10 Jul Weekly E-bulletin

Senate May Be Moving to Plan B on Health Care

Congress gets back to work in Washington this week, but it appears the Senate is no closer to a deal on its health care reform legislation than before the week-long recess.  Here’s a summary of where the legislation stands today:

• Senate Leader Mitch McConnell says the GOP must shore up ACA insurance markets if Senate bill dies.  His comments last week could point to bipartisan talks. Click here and here.
• Two more GOP Senators, who were thought to be supportive of McConnell’s legislation, did anything but show their support last week.  Click here for Kansas Senator Moran.  Click here for North Dakota’s John Hoeven.
• The Senate health bill could lead to a loss of nearly one million jobs over the next decade, according to a new report from the Commonwealth Fund and George Washington University, which models out the effect of the legislation’s funding cuts on the economy. Click here for the report.
• An American Academy of Actuaries assessment of the Senate’s repeal bill out last week raises concerns about the long-term effects of Medicaid changes, as well as the elimination of the ACA’s individual mandate and cost-sharing subsidies, among other tissues. Click here.
• One conservative litmus test may come from Sen. Ted Cruz (R-TX).  Cruz’ amendment would allow insurance companies to sell healthcare plans that are not compliant with the Affordable Care Act as long as they make one plan available that qualifies under the current law. Cruz said his goal is lower premiums, but Minority Leader Chuck Schumer, D-NY, countered that many would pay instead through more expensive deductibles and copayments. Click here for the report.
• For a variety of reasons, the House and Senate health care legislation is very unpopular across the country.  Click here and here for some of the latest polling. This report says it’s the most unpopular bill in three decades.
• Other efforts that are garnering much less attention would further reshape Medicaid, potentially knocking millions more off the rolls. They include asking beneficiaries to verify their eligibility twice a year, instead of once under the current law. Click here for another look at the Medicaid impact.

In Letter To Trump, House and Senate Democrats Urge Support for 340B Program

In response to the leaked draft Executive Order on drug pricing, specifically on the language relating to reform of the 340B Drug Pricing Program. The proposal directs HHS to review the 340B program and likely revamp it in its entirety. The 340B Drug Pricing Program allows disproportionate share (DSH) hospitals and other health care providers to obtain discounted prices on covered outpatient drugs from pharmaceutical manufacturers. While it still remains unclear whether the President will sign the Executive Order, 29 Democrats from the House and Senate are urging Trump to maintain the 340B program and work to bring down drug prices.  To read the letter, click here.

41 Percent of Rural Hospitals Had Negative Margins Last Year: Study

Approximately 41 percent of rural hospitals faced negative operating margins in 2016, according to a recent study of more than 2,100 rural hospitals.  Researchers said that rural hospitals located in states that elected not to implement a Medicaid expansion program operated with lower margins compared to their peers in expansion stated. Click here for the complete report.

Generic Drug Prices on the Rise Unless More Competition: Study

Generic drug prices may keep rising unless more is done to encourage competition, especially in the cases where pharmaceutical manufacturers have few financial incentives, according to a study published in the Annals of Internal Medicine last week. This comes out in light of the FDA announcement that they are looking to address such concerns by giving priority reviews to new generic drugs until there are at least three competitors on the market. But the authors contend that addressing competition alone might not be enough to stop the problem as manufacturers do not always incentives to make compounds, or may not be able to get raw materials at competitive prices. Click here for the study, and here for the FDA announcement.

Opioid Prescriptions on the Decline, But Still Not Low Enough: CDC

The opioid prescription rate is going down, according to new CDC data, but the agency doesn’t see this is necessarily a positive thing. The number of opioid prescriptions in the United States peaked in 2010 at 81.2 prescriptions per 100 people, CDC said. The rate then stayed close to the same rate until 2012, when it decreased to 70.6. The trend is positive, but the data still indicates too many opioids are being given out, public health officials at the CDC said. There is also a large variation of county-by-county prescribing patterns, as some localities saw as much as six times more than others. To read the full report, click here.

Bipartisan Heroin Task Force Releases Priorities

The Bipartisan Task Force to Combat the Heroin Epidemic, led by co-chairs Congresswoman Kuster (NH-02) and Congressman MacArthur (NJ-03), released an outline of its priorities for the coming year including its nine legislative proposals.  The bills include legislation that would address everything from prevention and treatment to law enforcement, and how the Veterans Affairs handles patients with addiction. For example, the STOP OD Act is being considered by a handful of House Committees and could provide up to $150 million in grants for access to Naloxone. Another proposal would give family members the option of using funds in their Health Savings Accounts or Flexible Spending Accounts to pay for addiction treatment for any relative. Click here for the release.

House Subcommittee to Look at State Response to Opioid Crisis

The House Energy and Commerce Subcommittee on Oversight and Investigations announced a hearing for Wednesday to look at the state efforts to combat the ongoing opioid epidemic.  Witnesses include officials from Rhode Island, Virginia, Maryland, and Kentucky who will speak to current challenges in combating the epidemic, ways the federal government can assist, and their efforts that have begun to make a difference. To view the hearing notice, click here.

