ABL HEALTHCARE ONLINE
ABL Healthcare Member News & Industry Trendletter * July 31, 2018
HEALTHCARE NEWS
FEATURING ADDITIONAL INSIGHTS
FROM ABL MEMBERS
Santa Clara County Interested in Buying O'Connor & St. Louise Hospitals

Santa Clara County is hoping to buy a pair of struggling hospitals that have long served as a safety net for the poor, less than three years after the Daughters of Charity sold them to a New York hedge fund in a state-approved deal to ensure they remained open, made facility improvements, and didn't cut charity care, jobs, or pay. Introduced to us by ABL Member Tyler Haskell, Santa Clara County Executive Jeff Smith (pictured) said the county sees a renewed opportunity to acquire O'Connor Hospital in San Jose and St. Louise Regional Hospital in Gilroy as public hospitals to extend its reach and help relieve overcrowding at the county-run Santa Clara Valley Medical Center in San Jose. "If the County is successful with its bid, we will operate both hospitals as general acute care hospitals - just as they are now," Jeff Smith wrote to ABL. "O'Connor would operate under VMC's license, thereby becoming a disproportionate share hospital (eligible for new funding for Medi-Cal and Medicare patients). St. Louise would continue on its current license. All clinical employees and most administrative employees would be offered County employment. This transaction would be a strategic action for the County because we need additional capacity for our patients. Unlike private health systems that rely upon a large population of privately insured patients to make a profit, we rely upon supplemental Medi-Cal payments in order to pay our costs. So, because of demographic changes since these hospitals were built, private systems will not be able to operate them profitably. We can operate them and cover our costs."
          Santa Clara County's interest comes after Verity Health System, the nonprofit that now runs the hospitals, announced the "potential sale of some or all" of the hospitals among options "to alleviate financial and operational pressures." The Daughters' $260M sale to the hedge fund was the largest nonprofit hospital transaction in state history at the time, but already, the deal has soured. Verity saw operating losses of $55.8M in the nine months that ended March 31. The hospitals in San Jose, Gilroy, Daly City, Half Moon Bay, and Los Angeles provide 1,650 inpatient beds, emergency rooms, a trauma center, and a host of medical specialties, and employ 7,000. (The Mercury News, 7/23/18)

Adventist Health Lending $10 Million to Help Tulare Regional Reopen

Tulare Regional Medical Center, where ABL Member Larry Blitz is Interim CEO, is getting a $10 million loan from Adventist Health to help it reopen. It will go toward hiring and paying staff, financing projects, and supply-related costs, according to ABL Member Richard Gianello, a partner with Wipfli/HFS Consulting, the hospital's temporary manager, accounting, and healthcare consulting firm. A report states the money can also go toward consulting and legal bills. Tulare Regional, which closed in October, is slated to reopen within about three months under an approved proposal from Adventist Health, which includes the $10 million loan and technical help with the reopening. Adventist Health and hospital officials are working to finalize the agreement. (Becker's Hospital CFO Report, 7/20/18)

23andMe Lands $300 Million Investment from GSK

23andMe announced that GlaxoSmithKline has invested $300 million to gain exclusive access to the genetic testing startup's DNA database. The deal could accelerate GSK's drug development work; recent reports say that GSK intends to use the data to develop an experimental Parkinson's drug. 23andMe already has a portfolio of early-stage therapeutic research programs across a wide range of disease indications. ABL Member Arlene Kirsch, a former GSK senior executive, shares with ABL that the deal was "orchestrated by the new head of R&D at GSK." (mobihealthnews, 7/25/18)

