Jun 12, 2017
Washington Healthcare Update
This Week: Senate Republicans continue to work on repeal and replace…FDA User Fee Reauthorization moves forward in the House…Drug pricing is a focus of committees
3. State Activities
4. Regulations Open for Comment
House Energy and Commerce Committee Moves Forward FDA User Fee Bill
On June 7, the House Energy and Commerce Committee reported out a bill
reauthorizing FDA user fee programs for drugs and medical devices in a
unanimous 54-0 vote. The user fees covered by the legislation account for
nearly half of the FDA’s budget for regulating medical products. The Senate
HELP Committee voted its reauthorization out of committee nearly one month
Chairman Walden (R-OR) offered a bipartisan manager’s
including measures approved at a health subcommittee markup last month that
was adopted by voice vote. The subcommittee last month approved four
bipartisan amendments, including one designed to increase generic drug
competition to address price hikes of older drugs and another that would
establish a category of FDA-approved over-the-counter hearing aids.
The full committee also adopted four bipartisan amendments that would:
the FDA review process for medical imaging devices intended to be used in
conjunction with contrast agents;
the FDA’s high-risk classification for low-risk medical devices;
pilot projects to generate “reliable and timely” safety surveillance data
on approved medical devices; and require HHS to submit a report to Congress
about how FDA ensures the safety and continued effectiveness of medical
devices that have been serviced.
The panel considered several controversial proposals dealing with marketing
and importation. One from Rep. Morgan Griffith (R-VA) would have
restrictions on off-label promotion of medicines. An amendment from Rep.
Peter Welch (D-VT) would have
for the reimportation of drugs from Canada.
Griffith’s proposal drew threats from Democrats, including ranking member
Frank Pallone (D-NJ) and Gene Green (D-TX), who vowed to sink the entire
user fee package if the language was adopted. Congressional leaders from
both parties and houses have stressed the need to keep contentious language
out of the must-pass package in order to ensure passage before the August
recess. The amendment was withdrawn.
Another amendment by Welch and David McKinley (R-WV)
attempts by some brand-name drug companies to use FDA’s risk management
programs to block potential generic competitors’ access to samples of the
branded products that are needed to bring a generic to market. That
measure, opposed by the industry, was withdrawn. The RACE for Children Act,
which would require drug companies to research cancer treatments in kids,
was not brought up for a vote, either.
In addition to the FDA user fee reauthorization legislation, the committee
also advanced bills that would
research of congenital heart disease,
a sickle cell disease and prevention program and
doctors and other health care providers to carry controlled substances
between practices in different states.
House Health Leaders Look into 340B
House Energy and Commerce Chairman Greg Walden (R-OR)
the Health Resources and Services Administration to provide any audits of
health providers participating in the drug discount program for 2015 and
2016. The letter cited earlier audits, which “commonly find that covered
entities bill for duplicate discounts on the same drug, and divert 340B
drugs to ineligible patients.”
The letter, signed by Oversight Subcommittee Chairman Tim Murphy and Health
Subcommittee Chairman Michael Burgess, also says, “HRSA’s lack of follow-up
audits when it finds violations is troubling and combined with the high
rate of noncompliance, indicates a need for additional oversight of this
340B Health, representing hospitals and health systems participating in the
program, issued a statement citing “extensive additional oversight of 340B
hospitals and other providers in recent years,” with 644 covered entity
audits completed since 2012 and 400 more planned for 2017 and 2018.
Bipartisan Letter Urges Price to Overturn Third-Party Payer Ban
A group of 184 House Democrats and Republicans wrote a
letter to HHS Secretary Tom Price asking him to issue a rule that would
explicitly require qualified health plans to accept premium payments from
third-party payers, including charities and hospitals. The rule sought by
the lawmakers would reverse CMS’s controversial guidance from 2014, but, if
issued, also would address a December interim final rule that effectively
curbed dialysis facilities from helping patients get assistance through
Cramer has twice introduced bipartisan legislation to make sure nonprofits
and other groups can help people with their premiums.
