes eliminating the backlog of pending orphan drug designation requests older than 120 days by Sept. 21 of this year and streamlining the review process to ensure the agency responds to orphan drug designation requests within 90 days. In this modernization plan document, the FDA states that despite the growth in the number of orphan drugs developed since 1983, the agency realizes that developing drugs for rare diseases is costly and challenging, especially for rare conditions for which there is little scientific understanding. Currently, the FDA has about 200 requests pending, with a steady uptick in manufacturers seeking the designation intended for treating or preventing diseases that affect fewer than 200,000 people in the U.S. For more from the FDA and to view the plan, click here.