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WEEKLY FEDERAL UPDATE

WEEK OF MONDAY, OCTOBER 29, 2018

President's Proposal to Cut Drug Prices Would Reduce Provider Payments

President Trump has announced a proposal to lower drug prices by tying provider payments under Medicare Part B to the lower prices in Europe instead of the congressionally-mandated average sales price plus six percent. The notice of proposed rule states that the official proposal will come in the spring of 2019 with an effective date of Jan. 2020. Not surprising, the pharmaceutical quickly condemned the plan stating it is, "imposing foreign price controls from countries with socialized health care systems that deny their citizens access and discourage innovation." Physician groups are also skeptical as the AMA said in a statement that the plan, "raises a number of questions, and we need to have a greater understanding of the potential impact of the proposal on patients, physicians, and the health care system." Click here for the President's speech, here for the CMS notice, and here for the CMS fact sheet. For the statement from PhRMA, click here, and from AMA, click here.

An new HHS report says that Medicare often pays nearly twice as much as countries like France and Japan to use the same drugs. Click here for the report.

Rochester, Burlington, Charleston, Cincinnati, Baltimore Are Top Health Care Cities: Healthgrades

Healthgrades has released both its 2019 Annual Report to the Nation - an analysis of nearly 4,500 acute care hospitals and their variation in clinical quality and outcomes - and the 2019 National Health Index - a study that examines 100 cities across the U.S. to determine the cities leading the way in healthcare. What do these studies show? That geography matters when it comes to access to healthcare and quality of care. 

The analysis found that patients treated at hospitals receiving a 5-star rating have a lower risk of dying and a lower risk of experiencing one or more complications during a hospital stay than if they were treated at hospitals receiving a 1-star rating in that procedure or condition. Click here for the 12-page summary.
The Health Index evaluated more than a dozen variables, grouped into four health care factors: 1) whether the residents of each city were healthy overall, 2) if consumers had access to health care, 3) if local specialists achieved high marks in patient satisfaction and physician count per capita and 4) if patients had access to high quality hospitals, determined using the Healthgrades 2019 hospital quality analysis. Click here for the list of cities.

Anchorage, San Jose, San Francisco Have Highest Average Health Care Prices: Analysis

The Health Care Cost Institute's Healthy Marketplace Index looked at more than 1.78 billion commercial claims and compared the average price paid for the same healthcare service across 112 U.S. cities from 2012-16. Overall, 111 of the cities health care prices increased in the 5-year period. At 33 percent below the national average, Baltimore had the lowest overall healthcare price level in 2016. The five highest are Anchorage, AK at 65 percent above average, San Jose, CA at 65 percent above, San Francisco at 49 percent above, Milwaukee, WI at 17 percent above, and Green Bay, WI at 14 percent above. The lowest five cities are - Baltimore, at 33 percent below the average, Little Rock, AR at 32 percent below, Youngstown, OH at 28 percent below, Pittsburgh, PA at 27 percent below, and Louisville, KY at 26 percent above. For the interactive map to review all the stats, click here

President Signs Opioid Legislation, Administration Gets Programs Started

President has signed the sweeping opioid package (H.R. 6) lto address the crisis, almost a year after declaring the epidemic a public health emergency.  Attorney General Jeff Sessions announced $70 million in new funding - $35 million to support law enforcement agencies in combating methamphetamine, heroin, and prescription opioids, and another $35 million to establish new programs to provide services to children victims of the opioid crisis. HHS’ Office for Civil Rights launched a new awareness campaign highlighting civil rights protections for people with addiction as part of the broader efforts to address the opioid crisis. Click here for the President's remarks on signing H.R. 6, here for more on the Justice Department grants, and here for the HHS campaign.

Justice Department’s Criminal Division has announced the formation of the Appalachian Regional Prescription Opioid Strike Force (ARPO Strike Force), to identify and investigate health care fraud schemes in the Appalachian region and surrounding areas. Click here.
CMS released a new model to address Maternal Opioid Misuse (MOM) model to help coordinate the care given to pregnant or postpartum women with opioid use disorder who are Medicaid beneficiaries. Click here.
Sadly, there seems to be a positive to the opioid crisis - increased organ donation. Click here.
FDA launches global operation to crack down on websites selling illegal, potentially dangerous drugs including opioids. Click here.