CMS Proposes Drive to "Foster Innovations in Treatment" in ESRD Programs

CMS has proposed changes to the payment rules for the End-Stage Renal Disease (ESRD) program, including a proposal to address new renal dialysis drug and biological costs and foster innovations in treatment by incentivizing new therapies for patients on dialysis and a proposal to reduce facility-related documentation burden.
          Since ABL Member Bob Funari is the Chairman of NxStage, makers of NxStage System One portable hemodialysis system (the only dialysis cleared for home use - during the day or nocturnally), ABL's Mimi Grant asked him for his thoughts on this announcement. Bob's take is, "Since Medicare is by far the largest payer of dialysis services, they've frequently stated their goal of having 50% of patients currently treated in dialysis centers be treated in alternate locations, primarily the home (or SNF)." According to UCSF's "The Kidney Project," the 650,000+ people who live with ESRD are 1% of the U.S. Medicare population but account for roughly 7% of the Medicare budget, and in center dialysis runs about $89,000/patient/year - compared to at HHD, which costs about $71,000/patient/year. This amounts to a total annual hemodialysis cost of $42 billion, $34 billion of which is absorbed through the Medicare budget.
          Bob continues: "Currently, only 10-12% of End Stage Renal Disease (ESRD) patients dialyze at home. Because these patients are typically dialyzing more frequently, and for longer time periods, they also are hospitalized less" (which is documented in a study posted in the Journal of Nephrology & Renvascular Disease on NIH.gov), "this study confirms the superiority of the HHD [home hemodialysis] treatment option in improving patient outcomes. Admission patterns of HHD patients fared very well against a control group which consisted of reasonably well dialysis patients."
          Better quality of life, at less total cost of care; little wonder CMS wants to incentivize more ESRD patients to be dialyzed at home.

CMS Also Proposes to Modernize DME Programs

CMS has also proposed payment rule changes for Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) program. The DME proposals in the rule aim to increase access to items for patients and simplify Medicare's DMEPOS Competitive Bidding Program (CBP) to drive competition and increase affordability. The process for re-competing contracts with suppliers currently in effect under the DMEPOS CBP has not yet been initiated. As a result, current contracts for the DMEPOS CBP will expire on December 31, 2018. Beginning January 1, 2019, and until new contracts are awarded under the DMEPOS CBP, beneficiaries may receive DMEPOS items from any Medicare enrolled DMEPOS supplier. (CMS release, 7/11/18)
          Since ABL Member Dave Sayen, now with Gorman Health Group, was the Region 9 CMS Administrator - and the lead CMS official responsible for standing up the CMS Competitive Acquisition program, we asked him to share a few words on this subject - and he has plenty! - in this Guest Blog, below. . .


Giving Away
the Store
Guest Blog by Dave Sayen, SVP, Gorman Health Group
(formerly CMS, Region 9 Administrator -
- and on CMS's executive team responsible
for standing up the CMS Competitive Acquisition program

Does anyone remember the Sopranos? In one episode Tony's brother-in-law who owns a sporting goods store runs up a gambling debt with the mob. Tony and his pals 'bust out' the business. They run up all his lines of credit until he goes bankrupt and they keep the money. It is beginning to feel that is what is happening to the USA.

Case in point: On July 11 the CMS issued a proposed rule that (among other things) makes significant changes to the fee schedule for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, or DMEPOS. The current system called Competitive Acquisition was instituted in 2011 and has yielded considerable savings to the government and beneficiaries. Projected savings under the current program are $25.7 Billion over 10 years in benefit dollars. From the start the industry has argued that the program harmed beneficiaries by impeding access to products. This assertion has never been proven. It is true that a lot of small suppliers left the program, but for the most part they had a small Medicare business. The approach was to solicit bids for the largest volume items, and set prices in a particular area to the median bid.

Now in an unprecedented giveaway of your tax dollars, the bids will be keyed to the 'lead item' or the highest price of an item in winning bids. That adjustment yields a modest spending uptick of $10 million over 5 years. But wait, there's more. The agency hasn't begun the process to re-compete the Competitive Bidding Areas for 2019, so there will be a lapse before the new program is implemented (which could take years); meanwhile suppliers get a blend of the current rate in their area and the rate in the non-competition areas which are higher, basically the old fee schedule the whole program was designed to correct. This piece, along with some other technical changes will cost $1,050 million over 10 years. That is how they state the number in the cost estimate section of the rule. I guess they didn't want to say a billion dollars like Austin Powers might put it.