In December, CMS issued an interim final rule that allowed health plans to
reject coverage for end-stage renal disease patients who receive premium
help from other parties, which kidney care and ESRD stakeholders say
effectively blocks coverage for people with expensive preexisting
Senate HELP Committee to Hold Hearing on Drug Pricing
The Senate Health, Education, Labor and Pensions (HELP) Committee will hold
a hearing on June 13 at 10 a.m. The hearing will focus on the “the process
of moving prescription drugs from the manufacturer to patients and how the
drug delivery system affects what patients pay when picking up their
For more information,
Senate Takes Steps to Move Health Care Bill
On June 7, Senate Majority Leader Mitch McConnell (R-KY) took the
procedural first steps to move the Republican health care bill closer to a
floor vote. McConnell asked for a second reading of the bill and for it to
be placed on the calendar. To vote by June 30, Republicans would have to
have their bill to the CBO about two weeks prior. Unlike the House, the
Senate needs to have the score before its members vote on the bill because
they are required to come up with $133 billion in savings. Staff has
already started early discussions with CBO on pieces of what could be in
the bill. That gives the Senate only about 10 more calendar days to
finalize its legislation.
If a repeal bill is approved by the Senate by June 30, Republicans would
still have one month before the August recess to merge the House and Senate
bills, which are expected to have major differences.
Congressmen Push Funding for State Health Insurance Assistance Program
A group of Senate Democrats and two independents wrote a letter urging the
Senate Appropriations HHS subcommittee to fund the State Health Insurance
Assistance Program (SHIP) at the fiscal 2016 level after the most recent
fiscal 2017 spending agreement cut $5 million from the program and
President Donald Trump seeks to eliminate discretionary funding for the
effort in fiscal 2018. The letter was led by Sen. Chris Murphey (D-CT).
The letter asks HHS subcommittee Chair Roy Blunt (R-MO) and ranking
Democrat Patty Murray (WA) to provide $52.1 million for SHIP in fiscal
2018, saying that restoring the funding to fiscal 2016 levels is critical
as more individuals become eligible for Medicare.
The National Council on Aging, the National Association of Area Agencies on
Aging and others are engaged in pushing back against proposed cuts.
Mandatory funding for SHIP would also need to be reauthorized for fiscal
2018 to be continued. The Medicare Access and CHIP Reauthorization Act
included $13 million for SHIP in fiscal 2016 and 2017 as part of funding
for low-income outreach and assistance, the Congressional Research Service
noted in a February report, but funding for these programs has not been
enacted for fiscal 2018 and runs out in October.
Misclassification of EpiPen May Have Cost Taxpayers $1.27 Billion
In a letter to Senator Chuck Grassley (R-IA), the Office of the HHS
Inspector General says taxpayers may have spent $1.27 billion too much for
Mylan’s EpiPen because the product was misclassified for years as a generic
instead of a brand-name drug. The estimate covers Medicaid spending on the
EpiPen from 2006 to 2016.
That amount is close to three times the $465 million agreement that the
Department of Justice and the company had reportedly negotiated last year,
although the settlement has still not been finalized and no deal has been
confirmed by DOJ.
Grassley’s office said that CMS recently provided documents showing that it
repeatedly told Mylan that the treatment had been misclassified, although
it is unclear when CMS first raised the issue and what the agency did to
force a change.
CMS Announces IMPACT Act Special Open Door Forum
CMS recently announced it will be holding a Special Open Door Forum (SODF),
which will provide information and solicit feedback pertaining to the
Improving Medicare Post-Acute Care Transformation Act of 2014 (commonly
referred to as the
). This SODF will focus on the goals of the IMPACT Act, update attendees on
the RAND contract activities for item development, including the upcoming
national testing, and identify opportunities for providers, consumers,
stakeholders, researchers and advocates to become involved over the next
The forum will take place on Tuesday, June 20, from 2:00-3:00 p.m.
IMPACT Act SODF Announcement- 6-20-17
for more information.
