Weekly E-bulletin

Two Major Doc Groups Smack Proposed MACRA Regs

Two major physician groups have largely turned against CMS’ newly proposed physician payment system mandated by MACRA, according to public comments submitted late last week by the American Academy of Family Physicians (click here) and the Medical Group Management Association (click here). The AAFP is requesting a delay in the rules’ implementation saying they are “overly complex and burdensome.” The MGMA says the proposed rule “strays significantly from the terms and themes of MACRA.“  Both organizations praised various aspects of the proposed regulations in their comments.  (MACRA – the Medicaid and CHIP Reauthorization Act of 2015 – repealed the old physician payment formula and replaced with new requirements.  CMS calls its new proposed system the Quality Payment Program.)  All public comments are due to CMS today.  CMS is expected to issue final regulations in September.

  • “Doctors are going to be livid when they absorb the fact that they spent so much political capital to enact MACRA only to find out … that under the current payment system, doctors are going to get paid less; that gap will grow over time,” said Robert Moffit, PhD, senior fellow in the Center for Health Studies at the Heritage Foundation, a right-leaning think tank here. “When they absorb that fact, I think we’re going to see more trouble on Capitol Hill over physician payment.” Click here for the story.

One Medicare ACO was able to achieve cost savings and care quality for two successive years by targeting high-risk patients, according to a study published in the American Journal of Managed Care. Researchers with the Hackensack Alliance Accountable Care Organization analyzed Medicare expenditure data and collected quality data on 33 measures from Medicare claims files, a chart review of physician notes and a Medicare patient experience survey of ACO beneficiaries. Click here for the study.

  • Some of the nation’s leading health policy advocates are urging HHS to initiate more mandatory  bundled payment pilots. “In the remaining months of this administration, we urge you to initiate several additional mandatory bundled payment demonstrations,” the letter reads, encouraging HHS to specifically focus on cardiac cath procedures. Click here for the letter.
Best Children’s Hospitals Named by U.S. News

The 2016-17 rankings were created from data collected through a clinical survey sent to 183 hospitals and a reputational survey sent to pediatric specialists and subspecialists. Of those, 78 hospitals ranked among the top 50 in at least one specialty and 11 earned a spot on the magazine’s Honor Roll. Most of the hospitals surveyed for the annual rankings are freestanding children’s hospitals or multispecialty pediatric departments large enough to function as if they are a hospital within a hospital. A few others focus on specialties such as cancer or are included because they were previously ranked or have been recommended by trusted sources. Click here the article and list.

Oncology Group Threatens Lawsuit while Senate Holds Hearing on Part B Demo

The Community Oncology Alliance (COA) has warned CMS a possible lawsuit could be filed if the agency moves forward with the proposed Part B drug cost-control demonstration. The group has constitutional concerns with CMS’ plan to use a CMS Innovation Center demo to change Part B reimbursement, saying this sets a dangerous precedent of using CMMI to revamp current law. Additionally, the oncologist say that CMS did not pick a defined population with deficits of care for the first phase of the demo, and that it violates the ACA by creating a mechanism to influence clinical decision-making and direct patients away from a guaranteed benefit. The Senate Finance Committee officially announced a hearing on CMS’ controversial Part B drug payment demonstration for June 28th that will have CMS’ number two leader, Patrick Conway, testify. Click here for the COA letter, and here for the Senate hearing announcement.

Democratic Senators Urge DOJ To Block Major Insurance Mergers

Seven Democratic senators urged the U.S. Justice Department last week to block two mergers of major health insurance companies, saying that the proposed deals would mean higher premiums and lower-quality healthcare for consumers. The department is reviewing Aetna Inc’s $33 billion plan to buy Humana Inc and Anthem Inc’s $48 billion proposal to buy Cigna Corp. If approved, the deals, both of which were announced last July, would reduce the number of national health insurance carriers from five to three. Click here for the letter.

Wasteful Medical Care? Don’t Blame Advanced-Practice Clinicians

A new study found that when it comes to providing wasteful medical care and treatments to their patients, nurse practitioners and physician assistants are “no worse” than physicians. UCLA and Harvard Medical School researchers say their analysis dispels commonly held beliefs among physicians that advanced-practice clinicians provide lesser-quality care than doctors while ordering up more unneeded care like X-rays or unnecessary antibiotics. Click here to read the study.