I wish the so-called conservatives running things in Washington would be a little more conservative with our money.
____________________________________________________________________

 
UPCOMING ABL HEALTHCARE
ROUND TABLES
  • 8/01 - Orange County Round Table
  • 8/07 - Silicon Valley Round Table
  • 8/08 - San Francisco / Bay Area Round Table
  • 8/09 - East Bay / Bay Area Round Table
  • 8/16 - Sacramento Round Table
  • 8/17 - Los Angeles Round Table
ARTICLES
ABL HEALTHCARE MEMBER NEWS
Alvaka Networks Reports on GDPR & California's Similar Act

In GDPR for California: California's Consumer Privacy Protection Act, Alvaka Networks' Oli Thordarson notes that the State of California recently passed AB 375, which mandates the nation's most comprehensive privacy rights for consumers. It's very similar to the General Data Protection Regulation, the European Union's approach to privacy for its citizens. In this article, Oli provides a bullet-point summary of AB 375. Other recent articles from Alvaka include How Does GDPR Affect Companies Doing Business in California?, which reports that the GDPR applies to any company or organization anywhere in the world that employs 250+ people and processes the personal data of at least one EU citizen, and Steps for an Effective Cybersecurity Incident Response Plan. (Oli Thordarson, Orange County)

Anthem Blue Cross Launches Medi-Cal Health Homes Program

Anthem Blue Cross Medi-Cal Health Plan has launched a new Health Homes Program, designed to serve eligible Medi-Cal beneficiaries with multiple chronic conditions or severe mental illness who have frequent hospital or ER visits, or who are homeless. Anthem will partner with community clinics and community-based organizations to provide a full range of services to address needs related to physical and behavioral health, and community-based long-term services and supports. A care coordinator will be assigned and responsible for providing comprehensive care coordination across health providers and can assist in finding and applying for community programs and services, such as food and housing. (Jack Asher, Silicon Valley)

Covered California Holds Rates Down to 8.7% Increase

Covered California has announced that it expects to increase its health insurance premiums by a statewide average of 8.7% in 2019, almost double what it would have been if Congress had not dropped a tax penalty that encouraged U.S. citizens to maintain health insurance. It's the fifth straight year that premiums are rising for such health plans. The increase applies to the 1.1 million lower-income Californians who receive federal financial assistance to buy plans on Covered California, as well as the 1.2 million residents who buy plans without subsidies. The average increase in California is smaller than the double-digit hikes expected around the nation, due largely to a healthier mix of enrollees and more competition in its marketplace. Meanwhile, other areas of the country have not been as fortunate: A Kaiser analysis shows, for example, that the average premium in Maryland will increase 30% next year, with a 24% spike in New York and 19% in Washington. (California Healthline, 7/20/18) (Kathy Keeshen, Sacramento)

Dignity Health Teams with UCSF on Digital Platform

Dignity Health and UCSF Health are collaborating to develop a state-of-the-art digital engagement platform that will provide information and access to patients when and where they need it as they navigate primary and preventive care, as well as acute and specialty care. The platform, which ultimately aims to serve as a model for health systems nationwide, will be hosted by Dignity Health. The two organizations will leverage technological expertise and cloud-based infrastructure that Dignity has developed for its 40 hospitals. As one of the nation's top-ranked academic medical centers, UCSF Health will contribute its extensive knowledge of the patient experience in specialty care. (Marvin O'Quinn)

El Camino Named Top Performer for Heart Attack Treatment

El Camino Hospital has received the American College of Cardiology's NCDR ACTION Registry Platinum Performance Achievement Award for 2018, one of only 203 hospitals nationwide to do so. The award recognizes El Camino's commitment and success in implementing a higher standard of care for patients experiencing a heart attack. It also signifies that the hospital's cardiovascular team has reached an aggressive goal of treating these patients to optimal levels of care as outlined by the American College of Cardiology/ American Heart Association clinical guidelines and recommendations. (Cecile Currier & Jeff Gruer, both Silicon Valley)