CMS Seeks Input on Reducing Regulatory Burdens of the Patient Protection and Affordable Care Act
On June 8, CMS issued a request for information (RFI) seeking
recommendations and input from the public on how to create a more flexible,
streamlined approach to the regulatory structure of the individual and
small group markets. CMS’s goal is to identify and eliminate or change
regulations that are outdated, unnecessary or ineffective; impose costs
that exceed benefits; or create inconsistencies that otherwise interfere
with regulatory reform initiatives and policies.
Consumers who have obtained coverage through the exchanges are facing
significant premium increases. A recent
issued by the Department of Health and Human Services states that the
average premium in the 39 states using HealthCare.gov in 2017 increased from
$232 in 2013 to $476 in 2017, which is a 105 percent increase. Consumers
are also dealing with fewer plans to choose from and a continuous stream of
issuers exiting the exchanges.
The RFI follows steps CMS has already taken to help improve the health care
system, including issuing the Market Stabilization Final Rule on April 18,
2017. This new rule will place downward pressure on premiums, limit special
enrollment period abuses and help to improve choices, while also reducing
regulatory burden. The RFI will be open for public comment for 30 days.
To view the request for information,
HHS Secretary Price Endorses Budget Cuts for the Agency
HHS Secretary Tom Price officially endorsed deep cuts to the agency’s
funding as part of a proposed fiscal 2018 budget, telling senators that HHS
badly needs an overhaul—not more money. Price, during the first of his two
congressional hearings, defended slashing the budget for antipoverty
programs like Medicaid and Temporary Assistance for Needy Families, as well
as stripping billions of dollars from agencies such as NIH. The cuts are
part of a bid to make HHS more efficient and effective, he told the Senate
Finance Committee, rather than continue to throw money at programs that
Price believes are not working.
Site-Neutral Payment Reform Pushed for Upcoming Outpatient Pay Rule
The Alliance for Site-Neutral Payment Reform asks that CMS use the upcoming
outpatient pay rule to pay equal rates to hospital outpatient facilities
and doctor offices, which is the opposite of hospitals’ request.
Medicare pays far more for services in hospital-owned doctor offices than
in independent doctor offices, the site-neutral group states, so expanding
site-neutral policies would significantly reduce Medicare spending and
lower copays for beneficiaries, who are responsible for 20 percent of the
cost of services.
In 2014, Congress passed the Improving Medicare Post-Acute Care
Transformation Act to set up the post-acute care sectors for eventual
payment reforms, including site-neutral pay. The following year, Congress
wrote a law that directs CMS to lower doctor’s office rates to physician
practices that hospitals buy and turn into outpatient departments. The
policy applies to off-campus outpatient facilities that were not billing
Medicare as of Nov. 2, 2015. Hospitals then convinced Congress a year later
to include a measure in 21st Century Cures that exempts hospital outpatient
departments that were in development when the site-neutral law took effect.
The Alliance for Site-Neutral Payment Reform wants site-neutral pay rates
applied to all off-campus outpatient facilities.
The Alliance for Site-Neutral Payment Reform assembled reports on the trend
of hospitals’ buying doctor practices, which the group says is largely due
to the pay rate differences that encourage doctors to sell out and cash in.
Cancer doctor practices are especially vulnerable to hospital buyouts. A
Milliman study found the portion of chemotherapy infusions the Medicare
beneficiaries receive in hospital outpatient departments increased from 16
percent in 2004 to 46 percent 2014.
CMS could make administrative changes that help equalize pay rates for like
services, the site-neutral groups says, such as eliminating hospital
outpatient department facility fees. The group also says CMS should require
that outpatient departments attest their off-campus provider-based
facilities meet requirements for receiving higher OPPS payments. The HHS
inspector general reported last year that about three-quarters of the 50
hospitals it reviewed had not voluntarily attested their off-campus
provider-based facilities meet at least one requirement for higher
CMS also should alert consumers to the cost of receiving care at
hospital-owned facilities, the group said. CMS’s website lets beneficiaries
scroll through a list of covered services to see the availability and
potential cost of services. However, Medicare.gov does not include
information on costs associated with different care settings.