CMS Releases Proposed Rates for ESRD and DME Fee Schedule

CMS has released a proposed rule that would update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services as well as the July 2016 Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) fee schedule amounts. The rule also proposes new quality measures on care by dialysis facilities treating patients with end-stage renal disease; provisions for coverage and payment of renal dialysis services furnished by ESRD facilities to individuals with acute kidney injury; policies to require bidding entities to obtain and provide proof of a bid surety bond for each competitive bidding area in which the entity submits its bid(s); and changes to the methodologies for adjusting DMEPOS fee schedule amounts using information from the DMEPOS Competitive Bidding. Click” here “:http://https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-06-24.html for the CMS fact sheet.

300+ People Charged in Fraudulent Billings Schemes of $900+ Million

The Medicare Fraud Strike Force has charged more than 300 people with schemes that netted more than $900 million in fraudulent billings of federal health programs in 2016. This year’s operation is the largest, in terms of dollars and geographic spread, and targeted doctors, nurses, pharmacists and other providers both real and fake. The charges include prescribing unnecessary drugs, bribery, money laundering and submitting false claims. According to the Justice Department release, criminals are increasingly targeting Medicare Part D with growing use of stolen medical identities for fraudulent prescriptions. Click here for details from DOJ.

  • More than 500 home healthcare agencies—about 5% of the total—and 4,500 doctors across the country share characteristics that often point to home healthcare fraud, according to a new report from HHS’ Office of Inspector General. Click here for the report.
 UN: US has a Heroin Epidemic

According to the UN’s World Drug Report released last week, heroin use in the United States has sharply increased in the past decade. One million heroin users were reported in 2014, almost three times as many users since 2003, and heroin-related deaths have increased 500 percent since 2000. Click here for the full report.

Opioid Use in US Doubles in a Decade

According to a new NIH study, nonmedical use of prescription opioids more than doubled among adults in the United States from 2001-2002 to 2012-2013. In the later years, 4.1 percent, or nearly 10 million people used opioid drugs, up from 1.8 percent of the adult population 10 years earlier. Additionally, over 11 percent of Americans report nonmedical use of prescription opioids at some point in their lives, a huge increase from 4.7 percent in 2001-2002. Overall, the study found that nonmedical prescription opioid use has increased by 161 percent from 2001-2002 to 2012-2013. To read the study, click here.

  • Federal and state officials have urged doctors to initially treat pain without opioids, in an attempt to decrease the likelihood of drug abuse. Doctors have explored alternative treatments, such as acupuncture, to help patients cope with pain. Click” here”:http://http://www.nytimes.com/2016/06/23/business/new-ways-to-treat-pain-without-opioids-meet-resistance.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=second-column-region&region=top-news&WT.nav=top-news&_r=2 for the NY Times article.
Legislation Pushed To Improve Care for the Seriously Chronically Ill

Doctors and lawmakers last week pushed legislation that would require training more providers who specialize in hospice and palliative care and improve options for patients with serious chronic illnesses. At a hearing of the Senate Special Committee on Aging, Sen. Sheldon Whitehouse (D-RI) said he is introducing a bill that would allow for more pilot programs and Medicare waivers regarding hospice care.  Best-selling author and surgeon Dr. Atul Gawande told the committee that the system of care for those with serious and chronic illness is often inadequate and inhumane. Research has shown that in the last month of life, more than half of people experience moderate to severe pain and many also have depression. Those who receive palliative care suffer less, are more physically capable and can interact with others for longer. But they do not die sooner, and their costs are typically lower. Click here for Gawande’s very interesting written testimony.

ER Use Booming: CDC

People in the US go to the emergency room more than you might think — 20 percent of people in the US head to the ER at least once each year, according to new numbers out from the Centers for Disease Control.  That translates to about 131 million ER visits a year, 11 percent of which result in a patient being admitted to the hospital. Visits in the five most populous states — New York, California, Florida, Texas, and Illinois — accounted for 36 percent of all ER visits nationwide. Click here for details.