ElderConsult to Present Dementia & Finances Conference

On September 11, in San Rafael, ElderConsult Geriatric Medicine will present an ElderConsult Dementia Conference: Protecting Your Loved Ones and Their Finances. Suitable for families and elder care professionals, topics will include: How do medications play a role in helping or harming elders? Who preys financially on elders and how do they do it so well? What protections can elders have for preventing elder financial abuse? (Elizabeth Landsverk MD, Bay Area)

Dave Sayen Examines Payment Rule & MAQI Demo

In CMS Aims to Restore Doctor Relationship with Payment Rule & MAQI Demonstration, Gorman Health Group's Dave Sayen discusses CMS Administrator Seema Verma's recent "Dear Doctor" letter that accompanied the annual proposed physician fee schedule rule. He says: "She is promising to cut red tape, get doctors back to practicing medicine, simplify things, and put a chicken in every pot. Problem is, the red tape was created for a reason. Most of it is there to patch up structural vulnerabilities in the fee-for-service program that can result in fraud, waste, and abuse." Dave then touches on the most significant recent developments, highlighting what is important to health plans in particular. (Dave Sayen, Bay Area)

Hospice East Bay Anticipates Upcoming Art & Wine Benefit

On the evening of September 24, the Friends of Hospice Rossmoor and Creekside Grill will present the annual Art & Wine Benefit, a fundraiser for Hospice East Bay's Rossmoor Respite Fund. The event will feature local artwork, fine California wines, delicious appetizers, and a silent auction. (Cindy Hatton, Bay Area)

HumanGood's East Bay SNF Earns 5 Stars from CMS

Piedmont Gardens' skilled nursing center, a HumanGood facility, earned a national five-star quality rating from CMS, the highest possible rating, based on state-conducted health inspections, staffing, and quality measures of medical care. Skilled nursing care at Piedmont Gardens, known as The Village, received the highest rating in the top four major areas of focus for CMS. In addition, The Village earned a five-star rating for staffing of registered nurses, which is displayed separately on the Nursing Home Compare website. Piedmont Gardens was also recently named the best in senior living for 2018 in Oakland Magazine's Readers' Choice awards. (Tara McGuinness, Bay Area)

Kaiser Permanente Receives Women's Choice Awards

Kaiser Permanente Southern California has received the Women's Choice Award designation of "California's Most Recommended Health Insurance Plan," and its medical centers throughout the region received multiple "America's Best Hospitals" awards, including: Best Patient Safety, Best Hospital for Obstetrics, Best Stroke Care, America's 100 Best Hospitals, Best Bariatric Surgery, and Best Breast Center. Also, Kaiser was ranked among Forbes' recent list of the best employers for women. (Walt Meyers, Bay Area)

Kindred Continues Growth of Inpatient Rehab Hospital Business

Kindred Healthcare recently opened 44-bed Community Rehabilitation Hospital South, near Indianapolis, in partnership with Community Health Network. Kindred now operates 22 inpatient rehabilitation hospitals, in 11 states; the majority are operated in partnership with leading health systems. These hospitals care for adults recovering from stroke, traumatic brain injury, spinal cord injury, amputation, and other conditions. Meanwhile, Humana Inc., TPG Capital, and Welsh, Carson, Anderson & Stowe have completed the previously announced acquisition of Kindred Healthcare, Inc. (Adam Darvish, Orange County)