Medicare Cards Will No Longer Have Social Security Numbers
On May 30, CMS announced that new Medicare cards will use a unique,
randomly assigned number, called a Medicare Beneficiary Identifier (MBI),
to replace the Social Security-based Health Insurance Claim Number (HICN)
currently used on the Medicare card. CMS will begin mailing new cards in
April 2018 and will meet the congressional deadline for replacing all
Medicare cards by April 2019.
Providers and beneficiaries will both be able to use secure look-up tools
that will support quick access to MBIs when they need them. There will also
be a 21-month transition period during which providers will be able to use
either the MBI or the HICN, further easing the transition.
CMS has a website
dedicated to the Social Security Number Removal Initiative (SSNRI) where
providers can find the latest information and sign up for newsletters. CMS
is also planning regular calls as a way to share updates and answer
provider questions before and after new cards are mailed beginning in April
HHS Makes Grants Available to Treat People for Opioid Use
On May 31, HHS announced it was making $70 million in grants available to
help communities and health care providers prevent opioid overdose deaths
and treat people with opioid use disorder. This amount includes $28 million
dedicated to medication-assisted treatment.
Other funds—$41.7 million over four years—will be available to about 30
grant recipients to train and provide resources for first responders
administering FDA-approved emergency treatments for opioid overdose. Up to
$1 million over five years will be available to one grantee to expand
availability of overdose reversal medications in health care settings and
to establish protocols to connect patients who have experienced an overdose
These grants are in addition to $485 million in grants HHS announced in
April 2017 provided by the 21st Century Cures Act to address opioid abuse
prevention, treatment and recovery.
FDA Orders Painkiller Off the Market
On June 8, the FDA told Endo Pharmaceuticals to pull its painkiller Opana
ER from the market—the first time the agency has taken such an action
because of an opioid’s potential for abuse.
An agency review of postmarket surveillance data found “a significant
shift” in the way the reformulated drug was being abused—from snorting to
crushing and injecting it.
“We will continue to take regulatory steps when we see situations where an
opioid product’s risks outweigh its benefits, not only for its intended
patient population but also in regard to its potential for misuse and
abuse,” FDA Commissioner Scott Gottlieb said in
of the decision.
The decision follows an advisory board vote in March that the drug’s
benefits no longer outweigh its risks. In 2012, Endo introduced a
reformulated version of Opana ER—first approved in 2006 — that included
abuse-deterrent properties. But the new formulation has been linked to
infectious disease outbreaks, including a 2015 HIV outbreak in Indiana tied
to injections of the drug.
FDA Advisory Committee to Meet About Two Biosimilar Applications
On July 13, FDA’s oncology advisory committee will meet to recommend
whether FDA should approve two biosimilar applications: Amgen’s biosimilar
application for Genentech/Roche’s Avastin and Mylan GmbH’s application for
Genentech’s Herceptin. There are no FDA-approved biosimilars for either
biologic. The panel will consider approval of Amgen’s biosimilar for all
currently approved indications for Avastin: Metastatic Colorectal Cancer;
Non-Squamous Non-Small Cell Lung Cancer; Glioblastoma; Metastatic Renal
Cell Carcinoma; Persistent, Recurrent, or Metastatic Carcinoma of the
Cervix; and Recurrent Epithelial Ovarian, Fallopian Tube, or Primary
The panel will also consider approval of Mylan’s biosimilar to treat
Adjuvant Breast Cancer; Metastatic Breast Cancer; and Metastatic Gastric
Cancer—all indications for which Genetech’s biologic is currently
FDA has approved five biosimilars to date. On May 26, the Oncology Advisory
Committee also recommended approval of Hospira’s epoetin alfa biosimilar,
but FDA has not yet approved the application.
Veterans Affairs Scraps VistA Electronic Health Record System
Secretary of Veterans Affairs David Shulkin has decided to scrap the VistA
electronic health record system and go with Cerner instead. Shulkin said he
signed a special authorization enabling him to skip the normal competitive
bidding process and move ahead with a direct solicitation to Cerner. The VA
will not adopt the identical EHR that the Department of Defense uses, but
intends to be located on a similar Cerner platform, Shulkin said.