House GOP Releases Obamacare Replacement, Health Analysts Not Impressed

House Republicans last week released their long-awaited plan to replace Obamacare.  The GOP proposal starts with a transition period out of Obamacare. It would encourage people to have insurance coverage with the help of advanceable, refundable tax credits adjusted for age. It would encourage small group health plans and provide $25 billion in incentives to states to set up high-risk insurance pools. In place of Obamacare’s individual mandate, the plan would prohibit insurance companies from denying patients coverage or charging them more because of pre-existing conditions, but only if they keep continuous insurance coverage, although they could switch plans or carriers. Click here for the plan. Click here for the response from health analysts and others.

Health Care Affordability at All-Time High: Gallup

A record low of 15.5 percent of Americans are unable to afford health care or medicines, according to a new Gallup poll. The poll shows that the percentage of U.S. adults reporting health care insecurity has dropped 3.5 percentage points since the end of 2013, coinciding with people signing up for health insurance exchanges as well as expanded Medicaid. Gallup found that in the initial months of 2016, nearly 42 percent of the uninsured reported having health insecurity, compared to 12.3 percent of those who had health insurance. Click here for the poll results.

Even an Inexpensive Meal Can Influence Physician Prescriptions: JAMA Study

Physicians were more likely to prescribe the brand-name drugs promoted by pharmaceutical reps when they received even a single, relatively inexpensive industry-sponsored meal, according to a new JAMA study. Study showed that additional and costlier meals were both associated with greater increases in prescriptions as well. Researchers examined records for nearly 280,000 physicians, who received more than 60,000 payments associated with four brand name drugs. More than 95 percent of the payments were for meals that averaged less than $20. To read the study, click here.

Medicare Trust Fund Runs Out of Money in 2028

According to the new trustee report released last week, Medicare’s hospital trust fund is expected to run out of money in 2028 – two years earlier than last year’s report. The report also showed that Medicare’s total costs will grow from roughly 3.6 percent of GDP in 2015 to 5.6 percent in 2040. The trustees state that recent increases in Medicare spending have come from an influx of new people signing up for the federal program as well as from rising drug costs. Click here the report and actuarial tables.

Senate Passes Bill to Delay DME Cuts

The Senate has passed the Patient Access to Durable Medical Equipment (PADME) Act (S.2736) to delay durable medical equipment supplier payment cuts in rural and non-competitive bid areas for a year. CMS was required to adjust Medicare fee schedule amounts for non-competitive bid areas by Jan. 1. The agency decided to phase in changes to the DME fee schedule rates during the first half of 2016 so that the rates in all areas would be based on a 50/50 blend of current rates and adjusted rates. Another round of cuts is scheduled to go into effect July 1. The Senate bill would;

  • Delay the second payment cut for DME in non-bid areas for 12 months;
  • Lock in the bid ceiling for future rounds of bidding at the bid rates in effect on July 1;
  • Require CMS to solicit stakeholder input and take into account travel costs, volume, clearing price and information on the number of suppliers in a bid area as part of rate setting in January 2019 and after; and
  • Push up the date when Medicaid reimbursement will match Medicare competitive bid rates from January 2019 to October 2018.

The House has similar legislation slated for Floor consideration soon. Click here to view the bill.

HHS Releases $742,000 To Fight Zika Off-Shore

HHS last week announced more than $742,000 in funding to three health centers in American Samoa and the U.S. Virgin Islands to help combat the Zika virus. These funds will be used to expand preventive and primary care services, outreach, and patient education and screening. The three health centers and their 12 delivery sites in American Samoa and the U.S. Virgin Islands served nearly 26,000 patients in 2014, including more than 6,000 women age 15 to 45. Click here for details.

One-Third of Hospitals in the Developing World Don’t have Clean Water

A new report examined 430 hospitals in developing countries and found that one third of clinics did not have a reliable source of clean water to perform surgical operations. The researchers analyzed previous research related to surgical capacity in low- and middle-income countries. They identified 19 surgical capacity studies undertaken between 2009 and 2015 that included information on water availability covering 430 hospitals in 19 nations. Click here)30161-5/abstract for the report.

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