King & Spalding Discusses Implications of Healthcare Rulings

In Judge Grants Summary Judgment in Favor of OCR for HIPAA Violations Ordering a Texas Cancer Center to Pay $4.3 million in Penalties, King & Spalding (K&S) shares that on June 18, 2018, HHS and its Office for Civil Rights (OCR) announced an Administrative Law Judge's (ALJ) ruling that OCR properly imposed penalties against The University of Texas MD Anderson Cancer Center for failing to encrypt laptops and USB thumb drives, in violation of HIPAA. One reason this decision is significant is that it may resolve an unsettled question: Is the use of encryption mandatory in the Security Rule? HHS's short answer has been "No," but based on the ALJ opinion, its long answer equates to "Yes" - at least when covered entities and business associates decide that encryption is necessary.
          And, in DC Circuit Clears the Way for Hospitals to Challenge Base-Year Factual Determinations, K&S reports on the broad implications of the U.S. Court of Appeals for the District of Columbia Circuit recently holding in Saint Francis Medical Center v. Azar that Medicare's reopening regulation, which prohibits providers from seeking to revise payment determinations after three years, including the predicate facts that support those determinations, does not apply to cost report appeals.
         Meanwhile, K&S has published a recap of its recent International Cryptocurrency & Blockchain Forum, and announced its 11th Annual Medical Device Summit, to be held on September 6, in Chicago. (Marcia Augsburger, Sacramento, & Travis Jackson, Los Angeles)

Mazzetti Wins for Sustainability & Reimagines Childbirth Facilities

The Business Intelligence Group recently named the winners of its 2018 Sustainability Awards, which included Mazzetti for its work with Lucile Packard Children's Hospital Stanford in the "Sustainability Service of the Year" category. Meanwhile, in Future Childbirth Facilities - Ideating to Solving, Mazzetti notes that earlier this year, it hosted a workshop to reimagine childbirth facilities, with input from clinicians, architects, engineers, facility owners, and others. The article provides a "small taste" of the ideas, so that "we can expand the dialogue and further question and develop ideas into solutions." (Walt Vernon, Bay Area)

Nelson Hardiman Lauded Among Midsize Firms

Nelson Hardiman (NH) has been named to Vault's 2019 "Top 150 Under 150," a national list highlighting "the best and most sought-after law firms with fewer than 150 attorneys." NH was ranked #1 best midsize law firm for hours; #2 to work for; #2 for quality of work; and #2 for diversity. Also, NH's Harry Nelson was recently interviewed on Voice of America: International Edition about the ever-growing drug addiction epidemic, including the recent development of pop-star Demi Lovato's apparent drug overdose. Meanwhile, NH provided regulatory licensing and enrollment advice on a $163 million acquisition of a home health agency and two specialty infusion pharmacies that operate in 47 states. (Harry Nelson, Los Angeles)

NorthBay Healthcare to Host Evidence-Based Symposium

Registration is now open for NorthBay Healthcare's annual Evidence-Based Practice & Nursing Research Symposium, open to all healthcare professionals who are interested in exploring the challenge of delivering evidence-based care and attempting to keep pace with the latest recommendations for excellence in clinical practice. The event is scheduled for August 24, in Fairfield. (Elnora Cameron, Bay Area)

OneLegacy Sees Record Month of Donations & Transplantations

OneLegacy recently announced a new one-month record of organs and tissues recovered and transplanted. With 55 organ donors, 168 lifesaving organ transplants, and 281 tissue donors in May, OneLegacy saw a 28% increase in organ donors, 20% increase in organs transplanted, and nearly 11% more tissues recovered, as compared with the same numbers from May 2017. (Tom Mone, Los Angeles)

PriceMDs Partners with NFL Alumni on Health Services

NFL Alumni recently announced its partnership with PriceMDs, whose platform enables workers compensation benefactors and third-party administrators to significantly reduce the cost of elective surgical procedures. The platform gives NFL Alumni members and their families unlimited access to high-quality healthcare providers, ambulatory surgery centers, and imaging facilities at a lower cost through exact bundled pricing. (Marc Grossman, Orange County)

Satellite Healthcare Shares Research Findings

Satellite Healthcare recently announced the key findings of its 2018 Extramural Grants Symposium aimed at research that improves care for people who suffer from chronic kidney disease (CKD). Recognizing the importance of supporting applied clinical research, each year Satellite Healthcare grants funding for projects that seek to improve the lives of those living with CKD. The symposium offers the opportunity for grant recipients to present their work and evaluate new research applications. (Rick Barnett, Silicon Valley)