3. State Activities
Illinois: Federal Judge Rules Illinois is not Complying With Court Orders to Pay Health Care Bills
A federal judge ruled this week that Illinois is not complying with court
orders to pay health care bills for low-income people while the state
continues for a third year without a budget. The judge, however, did not
order the state to pay the $2 billion in unpaid medical bills. Instead, she
instructed state attorneys to negotiate an agreement with Medicaid
recipients, which reportedly could happen in the coming days. The judge’s
ruling said the state has not lived up to its agreements in a decades-old
civil case that required the state to keep making Medicaid payments in the
event of a financial crisis.
Michigan: State Would Pay Big to Keep Medicaid Expansion if Repeal Bill
Michigan would have to pay up to $800 million per year to keep Obamacare
Medicaid expansion if the House’s repeal bill becomes law. More than
650,000 people are enrolled in the expanded program in Michigan and state
officials say it would be very difficult to maintain the program if those
funding cuts are enacted. Even though the Senate is rewriting the House
bill, the Senate is still discussing phasing out the enhanced federal
funding for expansion over a longer period of time.
4. Regulations Open for Comment
FDA Considers Establishing New Office of Patient Affairs
The FDA is considering establishing a new Office of Patient Affairs that
would centralize its work on patient involvement in the review and approval
of drugs and medical devices, according to a
March 14 notice
in the Federal Register.
Comments on the new office are due by June 12, 2017.
CMS Releases Proposed Hospital Pay Rule
In a new proposed
2018 Medicare payment rule, CMS
says it will look to cut hospital industry regulations and streamline
oversight, and it’s asking hospitals themselves for help. The agency is
soliciting ideas for changes to rules and procedures governing acute-care
and long-term care hospitals. The initiative aims to “relieve regulatory
burdens for providers,” as well as promote flexibility and innovation, CMS
said in a statement.
The new proposed rule would suspend for one year a provision penalizing
long-term care hospitals that receive more than 25 percent of patients from
a single acute-care hospital. It would also reduce certain quality
reporting requirements for hospitals that have implemented electronic
CMS projects the rule would increase Medicare spending on inpatient
hospital services by $3.1 billion in 2018, with operating payments to
hospitals increasing 2.9 percent. Long-term care hospitals’ Medicare
payments are projected to decrease by $173 million, or 3.75 percent, over
the same period.
Comments on the rule must be submitted no later than 5 p.m. EDT on June 13,
CMS Proposes 2018 Payment and Policy Updates for Medicare Hospital
CMS is offering hospitals a 90-day meaningful use reporting period in 2018,
according to a
proposed payment rule
released April 14.
The first major payment regulation released under HHS Secretary Tom Price
marks a change from the back-and-forth over electronic health records
meaningful use requirements seen under the Obama White House. The previous
administration would typically propose a yearlong reporting period, then
scale it back at the last minute after intense lobbying pressure. As a
Republican congressman from Georgia, Price often pushed the Obama
administration hard for 90-day meaningful use reporting periods.
In connection with the 21st Century Cures Act, CMS also is
to remove from meaningful use clinicians who see most of their patients at
ambulatory surgery centers.
Price and CMS are also changing previously finalized requirements from
electronic clinical quality measures. Under the proposed rule, hospitals
can select six measures and report on them for the first three quarters of
For more information,
CMS is Accepting Measure Submissions for the Advancing Care Information
Performance Category until June 30
CMS is still accepting measures for the Advancing Care Information
performance category of the Merit-based Incentive Payment System (MIPS).
The Annual Call for Measures and Activities ends June 30, 2017.
CMS encourages providers to identify and submit measures for the MIPS
Advancing Care Information performance category. To be considered,
proposals must include specific criteria including, but not limited to,
measure description, measure type and numerator and denominator
CMS requests that stakeholders consider outcome-based measures, patient
safety measures and cross-cutting measures that use certified EHR
technology to support the improvement activities and quality performance
categories of MIPS.