CMS Releases Map Showing Projected Insurer Participation in Health Insurance Exchanges

According to an updated CMS map of insurer participation, more insurers are now projected to drop out of the exchanges. The map shows that 40 counties will have no longer have insurers in their exchanges and up to 1,300 counties could have only one insurance option. This means that as many as 2.4 million exchange participants will have only one choice and at least 35,000 active Exchange participants live in counties that are projected to be without coverage in 2018. Click here for the CMS press release, and here for the map.

• California Public Employees’ Retirement System, CalPERS, in June adopted 2018 rates reflecting a 2.3 percent overall average premium increase. Are they doing something different than everyone else? But benchmark analysis by consulting firm Mercer shows CalPERS’ premium increases from 2014 to 2017 were markedly lower for every year except 2016, when rising pharmacy costs put pressure on rates. Click here for more.

Rural Areas Have Higher Rates of Cancer

Despite a nationwide drop off in cancer deaths, rural areas have a higher mortality rate from cancer than urban centers, according to new data from the CDC. Death rates in rural areas (180 deaths per 100,000 people) are higher when compared with urban areas (158 deaths per 100,000 people) between 2006 and 2015. Researchers also found that rates of new cases for lung, colorectal, and cervical cancer were higher in rural America, however there was a lower incidence of breast and prostate cancer in those counties. This report gives a comprehensive assessment of cancer, and deaths by cancer type in non-metropolitan and metropolitan counties across the country.  To view the CDC’s report, click here.

FDA Announces Plans for 21st Century Cures Funds

The Food and Drug Administration has released an outline for how it will spend the $500 million in new funding it received as part of 2016’s 21st Century Cures Act. One of the largest amounts of money, $185.2 million, will go towards patient access to therapies and information. This sum includes FDA’s work towards allowing companies to use data summaries instead of full data sets to get approval for a secondary indication of a medical product. Additionally, FDA said it’s first focus will be on using the authority for cancer drugs. The $185.2 million will also be used to develop a new program to foster regenerative medicine treatments and to update FDA’s regulation of combination drug and device products. Click here for the announcement and list.

CMS Provides Regulatory Relief to Long-Term Care Facilities, Home Health Agencies

Provider groups are cheering a delay by CMS on enforcement remedies for specific Phase 2 nursing home survey requirements.  Although CMS did not delay when providers should be ready for the new survey process — that’s still Nov. 28 — the limitation on penalties will give providers a chance to understand, prepare, and comply with some of the most complex and challenging aspects of the new requirements. “Specifically, we will not utilize civil money penalties, denial of payment, and/or termination. Should a facility be found to be out of compliance with these new requirements beginning in November of 2017, CMS would use this year-long period to educate facilities about certain new Phase 2 quality standards by requiring a directed plan of correction or additional directed in-service training,” CMS stated. Clickhere for the CMS memo.

• CMS has also delayed the effective date from July 13, 2017 to Jan. 13, 2018 for its final rule implementing significant changes to the requirements for home health agencies that participate in the Medicare and Medicaid programs.  Click here for the CMS announcement.

Advisory Board Could Be Acquired and Split Up

UnitedHealth Group Inc. and Vista Equity Partners are nearing a deal to acquire and split up the health and education consultant Advisory Board Co., according to people familiar with the matter and reported by Bloomberg.  UnitedHealth would acquire Advisory Board’s health-care division and Vista would buy its education business, said the people, who asked not to be named because discussions are private. The education unit may sell for as much as $1.5 billion, one of the people said. Click here for the report.

New Bipartisan Bill Would Ease Meaningful Use Burden

A bipartisan bill that would apparently open the door for HHS to ease the burden on hospitals of meaningful use reporting was introduced in the US House of Representatives on June 30.Its sponsors include Reps. Michael C. Burgess, MD (R-TX), Debbie Dingell (D-MI), Patrick Tiberi (R-OH), and Mike Thompson (D-CA). Click here for details.

New CDC Director Named

HHS Secretary Tom Price, M.D., last week named Brenda Fitzgerald, M.D., as the 17th Director of the Centers for Disease Control and Prevention (CDC) and Administrator of the Agency for Toxic Substances and Disease Registry (ATSDR). Click here for the announcement.

WHO: Antibiotic Resistant Gonorrhea on the Rise

Antibiotic resistance is causing gonorrhea to become harder and, in some instances, impossible to treat and cure, according to a new World Health Organization report. Gonorrhea, a sexually transmitted disease that can cause infertility if untreated, effects an estimated 78 million people each year, according to WHO. Data collected from 77 countries, shows the disease has developed resistance to some antibiotics, and an increasing number of countries are finding that the infection has become untreatable by all known antibiotics.  To read the report from the WHO, click here.

High Serotonin Levels Found in Blood of SIDS Babies

A new NIH study led by Robin L. Haynes, PhD, of Boston Children’s Hospital and Harvard Medical School showed blood samples from infants who died of Sudden Infant Death Syndrome had high levels of serotonin, a chemical that carries signals along and between nerves. SIDS is the sudden death of an infant under one year of age that remains unexplained even after a complete autopsy and death scene investigation. The researchers of the study state that 31 percent of SIDS infants (19 of 61) had elevated blood levels of serotonin.  To read the study, click here.