SAVI Group Offers Insights on Outsourcing & Technology

In What to Look For in an Outsource Medical Billing Company, SAVI Group's Sumit Mahendru discusses the key factors of level of expertise, technological proficiency, medical reporting, and customer service. And, in How Technology is Revolutionizing the Patient Care Model, Sumit delves into remote monitoring care strategies and turnkey billing solutions. (Sumit Mahendru, Orange County)

SCU Welcomes Visit from Eastern Medicine Practitioners

Southern California University of Health Sciences (SCU) recently hosted an on-campus visit from members of the UCLA Center for East-West Medicine along with administrators and faculty from Beijing Hospital, Beijing University of Chinese Medicine. Professors at the Hospital's National Center of Gerontology, were particularly interested in learning more about the integrative approach to patient care, specifically chiropractic care, and to learn about SCU's College of Eastern Medicine and its groundbreaking interprofessional educational model. (John Scaringe, Orange County)

VivaLNK's Developer Program Chosen by AlacrityCare & Myia

VivaLNK, a leading provider of connected healthcare devices, has announced some exciting solutions built on its developer program. AlacrityCare is currently developing clinical-grade digital monitoring solutions that connect patients, providers, and caregivers throughout the cancer treatment journey. Using VivaLNK's Fever Scout and an ECG recorder for remote continuous temperature and ECG monitoring, AlacrityCare offers better insights into what is happening throughout the treatment journey and helps to avoid unnecessary hospitalizations due to more proactive care. And Myia, which is developing an intelligent health platform for managing chronic conditions, is using the VivaLNK ECG recorder software development kit to gather the real-time data that powers the analytics behind its actionable insights for preventing costly and avoidable medical events. (Jiang Li, Silicon Valley)

TECH MEMBERS' HEALTHCARE NEWS
Eckert & Ziegler Chosen as Manufacturing Partner for Bayer

Eckert & Ziegler AG (EZ) has been selected as the manufacturing partner for the clinical supply of Bayer's innovative Targeted Thorium Conjugates (TTCs) in Europe. EZ will provide the infrastructure for handling, manufacture, and distribution of the TTCs for the purpose of clinical trial testing. TTCs are a versatile, next-generation targeted alpha therapy. The approach uses tumor targeting molecules, such as antibodies, that carry alpha-particle emitting Thorium-227 to the tumor. TTCs have the potential to be used in a broad range of tumors, and also for patients who are refractory to chemotherapy or conventional targeted oncologics. (Frank Yeager, Downtown Los Angeles Technology)

PCIHIPAA Endorsed as Partner by New Mexico Dental Association

As a recently added member service, PCIHIPAA is now helping to protect New Mexico Dental Association (NMDA) members from the onslaught of ransomware attacks, HIPAA violations, and data breaches. NMDA announced that PCIHIPAA's OfficeSafe Compliance Program is the right solution for its members, noting that the program takes the guesswork out of HIPAA compliance and is easy to implement. (Jeff Broudy, West Los Angeles Technology)

Intellect Educates on Compliance Regulations & Risk Management

Intellect's Romeo Elias has written recent blogs: Mobile and FDA Compliance: New Regulations in 2018, which examines groups of apps regulated by the FDA; and Best Risk Management in Laboratories, which delves into risk identification, assessment, management plans, and quality management systems. (Romeo Elias, West Los Angeles)

HEALTHCARE & GOVERNMENT
CMS Proposes Slashing Clinic Visit Payments in Site-Neutral Policy

In the massive 2019 Medicare Outpatient Prospective Payment System rule, CMS has proposed expanding its site neutral payment policy to clinic visits, a move that is expected to save Medicare $610 million and patients approximately $150 million. Clinic visits, or checkups, are the most common service billed under the outpatient pay rule. CMS often pays more for the same type of clinic visit in the hospital outpatient setting than in the physician office setting. The rule also expands the number of procedures payable at ambulatory surgical centers, and would make changes to the 340B program. Becker's has published "10 things to know" about the proposed rule. (Read Articles: Becker's Hospital CFO Report, 7/26; Modern Healthcare, 7/25/18)