Advancing Care Information Submission Form
to propose measures for inclusion, and send the form to
To learn more about the process for submitting measures, please visit the
Call for Measures
webpage, and review the
Call for Measures and Activities fact sheet.
CMS Looks to Boost Medicare Payments to Rehab Hospitals, Nursing
Facilities and Hospices
CMS could boost Medicare payments to a swath of rehabilitation hospitals,
nursing facilities and hospices under a trio of new proposed rules.
On April 27, the agency floated a
$390 million bump
in federal payments to skilled nursing facilities in 2018—or roughly 1
percent higher than this year. Hospices, meanwhile,
a 1 percent increase worth $180 million.
to increase reimbursement to rehab hospitals by $80 million for 2018, in
addition to eliminating a penalty on facilities that don’t submit certain
data to the federal government on time.
proposed payment rules for other
providers, CMS is asking the industries for input on regulations it should
overhaul or eliminate. CMS Administrator Seema Verma and HHS Secretary Tom
Price have pledged to review all of the agency’s rules in a bid to cut
unnecessary or burdensome regulations.
Comments on the trio of rules must be received no later than 5 p.m. on June
CMS Seeking Comments on Data Elements in IMPACT Act
CMS has contracted with the RAND Corporation to develop standardized
patient/resident assessment data elements in alignment with the Improving
Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act).
CMS seeks comments from stakeholders on data elements that meet the IMPACT
Act domains of cognitive function and mental status; medical conditions and
co-morbidities; impairments; medication reconciliation; and care
preferences. The public comment period opens on April 26, 2017, and closes
on June 26, 2017.
For more information, view the
CMS Issues 2018 IPPS Proposed Rule
CMS issued the FY 2018 Inpatient Prospective Payment System (IPPS) and Long
Term Acute Care Hospital (LTCH) rule on April 14, which proposes a number
of changes to the Medicare and Medicaid Electronic Health Record (EHR)
The proposals include:
For CY 2018, modifying the EHR reporting period from the full calendar
year to a minimum of any continuous 90-day period for new and returning
participants in the Medicare and Medicaid EHR Incentive programs.
Adding a new exception from the Medicare payment adjustments for
Eligible Professionals (EPs), Eligible Hospitals and Critical Access
Hospitals (CAHs) that demonstrate through an application process that
complying with the requirement for being a meaningful EHR user is not
possible because their certified EHR technology has been decertified
under ONC’s Health IT Certification Program.
Implementing a policy in which no payment adjustments will be made for
EPs who furnish “substantially all” of their covered professional
services in an ambulatory surgical center (ASC); applicable for the
2017 and 2018 Medicare payment adjustments.
Using Place of Service (POS) code 24 to identify services furnished in
an ASC as well as requesting public comment on whether other POS codes
or mechanisms should be used to identify sites of service in addition
to or in lieu of POS code 24.
Comments must be submitted by 5 p.m. on June 13, 2017.
To learn more, review the
CMS Publishes Post-Acute Care Proposed Rules
On May 11, CMS published the following proposed rules:
CMS Issues Proposed Revision Requirements for Long-Term Care
Facilities’ Arbitration Agreements
On June 5, CMS issued proposed revisions to arbitration agreement
requirements for long-term care facilities. The proposed revisions would
help strengthen transparency in the arbitration process, reduce unnecessary
provider burden and support residents’ rights to make informed decisions
about important aspects of their health care.
The Reform of Requirements for Long-Term Care Facilities Final Rule,
published on Oct. 4, 2016, listed the requirements facilities need to
follow if they choose to ask residents to sign agreements for binding
arbitration. The final rule also prohibited predispute agreements for
binding arbitration. The American Health Care Association and a group of
nursing homes sued for preliminary and permanent injunction to stop CMS
from enforcing that requirement. The court granted a preliminary injunction
on Nov. 7, 2016. After that decision, CMS reviewed and reconsidered the
arbitration requirements in the 2016 Final Rule.