Alaska, California, Wisconsin Post Cities with Highest Average Health Care Prices

And the lowest cities coming from Maryland, Arkansas, and Ohio according to the Health Care Cost Institute's Healthy Marketplace Index. The Index looked at more than 1.78 billion commercial claims and compared the average price paid for the same healthcare service across 112 U.S. cities from 2012-16. Overall 111 of the cities health care prices increased in the 5-year period. At 33 percent below the national average, Baltimore had the lowest overall healthcare price level in 2016 and Anchorage and San Jose had the highest each at 65 percent of the national average. Top five highest are - Anchorage, AK at 65 percent above average, San Jose, CA at 65 percent above, San Francisco at 49 percent above, Milwaukee, WI at 17 percent above, and Green Bay at 14 percent above.  The lowest five cities are - Baltimore, MD at 33 percent below the average, Little Rock, AR at 32 percent above, Youngstown, OH at 28 percent below, Pittsburgh, PA at 27 percent below, and Louisville, KY at 26 percent above. To view all the stats, click here

Medicaid Advisory Committee Urges Slowdown of Work Requirements

The Medicaid and CHIP Payment and Access Commission last week heard an update that raised concerns about the  implementation of work and community engagement requirements in the Arkansas Medicaid program. This led MACPAC to call for CMS to temporarily pause its approvals of work requirements in other states. This comes after the second consecutive meeting in which commissioners expressed alarm about the large number of beneficiaries kicked off Medicaid in Arkansas during the initial months of the state’s work-requirement program. Several members of the commission said they want to call on CMS to require Arkansas to stop removing people from Medicaid until the state enacts better procedural protections for beneficiaries. Click here for the presentation and report.

CMS Administrator Seema Verma pressed ahead with state waivers, announcing a new initiative in North Carolina, as a way to make Medicaid stronger. Click here.
Medicaid spending is rising even though enrollment is flat, according to a new report. Click here.
A new report by the Center for American Progress says expanding Medicaid in all states would save 14,000 lives per year. Click here.
According to a new report, Medicaid MCOs are increasingly using value-based payment models. In 2017, half of Medicaid MCOs indicated that they were piloting population-specific VBP models, while over 15 percent were expanding successful pilots. About 10 percent reported that they had extensive VBP arrangements in place in 2017.  Click here for the report.

New CMS Proposal Would Expand Telehealth

CMS proposed late last week a rule to update Medicare Advantage and Part D drug programs. The changes in the proposed rule required by the Bipartisan Budget Act of 2018 would allow plans to cover additional telehealth benefits, establish new minimum criteria for Medicare and Medicaid integration for MA Dual Eligible Special Needs Plans, and make several measure updates to Medicare Advantage and Part D Quality Rating System. Changes would impact plans beginning in the 2020 plan year.  For the CMS fact sheet, click here, and for the proposed rule, click here.

Lawmakers Urge CMS To Change ACO Proposal

A bipartisan group of nine House members is urging CMS to modify its proposed regulations impacting Medicare Shared Savings Program Accountable Care Organizations.  The lawmakers say the proposal to reduce the glidepath to bearing risk from 6 to 2 years and the reduction of shared savings from 50 percent to 25 percent would keep many ACOs from participating.  They say that CMS should provide more incentives for participation in this voluntary program.  Click here for their letter.

FDA Approves New Flu Treatment Just in Time for the Next Season

For the first time in about 20 years, the FDA has approved a new treatment for the flu. The FDA approved Xofluza, a single oral dose. The drug can be used for patients at least 12 years old who have not been symptomatic for more than 48 hours. Starting treatment within 48 hours lessens symptoms and time the patient is sick. In the drug trials, patients treated with Xofluza had a shorter time to alleviation of symptoms compared with patients who took the placebo. Click here for more from the FDA.

New CDC data shows that 40 percent fewer adults received flu shots in the US last year, click here.

Mississippi Has Highest, Utah Has Lowest for Rate for Childhood Obesity

Researchers from the Robert Wood Johnson Foundation studied data from the National Survey of Children’s Health to determine the differences in Childhood Obesity rates in each state. The data revealed that Mississippi’s rate of 26.1% was the highest state rate above the national rate of 15.8%. Ten states with the highest rates are mostly in the South or Midwest. The only state to see a statistically significant change was North Dakota with it's youth obesity rate dropping from 15.8% in 2016 to 12.5% in the combined 2016-17 data set. For the full report, click here
 
Human Organ Shortage Tackled by 3D-Printing

United Therapeutics Corps has an agreement with an Israeli regenerative medicine company to develop and commercialize 3D-bioprinted lungs for transplants. United Therapeutics will pay $5 million upfront with subsequent milestone payments of up to $15 million as the drugmaker also has the option to expand the license to include up to three more organs beyond lungs. This comes on the heels of Swedish company Cellink announced earlier this month that it has found a way to make skin, ears, liver cells, and can even replicate fully functional cancer tumors that can then be used to develop new cancer treatments. For more on United deal, click here, and on the Cellink research, click here.
 
New Study Shows that Organic Food Reduces the Risk of Cancer

A new French study found that adults who frequently consumed organic food had 25% fewer cancer diagnoses than those who never ate organic products. The study involved 70,000 adults, mostly women, who were tracked for five years. Participants provided information on how often they ate different types of organic products, their general health status, occupation, etc. There was a significant drop in incidence of lymphomas and breast cancer. However, nutrition experts at Harvard criticized the study because researchers did not test pesticide residue levels in the participants. They believe that a longer-term study is needed before making dietary recommendations about cancer prevention. Read the study, click here.
 

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