House Passes Bills to Delay Health Insurance Tax, Expand HSAs

House lawmakers approved legislation that would postpone implementation of the health insurance tax, which has already been suspended for 2019, by an additional two years, permit increased contributions to health savings accounts, and allow more people to purchase bronze or catastrophic plans with higher deductibles. The chamber also passed measures that would relax standards for use of HSA funds, including allowing use of HSAs for more over-the-counter drugs or for gym memberships. (Read Articles: Washington Examiner, 7/25; The Hill, 7/25/18)

Verma: "Medicare for All" Would Become "Medicare for None"

"Ideas like 'Medicare for all' would only serve to hurt and divert focus from seniors," CMS Administrator Seema Verma said during a recent speech in San Francisco, adding the focus of Medicare should be on seniors and disabled individuals and that expanding the program to cover younger, healthier people will drain the program of funding and deprive seniors of the coverage they need. "By choosing a socialized system, you are giving the government complete control over the decisions pertaining to your care or whether you receive care at all. It would be the furthest thing from patient-centric care," Verma said. (Read Article: Kaiser Health News, 7/26/18)

CMS Restarts Risk Payments, Will Pay Out $10 Billion to Insurers

CMS has issued a final rule to resume paying $10.4 billion in risk-adjustment payments to insurance companies with plans on the individual market. "This rule will restore operation of the risk-adjustment program and mitigate some of the uncertainty caused by the New Mexico litigation," CMS Administrator Seema Verma said. "Issuers that had expressed concerns about having to withdraw from markets or becoming insolvent should be assured by our actions today. Alleviating concerns in the market helps to protect consumer choices." (Read Article: Modern Healthcare, 7/24/18) The quick resolution also helps to preserve the significant investment made by states, issuers, and the federal government to stand up the program. (Read: CMS release)

Pay Schedule Changes Bolster 'Patients Over Paperwork' Initiative

CMS recently proposed changes to the Physician Fee Schedule and Quality Payment Program (QPP) that would increase the amount of time that doctors and other clinicians can spend with their patients by reducing the burden of paperwork that clinicians face when billing Medicare. Specifically, this proposal would: > Simplify, streamline and offer flexibility in documentation requirements for Evaluation and Management office visits; > Reduce unnecessary physician supervision of radiologist assistants for diagnostic tests; and > Remove burdensome and overly complex functional status reporting requirements for outpatient therapy. Also, provisions in the proposed Fee Schedule would support access to care using telecommunications technology by: > Paying clinicians for virtual check-ins and for evaluation of patient-submitted photos; and > Expanding Medicare-covered telehealth services to include prolonged preventive services.
          The proposed changes to QPP aim to reduce clinician burden, focus on outcomes, and promote interoperability of electronic health records, including by: > Removing MIPS process-based quality measures that clinicians have said are low-value or low-priority, in order to focus on meaningful measures that have a greater impact on health outcomes; and > Overhauling the MIPS "Promoting Interoperability" performance category to support greater EHR interoperability and patient access to their health information, as well as to align this performance category for clinicians with the proposed new Promoting Interoperability Program for hospitals. (Read: CMS release, 7/12/18)

Bill Allows Medicare Negotiations & Patent Sidestep If Talks Fail

As the Trump administration labors to execute its blueprint for tackling high drug costs, a group of Democratic lawmakers has introduced a bill that would allow the federal government to negotiate on behalf of Medicare - and authorize licenses for lower-cost generics when talks fail. Unlike other bills that would permit negotiations over Part D drugs, the legislation would allow HHS to pursue a generic alternative by issuing a competitive license when a company refuses to offer a reasonable price. In effect, the bill would create a new mechanism for the U.S. government to sidestep patents when it would be in the public interest to do so. (Read Article: Stat, 7/25/18)