The proposed rule focuses on the transparency surrounding the arbitration
process and includes the following proposals:
The prohibition on predispute binding arbitration agreements is
All agreements for binding arbitration must be in plain language.
If signing the agreement for binding arbitration is a condition of
admission into the facility, the language of the agreement must be in
plain writing and in the admissions contract.
The agreement must be explained to the resident and his or her
representative in a form and manner they understand, including that it
must be in a language they understand.
The resident must acknowledge that he or she understands the agreement.
The agreement must not contain any language that prohibits or
discourages the resident or anyone else from communicating with
federal, state or local officials, including federal and state
surveyors, other federal or state health department employees, or
representatives of the State Long-Term Care Ombudsman.
If a facility resolves a dispute with a resident through arbitration,
it must retain a copy of the signed agreement for binding arbitration
and the arbitrator’s final decision so it can be inspected by CMS or
The facility must post a notice regarding its use of binding
arbitration in an area that is visible to both residents and visitors.
This proposed rule is scheduled to be published in the Federal Register on June 8, 2017, and comments are due by Aug. 7,
2017. For more information,
CDC Report Finds 5 Percent of Zika Babies in U.S. Territories Have Birth Defects
According to a new CDC report, roughly 5 percent of women in U.S.
territories and associated states with a confirmed Zika infection during a
pregnancy last year had a baby with a birth defect associated with the
CDC researchers found that women who were infected with the virus during
the first trimester of their pregnancy were even more likely to have a baby
with a Zika-related birth defect. Among that group, about 8 percent of
babies were born with birth defects.
The report is the first to look at Zika-related birth defects in babies
from U.S. territories and associated states, including American Samoa,
Puerto Rico, the Federated States of Micronesia, the Republic of Marshall
Islands and the U.S. Virgin Islands. The report found that about 120 babies
were born with Zika-related birth defects out of a sample of 1,508 women
who had confirmed cases of the virus.
Altarum Report Finds Health Spending Growth Slows
Altarum’s monthly health care economic report finds key metrics trending
downward—a sign of possible good news for employers and payers. Among the
findings: hospitals added 5,500 jobs per month in early 2017, compared to
10,000 a year ago. Ambulatory settings (physician offices, clinics and home
health) added 14,000 jobs per month in 2017, compared to 20,000 in 2016.
To see the report highlights,
JAMA Study: Medicare Part D Susceptible to Gaming of Prescription Drug
According to a study published in JAMA Internal Medicine, Medicare
Part D is susceptible to gaming of prescription drug prices that can cause
Americans to pay more out of pocket and the federal government to pick up
more of the tab.
According to the authors of the study, rebates off a drug’s list price paid
by drug companies to pharmacy benefit managers and health plans are not
always passed along to patients and are widening the gap between list and
net prices. In addition, high list prices move patients more quickly into
and through the Part D “donut hole,” where patients are responsible for the
full cost of drugs. The authors say the problem could be alleviated by
shifting more of the costs onto insurers. The authors also recommend that
the government require data on the rebates for individual drugs.
To read the full study,
JAMA Study Suggests Hospital Price Gouging
in the May 30, 2017, issue of JAMA Internal Medicine found that
hospitals are charging uninsured emergency room patients nearly four times
what they accept from Medicare for identical services. In one example, the
study says hospitals charged emergency room patients without insurance up
to $1,260 for a $100 treatment. “It points to the practice of price gouging
by hospitals because patients often can’t pick their doctors in the
emergency department,” Tim Xu, the lead author of the study, told Reuters.
GAO Recommends CMS Use Data on Disenrollment and Beneficiary Health
In a new report, GAO recommended that CMS consider using data on the health
status of people who leave Medicare Advantage contracts, and the reasons
they give for leaving to help improve oversight of the program.
GAO found some contracts in which people in poor health were much more
likely than others to voluntarily leave the contracts’ health plans. These
contracts generally had lower quality scores, and their enrollees often
cited problems getting access to care.
To see the full report,
If you have any questions, contact the following individuals at
Kennan, Senior Vice President
Caroline Perrin, Research Assistant
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