Azar Taps Innovation Center Head to Lead Value-Based Care

HHS Secretary Alex Azar appointed Adam Boehler, the director of the Center for Medicare & Medicaid Innovation, as senior adviser for value-based transformation and innovation - one of Azar's four key departmental priorities. Boehler will hold both of his positions concurrently. Azar also named senior advisers for his other three departmental priorities: Jim Parker as senior advisor for health reform and director of the office of health reform; Dan Best as senior advisor for drug pricing reform; and Brett Giroir, MD, as senior advisor for opioid and mental health policy. (Read Article: Becker's Hospital Review, 7/18/18)

HEALTHCARE TRENDS
AHA Blasts Pharma Industry for Price Hikes

In a prominent advertisement in the July 26 Wall Street Journal, the American Hospital Association assured readers that while they may be frustrated with the rising price of care, hospitals and health systems are doing all they can to curb costs. "Unlike drug companies, hospitals and health systems have successfully tapped the brakes on price hikes," wrote AHA CEO Rick Pollack. "They have managed to slow price growth to under 2 percent during each of the last four years despite an increased demand for emergency care due to major natural disasters and epidemics." Pollack pointed to redesigning delivery systems, improving quality and outcomes, embracing new reimbursement models, and leveraging technology as steps hospitals and health systems have taken to improve value for patients. (Read Article: Becker's Hospital Review, 7/26/18)

Pharma Giants Agree to Freeze or Lower Some Prices

Bowing to political pressure from the White House, some of the biggest drug manufacturers have announced a series of temporary price freezes or even price cuts to their medications in recent weeks. Pfizer, Novartis, Bayer, Roche and AstraZeneca are among the major drug companies that announced they would not seek any price increases to their drugs for the rest of the year - and Merck was among those that promised to actually lower prices on certain drugs. (Read Articles: Money, 7/25; Reuters, 7/26/18)

SF Health Plan Adds 'Health Homes' for Eligible Medi-Cal Members

San Francisco Health Plan (SFHP), a community managed care health plan serving 140,000+ area residents, has launched a new benefit, "Health Homes for Patients with Complex Needs." San Francisco County is the first county in California to launch this new benefit allowing for fully coordinated care for eligible Medi-Cal members with chronic conditions. Services include comprehensive care management and transitional care, care coordination, health promotion, patient and family care support, community and social support services referrals, and more. (Read: San Francisco Health Plan release, 7/11/18)

Costs Decrease When Providers Have Medical Liability Immunity

Healthcare providers who are immune from malpractice lawsuits and liability order fewer tests and procedures, reducing inpatient spending by 5%, according to a study of doctors practicing in the Military Health System. The authors of the National Bureau of Economic Research paper called for policy changes to reduce the practice of defensive medicine. (Read Article: RevCycle Intelligence, 7/25/18)

Aggressive BP Reduction May Reduce Cognitive Impairment, Dementia

Researchers found patients with hypertension who lowered their systolic blood pressure to below 120 had a 19% reduced rate of developing mild cognitive impairment, and a 15% reduction in incidence of MCI and dementia combined, compared with individuals who had a BP target of below 140. The findings were based on data from 9,300+ patients in the SPRINT trial. (Read Article: Reuters, 7/25/18) Meanwhile, older adults with dementia had higher blood glucose levels at up to 14 years prior to diagnosis and at diagnosis, compared with the control group, according to a study in JAMA Psychiatry. (Read Article: Healio Psychiatric Annals)

U.S. Running Out of Family Caregivers - When It Needs Them Most

For generations, the nation has relied on family members to keep aging loved ones in their homes. Today, an estimated 34.2 million people provide unpaid care to those age 50+. These caregivers, about 95% family, provide an estimated $500 billion worth of free care annually - three times Medicaid's professional long-term care spending - and help keep people out of costly institutions, according to a 2017 Merrill Lynch study. But due to changing family dynamics, the supply of these caregivers is shrinking just as the nation needs them most. Meanwhile, demand for private home health aides is expected to exceed supply by more than three million in the next decade. Technology can alert remote caregivers to emergencies and keep families in touch, but it doesn't take the place of having someone there to make sure there is food in the refrigerator. (Read Article: Wall Street Journal, 7/20/18)

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